Chapter 9. Theory-Based Educational and Behavioral Interventions to Improve Oral Anticoagulant Adherence

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Rebecca J. Cope¹, and Harrison Sulkow²
¹The Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
²NYC Health & Hospitals, New York, NY, USA

Part of the book: Advances in Health and Disease. Volume 63

Abstract

Improving adherence to oral anticoagulant medications (OAC) for stroke prevention in non-valvular atrial fibrillation (NVAF) has been the focus of many published interventions due to the large reduction in morbidity and mortality associated with this behavior change. This review aimed to identify and describe behavioral and educational interventions for improving adherence to OAC in NVAF patients and examine the application of theory or incorporation of behavioral change techniques (BCTs) to the interventional study design. Out of the 25 trials included, only 3 reported applications of behavior change theory. Twenty-seven unique BCTs were identified in the study designs, with the most common being instruction on how to perform a behavior. The findings of this review suggest that behavior change theory is infrequently utilized when developing behavioral and educational interventions to improve OAC adherence in NVAF. Novel intervention types reported in this chapter include use of automated intelligence and smartphone applications to track adherence. A shift in the focus of adherence studies from Vitamin K antagonists to direct oral anticoagulants is also observed, in line with changes in clinical prescribing patterns. Future studies should seek to establish specific behavior change theories and BCTs which are most likely to result in significant improvements to OAC adherence.

Keywords: adherence, warfarin, direct oral anticoagulants, behavior change theory, non-valvular atrial fibrillation


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