Abstract:

Current debates are centered on the controversial question of whether individual health behavior changes occur in stages. Medication adherence, a crucial indicator influencing medical outcomes, significantly impacts the physical and mental health of individuals. Medication adherence refers to the extent to which consumers follow or adopt recommendations from individuals or organizations regarding acquiring (purchasing) and correctly using medications. This includes both prescription and over-the-counter drugs, as well as products or services related to physical health examinations. Previous studies on medication adherence levels have predominantly taken a medical perspective, focusing on adherence behaviors for specific diseases. However, with the increasing marketization of the health care industry, limited research exists from the consumer's perspective investigating the influence of information processing and psychological processes on consumer medication adherence behaviors.

Current research indicates a growing emphasis on the stage theory of health behavior change for studying and promoting health. Derived from social cognitive theory, stage theory posits that consumer health behavior is not a continuous process but rather a multistage process. Individuals go through inherently different ordered stages in deciding, initiating, and maintaining health-related behaviors. Individuals within the same stage face common obstacles, while those in different stages encounter distinct challenges. In medication adherence research, the health action process theory has demonstrated significant advantages in operability, intervention assessment, and cultural and environmental adaptability. This theory divides the process of changing health behavior into two stages: motivation and volition. In the context of medication adherence, these stages align well with the awareness stage of drug acquisition and the trial and adoption stage of drug usage, offering a comprehensive summary of consumer medication adherence behaviors in these stages. This theory is intuitive and conducive to the targeted design of intervention measures. Therefore, this study is grounded in the two-stage theory of the health action process model, systematically reviewing and summarizing consumer medication adherence behaviors in the identified stages.

Building upon the health action process theory, this paper categorizes the consumer's medication adherence process into the awareness stage and the trial and adoption stage. In the awareness stage, factors influencing consumer medication adherence, such as inherent beliefs, prior knowledge of medications, and information processing biases, are summarized through a review of past research. In the trial and adoption stage, factors affecting consumer medication adherence, including the effectiveness rate of medication, marketing communication of medications, and after-sales services, are systematically summarized. After the factors influencing medication adherence levels were clarified, this paper further investigates each stage, delineating and elaborating on interventions for consumer medication adherence. The medication awareness stage involves attitude intervention, while the medication trial and adoption stage focus on behavior intervention. Central to attitude intervention is increasing medication willingness, a crucial factor in promoting the initial level of medication adherence. This paper outlines intervention strategies from three perspectives: customer education, enterprise nudging, and media regulation. According to two-stage theory, the focus of intervention in the medication trial and adoption stage is to prolong consumers' will in this stage by increasing medication willingness, thus sustaining medication adherence. Enhancing consumer medication adherence at the behavioral level requires joint efforts from consumers, enterprises, and relevant government health service departments. Combining the review literature, this paper systematically outlines intervention strategies for the medication trial and adoption stage from three aspects: customer empowerment, enterprise incentives, and multiparty collaboration. In the future, this paper proposes several prospects, including exploring the gap between “intention‒behavior,” adopting an integrated approach to investigate the complete process of medication adherence behavior, exploring prefactors influencing medication adherence behavior from a diverse perspective, and delving into the intrinsic mechanisms and influencing factors of (non)adherence to medication.

In conclusion, nonadherence or low adherence has become a significant constraint on consumer health. This paper, based on the two-stage theory model, integrates the influencing factors of adherence behaviors in these two stages and proposes corresponding intervention measures to promote domestic research development in this field. This study aims to overcome the current fragmented nature of related research by constructing a two-stage integrated model based on the two-stage model of health behavior change, considering both the acquisition and usage stages of medications, and building an integrated model from cognitive and treatment perspectives. Possible contributions include: (1) providing a two-stage integrated model based on the concept and definition of medication adherence, revealing influencing factors of medication adherence behaviors, summarizing intervention strategies for consumer medication adherence, and proposing future research trends and prospects, contributing to exploring, understanding, and intervening in individual medication adherence behaviors from the perspective of health behavior change stages; (2) stepping out of the traditional medical theoretical framework and delving into the consumer group and consumer psychology perspective, revealing the research dynamics and progress of medication adherence behaviors in the consumer behavior domain; (3) advancing and enriching stage theories in the health domain, as researchers in the health field hold inconsistent views on whether behavior is staged or nonstaged. This study categorizes the influencing factors and intervention strategies of medication adherence behaviors in different stages of health behavior change, contributing to advancing and enriching stage theories on health behavior; (4) This study holds significant practical significance. The COVID-19 pandemic has posed a significant threat to the lives and health of people worldwide, sounding an alarm for health behavior. This study contributes to understanding consumer behavior in the postpandemic stage and provides marketing insights for chronic disease management.

Key words: medication adherence, consumer behavior, health care, behavioral intervention