Table 2 Examples of recommendations on how to address the barriers in an intervention

■ In case “fear of side effects” seems to be a barrier

 ○ Ask questions to try to find the cause(s) for de fear of side effects and identify the influence of external factors such as media and other persons.

 ○ Focus on the elimination of the fear, using the following possibilities:

  - explain that the medication can cause side effects and provide the patient information about the “number needed to harm,

  - discuss the balance between the risk for side effects and the desired effect,

  - discuss the best way for medication intake to prevent side effects, and

  - agree about the intake of the medication and encourage the patient to report existing side effects.

Examples of questions:

 ○ How do you generally think about the fact that you need to take medication?

 ○ What is your attitude toward medication, and toward the prescribed medication in particular?

 ○ What information did you get about the benefits of the medication?

 ○ For which side effects do you have fear and where does it come from?

 ○ Did this fear always exist or did it change? What caused this change?

 ○ How does this fear influence you? What is the effect on your medication intake?

 ○ Do you have information on your risk for particular side effects?

 ○ Which side effects play a major role in your well-considered decision on the intake of this medication?

 ○ Which side effects do you expect, and to what extent do they prevent you from medication intake?

 ○ Let’s go through the information leaflet to discover which side effects can possibly occur in your case.

■ In case “knowledge about medication scheme” seems to be a barrier:

 ○ Discuss the prescribed use of the new medication.

 ○ Discuss the use of other chronic medication and assimilate the new medication into the patient’s medication scheme.

 ○ Take the patient’s customs into account.

 ○ Explain the importance of regular medication intake for the efficacy of the medication and the possible side effects and interaction with other medication.

 ○ Choose the most appropriate option for the patient:

  - consider whether medication synchronization or a repeat prescription service will be helpful for the patient,

  - consider reminders for medication intake,

  - consider the use of a pill box at the start of each week with all medications,

  - consider streamlining medication regimens and the development of a new treatment plan, and

  - consider to involve an informal caregiver.

Examples of questions:

 ○ Do you have sufficient knowledge about your new medication scheme including all your medication?

 ○ Is this medication scheme feasible for you?

 ○ Do you need any support with regard to your medication intake?