Exploring young people's attitudes to HIV prevention medication (PrEP) in England: a qualitative study.

INTRODUCTION: Young people aged 18-24 years old are a key demographic target for eliminating HIV transmission globally. Pre-exposure prophylaxis (PrEP), a prevention medication, reduces HIV transmission. Despite good uptake by gay and bisexual men who have sex with men, hesitancy to use PrEP has been observed in other groups, such as young people and people from ethnic minority backgrounds. The aim of this study was to explore young people's perceptions and attitudes to using PrEP. DESIGN: A qualitative transcendental phenomenological design was used. PARTICIPANTS AND SETTING: A convenience sample of 24 young people aged between 18 and 24 years was recruited from England. METHODS: Semistructured interviews and graphical elicitation were used to collect data including questions about current experiences of HIV care, awareness of using PrEP and decision-making about accessing PrEP. Thematic and visual analyses were used to identify findings. RESULTS: Young people had good levels of knowledge about HIV but poor understanding of using PrEP. In this information vacuum, negative stigma and stereotypes about HIV and homosexuality were transferred to using PrEP, which were reinforced by cultural norms portrayed on social media, television and film-such as an association between using PrEP and being a promiscuous, white, gay male. In addition, young people from ethnic minority communities appeared to have negative attitudes to PrEP use, compared with ethnic majority counterparts. This meant these young people in our study were unable to make decisions about when and how to use PrEP. CONCLUSION: Findings indicate an information vacuum for young people regarding PrEP. A strength of the study is that theoretical data saturation was reached. A limitation of the study is participants were largely from Northern England, which has low prevalence of HIV. Further work is required to explore the information needs of young people in relation to PrEP.

Pharmacy Students' Lived Experiences With Atopic Dermatitis Inform Perceptions of Learning in the Curriculum.

OBJECTIVE: To explore the impact of lived experiences of pharmacy students with atopic dermatitis (AD) on perceptions of learning in pharmacy curriculum. METHODS: An exploratory qualitative study was conducted with pharmacy students in the United Kingdom to understand how their lived experiences affect their perception of AD in pharmacy curriculum. Semistructured interviews were conducted, and a thematic analysis method was followed. Firstly, codes were created, and then relevant codes were combined to identify themes. RESULTS: Thirteen pharmacy students were interviewed. Study findings showed pharmacy students support teaching with a holistic approach to management and patient-centered care in AD in pharmacy curriculum. Although students had empathy and moral support for patients, they also described a need for teaching on the mental health effects of AD in pharmacy education. CONCLUSION: This brief report explores the role of lived experience of pharmacy students in considering the provision of holistic, patient-centered care in AD teaching in pharmacy education. Participants also suggest the need within the pharmacy curriculum for training to provide mental health advice to patients with AD.

How cultural competence is conceptualised, developed and delivered in pharmacy education: a systematic review.

BACKGROUND: It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes. AIM: This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education. METHOD: Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875. RESULTS: The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other. CONCLUSION: There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education.

Factors influencing pharmacists' roles in preventing prescription and over-the-counter opioid misuse: a systematic review and narrative synthesis.

BACKGROUND: The prescribing rate of opioids is increasing and is a main contributor to opioid misuse. Community pharmacists can help reduce opioid misuse rates by carrying out prescription and over-the-counter (OTC) opioid misuse prevention services. Understanding the barriers and facilitators to community pharmacists' involvement has the potential to improve these services. OBJECTIVE: To review the literature on the barriers and facilitators of community pharmacists' involvement in prescription and OTC opioid misuse prevention. METHODS: A systematic review of primary research was carried out in MEDLINE, Embase, Scopus, Web of Science, CINAHL, and APA PsycINFO from January 2022 to March 2022. Narrative synthesis underpinned by the COM-B model was used to analyse findings from the included articles. Studies were included if they used qualitative or mixed methods; published in English and focussed on OTC or prescription opioids. RESULTS: Ten studies were included in the review. Barriers and facilitators were grouped into individual, environmental, and system-level factors. Based on the COM-B model, these factors were classified as capabilities (knowledge and skill), opportunities (e.g. relationship with prescribers, time), and motivation (pharmacists' attitude). CONCLUSION: Improving pharmacists' capabilities and opportunities might improve pharmacists' motivation to offer opioid misuse services. This could improve pharmacists' behaviour, that is, their role in preventing prescription and OTC opioid misuse. The findings of this review were based on information obtained from primary evidence from qualitative studies; However. further empirical work is needed to identify how pharmacists can be supported.

The role of pharmacists in deprescribing benzodiazepines: A scoping review.

Background: Polypharmacy can increase the risk of adverse drug events, hospitalisation, and unnecessary healthcare costs. Evidence indicates that discontinuing certain medications, such as benzodiazepines, can improve health outcomes, by resolving adverse drug effects. This scoping review aims to explore the pharmacists' role in deprescribing benzodiazepines. Method: A scoping review has been conducted to distinguish and map the literature, discover research gaps, and focus on targeted areas for future studies and research. A systematic search strategy was conducted to identify relevant studies from PubMed, Medline, and EMBASE databases. The eligibility criteria involved studies that focused on the role of pharmacists in benzodiazepine deprescribing, quantitative and qualitative studies conducted in humans, full-text articles published in English. Results: Twenty studies were identified, revealing three themes: 1) pharmacists' involvement in benzodiazepine deprescribing, 2) the impact of their involvement, and 3) obstacles impeding the process. Pharmacists involved in deprescribing procedures, mainly through completing medication reviews, collaborative work with other healthcare providers, and education. Pharmacists' involvement in benzodiazepine deprescribing intervention led to better health and economic outcomes. Withdrawal symptoms after medication discontinuation, dependence on medication, and lack of time and guidelines were identified in the literature as barriers to deprescribing. Conclusion: Pharmacists' involvement in deprescribing benzodiazepines is crucial for optimizing medication therapy. This scoping review examines the pharmacists' role in benzodiazepine deprescribing. The findings contribute to enhancing healthcare outcomes and guiding future research in this area.

Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis.

Understanding the contributions of community pharmacists as first-line health providers is important to the management of atopic dermatitis, though little is known about their contribution. A systematic review was carried out to examine practices and perceptions of the role of community pharmacists. A literature search was conducted in five different databases. Full-text primary research studies, which involved practices and perceptions of the role of community pharmacists in the management of atopic dermatitis, previously published in peer reviewed journals were used. Critical appraisal of included studies was performed using the Mixed Methods Appraisal Tool. Data were extracted and thematically synthesized to generate descriptive and analytical themes. The confidence of the findings of the included studies was assessed via either GRADE or CERQual. Twenty-three studies were included. Findings showed that community pharmacists lacked knowledge of the uses of topical corticosteroids. The recommendations of other treatments were limited. Pharmacists generally undertook dermatology training after graduation. Analytical themes indicated that the practices of community pharmacists were poor and misled patients. Inappropriate education in initial training was identified as a potential reason for their poor practices. This systematic review reveals a gap between patients' needs in practice and dermatological education provided to community pharmacists. Novel approaches regarding education and training should be explored to improve pharmacists' dermatological knowledge and skills.

Intersectional Identities: Making Sense of Skill Development on Clinical Placements.

OBJECTIVE: Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework. METHODS: Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach. RESULTS: Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice. CONCLUSION: Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.

KidzMed e-learning to upskill student pharmacists to teach pill swallowing to children.

BACKGROUND: Appropriate medication use is essential in ensuring optimal pharmacotherapeutic outcomes. It is mistakenly assumed that adults can swallow solid oral dosage forms (SODFs, e.g. tablets/capsules colloquially referred to as 'pills'), without difficulty and that children cannot. KidzMed is a 'pill swallowing' training programme designed to teach effective SODF use in patients of all ages. It may be utilised by healthcare professionals to assist patients taking SODFs. E-learning was essential for training during COVID pandemic to reduce viral transmission. The aim of this study was to explore UK student pharmacists views of e-learning to support swallowing solid oral dosage forms. METHODS: This study used pre- and post-intervention online surveys on Microsoft Forms to evaluate self-directed eLearning about pill swallowing on MPharm programmes at three UK Universities using a 13-item survey. A combination of five-point Likert Scales and free-text items were used. The eLearning was available via the virtual learning environment at the University and embedded within existing curriculum. Descriptive statistical analysis was used to explore responses. RESULTS: In total, 113 of 340 (33%) students completed the survey. Seventy-eight percent (n = 65) reported the eLearning would enable them to teach adults and children to swallow SODFs successfully. Learners either agreed or strongly agreed that they felt comfortable to teach patients (95%, n = 62/113) and parents or carers (94%, n = 60) to swallow medications having completed the e-learning. Student pharmacists generally found eLearning as an acceptable way to reflect on their own experiences of 'pill' swallowing and how to support patients to swallow SODFs. CONCLUSION: The KidzMed eLearning was well received by student pharmacists. Further work is needed to explore whether skills translates into real life application in the clinical settings.

A systematic review and thematic synthesis exploring the role of pharmacists in supporting better sleep health and managing sleep disorders.

BACKGROUND: Sleep is an essential part of mental and physical well-being. Sleep disorders may lead to psychiatric and physical conditions that contribute to morbidity and mortality. They lead to severe health and economic consequences across high-, intermediate- and low-income countries. Little is known about how pharmacists manage sleep disorders for patients in high, intermediate and low-income countries. METHOD: Four databases were systematically searched, and titles, abstracts, and full texts were screened to detect relevant studies. Data were extracted from literature and thematically synthesised to identify descriptive and analytical themes. RESULTS: Thirty-four studies met the inclusion criteria. Most studies were from high-income countries (n = 33) and based in community pharmacy settings (n = 17). Four descriptive themes were identified: (1) how pharmacists manage sleep disorders, (2) the impact of pharmacists' interventions on sleep, (3) barriers to managing sleep by pharmacists and (4) inappropriate sleep disorders management by pharmacists. Three analytical themes were synthesised from extracted data that identified the pharmacists have roles as (1) de-prescribers, (2) collaborators and (3) educators in sleep management services. CONCLUSION: Pharmacists have three clear roles in sleep disorder management; deprescribing, collaboration with other healthcare professionals and educators. However, most of the literature is from high-income countries; therefore, further work is needed to explore these roles in low and middle-income countries.

Barriers and enablers to pharmacists' involvement in a novel immunisation programme.

Aim: Pharmacists are involved in immunisation programmes for a variety of diseases. However, some patient populations may be considered at high risk of complications from vaccination and are excluded from these programmes. The study aimed to explore pharmacists' roles in a vaccination programme to identify factors that influence their involvement. Methods: Phenomenological qualitative semi-structured interviews were conducted online with a convenience sample of pharmacists working in a COVID-19 vaccination centre in January and February 2021, by a single researcher. Recordings of the interviews were transcribed automatically, manually quality checked and thematically analysed using NVivo Version 1 by all authors. Data were repeatedly read to identify what pharmacists did and how they did it. Results: Seventeen pharmacists were interviewed, and transcript analysis identified 1) What pharmacists did in the Vaccination Centre, 2) Barriers to involvement in the Vaccination Centre and 3) Enablers to being involved in the Vaccination Centre. Key findings indicate pharmacists adopted the roles of information counsellors, supporting patients with vaccine hesitancy, making autonomous prescribing decisions as well as documenting product administration and manipulation. Limited free time at work and desk-based roles for senior pharmacists were barriers to taking on a patient-facing role. National recognition of pharmacists' skills, access to information through official and unofficial networks and a sense of duty, or zeitgeist, enabled pharmacists' to be involved. Discussion: Pharmacists can support immunisation for patients during pandemics if given appropriate autonomy and recognition. Further work is needed to explore how pharmacists may be recognised for their work and use information obtained through informal networks.

Beyond the numbers: Utilising existing textual data for qualitative research in pharmacy and health services research.

INTRODUCTION: Qualitative research is a well-established branch of scientific enquiry that draws insights from experiences.1, 2Within social and administrative pharmacy research, interview and focus group methods are a mainstay of collecting data. However, other disciplines such as sociology, psychology and anthropology, use existing data that is routinely to provide a substance for qualitative inquiry. Drawing on our experiences of using interdisciplinary research methods, this paper presents three case studies where textual data was qualitatively analysed and critically examines the strengths and weaknesses of these method in relation to pharmacy practice. METHODS: Three case studies were selected that access different types of existing, routinely collected data from pharmacy practice. This included 1) a study utilising boardroom meeting minutes, 2) a study using incident reports and 3) a study using WhatsApp messages as data. Each case study is described and critically examined. The strengths and weaknesses of this approach are based on our own reflections of completing the studies. RESULTS: Relationships between people, products and organisations can be examined in documents, records and text that is routinely collected. Existing data can also provide insights into culture, working patterns, education and errors. Practical advantages of using existing data include faster data collection and access to first-hand, accounts of experiences of human relationship with pharmaceutical products and practice. Drawbacks of using existing data are that some data may be missing, participants may no longer be accessible for participant checking and the context of language may have changed. CONCLUSION: This paper critically examined the use of methods rarely used in pharmacy practice research which draw on existing, routinely collected data. Adopting a wider range of data collection methods may will provide new understanding and insights into social and clinical pharmacy practice.

Spoken propositional idea density, a measure to help second language English speaking students: A multicentre cohort study.

PURPOSE: Idea density has been shown to influence comprehension time for text in various populations. This study aims to explore the influence of spoken idea density on attainment in young, healthy subjects using demographic characteristics. METHODS: Students watched two online lectures and answered 10 multiple choice questions on them. Students received one more idea dense (MID) and one less idea dense (LID) lecture on two different subjects. RESULTS: Seventy-five students completed the study achieving a higher median score after a less idea-dense lecture (LID = 7(3), MID = 6(3), p = 0.04). Artificial neural network models revealed the first language as the main predictor of exam performance. The odds ratio (OR) of obtaining ≥70% after a more idea-dense lecture was six-time higher for the first language versus second language English speakers (OR = 5.963, 95% CI 1.080-32.911, p = 0.041). The odds ratio was not significant when receiving a less dense lecture (OR = 2.298, 95% CI 0.635-8.315, p = 0.205). Second-language speakers benefited from receiving a lower idea density, achieving a 10.8% score increase from high to low density, versus a 3.2% increase obtained by first language speakers. CONCLUSIONS: The propositional idea density of lectures directly influences students' comprehension, and disproportionately for second language speakers; revealing the possibility of reduced spoken idea density in levelling the attainment differential between first and second language speakers.

The Smarter Sleep educational interventions: an initiative to reduce hypnotic prescribing in in-patient psychiatric care.

AIMS AND METHOD: In-patients on mental health wards are commonly prescribed hypnotics for the long-term management of disturbed sleep. Specific sleep disorders remain underdiagnosed and effective behavioural interventions are underused. We developed a suite of three educational interventions (a video, poster and handbook) about sleep, sleep disorders, the safe prescribing of hypnotics and use of psychological strategies (sleep hygiene and cognitive-behavioural therapy for insomnia, CBTi) using co-design and multiprofessional stakeholder involvement. This controlled before-and-after study evaluated the effectiveness of these interventions across seven in-patient psychiatric wards, examining their impact on hypnotic prescribing rates and staff confidence scores (data collected by retrospective drug chart analysis and survey respectively). RESULTS: A marked reduction was seen in the percentage of patients prescribed hypnotics on in-patient prescription charts (-24%), with a 41% reduction in the number of hypnotics administered per patient (mean reduction -1.142 administrations/patient). CLINICAL IMPLICATIONS: These simple educational strategies about the causes and treatment of insomnia can reduce hypnotic prescribing rates and increase staff confidence in both the medical and psychological management of insomnia.

Young@Heart clinic: a feasibility study of an undergraduate pharmacy student-led blood pressure and healthy lifestyle clinic.

OBJECTIVES: Student-led clinics offer a work-based learning (WBL) opportunity for undergraduate healthcare students to engage with professional activities in a real-life setting. Participation is posited to provide experiential learning and prepare students for clinical practice. This study aims to assess the feasibility of establishing and engaging undergraduate students in one such initiative through the collaboration between one School of Pharmacy and local authority. METHODS: The clinic was developed using a logic model and delivered in 2019-2020. A service specification and training were developed and provided to volunteering undergraduate pharmacy students. Anonymised service data were collected and process outcomes around student and public engagement were recorded to assess feasibility for longer-term embedding into the undergraduate programme. KEY FINDINGS: The clinic was operational for 20 days from November 2019 to February 2020. Student volunteers (n = 43, 36.7%) were trained and provided blood pressure screening and healthy living advice to 131 members of the public. Student drop-out occurred due to the voluntary nature of the initiative. CONCLUSIONS: Collaborative working with the local authority facilitated this WBL experience outside conventional clinical environments. The study demonstrated the potential for students to participate in service provision. This offers value to the local population through a health prevention service when a structured approach to the design and delivery of the educational experience is undertaken. The study provides insight into how the WBL can work, what it requires (e.g. resource, preparation), and learning to inform the wider implementation of this WBL into the undergraduate curriculum.

The development of undergraduate pharmacy students as reflective thinkers for the evolving field of pharmacy.

OBJECTIVES: Iterative reflective practice is recognised to support learners' formation of humanism and resilience, facilitating the healthy development of professional identity. In one undergraduate pharmacy programme, students experience a series of seminars to develop their understanding and skills in the practice of reflection and its articulation. In Stage (year) 4, students engage in a reflection conference where they present a reflective account of a 'Significant Learning Event' or their journey 'From Student to Professional'. Student abstracts from this conference were investigated to explore the nature of the reflective practice. METHODS: The student abstracts submitted for the reflection conference in the academic years 2017-2018 and 2018-2019 were subjected to manifest and latent content analysis to investigate what and how students chose to reflect. This was supplemented by the ethnographic approach of the researchers, who attended, observed and engaged with students at the event. KEY FINDINGS: 107 abstracts were submitted across the cohorts. Students reflected mainly upon experiences across a range of extra- and co-curricular activities, and reported significant learning, according to Fink's taxonomy, mainly in the human dimension, caring and learning to learn. CONCLUSIONS: At the culmination of the reflection educational strand within this programme, students demonstrated purposeful, deliberate introspection and metacognition in their abstracts for the reflection conference. These skills are fundamental to support transformative learning, whereby students have the ability to self-regulate and critique their frames of reference with autonomy and flexibility that will enable them to most effectively engage and benefit from lifelong learning within the profession.

Exploring the role of pharmacy students using entrustable professional activities to complete medication histories and deliver patient counselling services in secondary care.

Entrustable professional activities (EPAs) allow tasks to be delegated to trainees. A new model of pharmacy placements was developed that used EPAs to appropriately supervise students providing patient counselling for inhalers, anticoagulation and simple analgesia at a tertiary care hospital. Students were provided with clinical communication training (e.g. how to do the counselling) as well as mandatory occupational training (e.g. fire safety). Data was collected (by students and placement facilitators) relating to the number of consultations (n = 1361) and patients who received counselling (n = 308) carried out by students (n = 71) over a 20 week period. Students documented these consultations, recording information such as the patient identification details, subjective and objective history, their assessment of the patients' need, as well as any action taken and any further planned action that was required. These notes were analysed using a Quality and Utility Assessment Framework by three clinical pharmacists. Data was analysed using simple descriptive statistical analysis on Microsoft Excel. Documentation was deemed High Quality (41%), Medium Quality (35%) and Low Quality (24%). The results indicate that pharmacy students can use entrustable professional activities to contribute to clinical services, completing high-quality patient consultations that have utility in clinical practice. Further work is needed to evaluate impact on clinical service delivery and establish the educational utility of using EPAs to support the pharmacy workforce to develop their consultation skills.

A systematic review and thematic synthesis to identify factors that influence pharmacists' involvement in asthma care services: An identity crisis.

Background: Asthma is a common chronic disease worldwide affecting an estimated 300 million people. Pharmacists can play key roles to support optimal health outcomes for patients with asthma. Goffman's Dramaturgical Theory was used in this review to critically examine the literature describing the role of pharmacists in asthma services. Objectives: The aim of this review is to identify factors that influence the role of pharmacists in asthma care services. Methods: A systematic literature search was conducted of seven electronic databases including: CINAHL, Midline (Ovid), PubMed, Scopus, Web of science, Embase and PsycInfo.). The search was not restricted by language or date of publication. Studies were screened according to inclusion criteria which included much relate to pharmacists, asthma services and include qualitative findings. Data was extracted and thematically synthesised to create demographic, descriptive and analytical findings. Results: Eighteen studies were included. The majority of studies were conducted in high income countries, with most of the studies conducted in Australia (n = 10). Semi-structured interview was used as a method for data collection in most studies (n = 11). Evidence indicated pharmacists engaged in asthma services positively and wanted to expand their roles in patient care. However, literature reported patients' attitudes and health-system factors such as remuneration, as well as inter-professional collaboration and expected low levels of knowledge and skills of pharmacists were barriers to implementation of pharmacy-led asthma care. Analytical findings suggest that pharmacists' involvement in asthma care services were influenced by patients' and healthcare professionals' expectations which were juxtaposed with pharmacists' own self-perceived identity. Conclusions: This review demonstrates pharmacists self-identified as being capable and equipped with appropriate knowledge and skills, however the expectations of patients and other healthcare professionals prohibited their involvement in delivering asthma care services.

A qualitative study exploring the lived experience of medication use in different disease states: Linking experiences of disease symptoms to medication adherence.

WHAT IS KNOWN: Medication non-adherence leads to negative health outcomes. Medication adherence is predicted if patients understand the necessity of medication use to control disease symptoms and progression. It could be expected then, that patients with diseases with symptoms which are managed with medications, such as chronic obstructive pulmonary disorder or gout, or diseases with high-mortality rates, such as cancer, would have higher adherence rates than asymptomatic diseases, such as hypertension. However, poor medication adherence remains problematic in both symptomatic and asymptomatic diseases. Further work is needed to explore patient experiences of medication adherence to understand the link between adherence and symptom control. OBJECTIVE: To explore patients' lived experiences of medication adherence. METHODS: Participants were recruited from community pharmacies and general practices. Forty-one semi-structured interviews and three focus groups were used to collect data from patients with disease states that had different symptomatic and asymptomatic profiles. Inductive thematic analysis was used to identify key parts of the experience of using medications. RESULTS: Participants reported similar experiences of medication adherence despite having different disease symptoms. Participants said that they used medications because it was an expected part of everyday life and that medications 'must be needed' because they had been supplied, rather than being used for a particular symptom. Participants reported short-term episodes of non-adherence were unlikely to lead to negative health outcomes but may result in negative social consequences. DISCUSSION: The findings broaden our understanding of patient experiences of medication use by indicating patients with symptomatic and asymptomatic diseases share similar experiences of medication use. The necessity to use medications appeared to come from 'the system' of healthcare professionals, family and friends that supply and recommend medications. WHAT IS NEW: There were key similarities in experiences of medication adherence in patients with different disease states. The negative consequences of short-term episodes of non-adherence were normalized by healthcare professionals. CONCLUSION: Patients with symptomatic and asymptomatic diseases share similar experiences of medication adherence.