{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T21:59:48Z","timestamp":1767909588084,"version":"3.49.0"},"reference-count":42,"publisher":"BMJ","issue":"2","funder":[{"name":"Health Education England \/ National Institute of Health Research"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,1,8]]},"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>People with bipolar disorder require long-term treatment but it is estimated that 40% of these people do not adhere to prescribed medication regimens. Non-adherence increases the risk of relapse, hospitalisation and suicide. Some evidence syntheses report barriers to mental health treatment adherence but rarely delineate between modifiable and non-modifiable barriers. They also fail to distinguish between the patients\u2019 perspective and that of other stakeholders such as clinicians despite of their different understanding and priorities about adherence. Facilitators of adherence, which are also important for informing adherence intervention design, are also lacking from syntheses and few syntheses focus on medications for bipolar disorder.<\/jats:p>\n                    <jats:p>This systematic review aims to identify modifiable barriers and facilitators (determinants) of medication adherence in bipolar disorder. We also plan to report determinants of medication adherence from perspectives of patients, carers, healthcare professionals and other third parties. A unique feature of this systematic review in the context of mental health is the use of the Theoretical Domains Framework (TDF) to organise the literature identified determinants of medication adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The protocol adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ) guidelines. This review will include both qualitative and quantitative primary studies exploring determinants of medication adherence in bipolar disorder. We will search the following databases using a preplanned strategy: CINAHL, Cochrane Library (CENTRAL), Embase, LiLACS, Medline, PsychINFO, PubMed without date restrictions. We will report the quality of included studies. We will use framework synthesis using the TDF as an a priori \u2018framework\u2019. We will map the literature identified modifiable determinants to the domains of TDF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42018096306.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026980","type":"journal-article","created":{"date-parts":[[2019,2,14]],"date-time":"2019-02-14T02:05:54Z","timestamp":1550109954000},"page":"e026980","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Mapping of modifiable barriers and facilitators of medication adherence in bipolar disorder to the Theoretical Domains Framework: a systematic review protocol"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7575-3566","authenticated-orcid":false,"given":"Asta Ratna","family":"Prajapati","sequence":"first","affiliation":[{"name":"Pharmacy, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK"},{"name":"School of Pharmacy, University of East Anglia, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3106-2242","authenticated-orcid":false,"given":"Alexandra Lelia","family":"Dima","sequence":"additional","affiliation":[{"name":"Health Services and Performance Research EA 7425 HESPER, University Claude Bernard Lyon 1, Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan B","family":"Clark","sequence":"additional","affiliation":[{"name":"Norwich Medical School, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Gant","sequence":"additional","affiliation":[{"name":"Patient and Carer Representatives, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Gibbons","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Gorrod","sequence":"additional","affiliation":[{"name":"Patient and Carer Representatives, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Mosa","sequence":"additional","affiliation":[{"name":"Norfolk and Suffolk NHS Foundation Trust, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sion","family":"Scott","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of East Anglia, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fujian","family":"Song","sequence":"additional","affiliation":[{"name":"Norwich Medical School, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonnie","family":"Teague","sequence":"additional","affiliation":[{"name":"Norfolk and Suffolk NHS Foundation Trust, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J","family":"Twigg","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of East Anglia, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Wilson","sequence":"additional","affiliation":[{"name":"Norfolk and Suffolk NHS Foundation Trust, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debi","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of East Anglia, Norwich, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,2,12]]},"reference":[{"key":"2025121410490070000_9.2.e026980.1","unstructured":"National Institute for Health and Care Excellence [NICE]. 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