{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T16:22:08Z","timestamp":1779294128199,"version":"3.51.4"},"reference-count":77,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T00:00:00Z","timestamp":1584921600000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,3,4]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Multimorbidity is highly prevalent among older patients and has been shown to be associated with poor health outcomes and lower quality of life. Adherence to medication treatments is essential in order to maximise the efficacy of treatments and improve health outcomes. However, nearly half of the older patients with multimorbidity fail to adhere to their medications, which can result in an increased risk of adverse health events, lower quality of life and higher healthcare cost. Only a few studies have explored the underlying mechanism and influencing factors of medication adherence among older patients with multimorbidity, which are inadequate to provide robust evidence for the development and evaluation of the medication adherence interventions. This study aims to examine and adapt the information\u2013motivation\u2013behavioural skills (IMB) model, a widely used social behaviour theory, to explain the medication adherence behaviour among community-dwelling older patients with multimorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A cross-sectional study will be conducted in community settings in China. Around 309 older patients with multimorbidity will be recruited to complete questionnaires on adherence knowledge, adherence motivation, adherence self-efficacy, medication adherence, medication treatment satisfaction, depressive symptoms, treatment burden, disease burden and basic demographic information. Structural equation modelling will be used to analyse and validate the relationships among variables in the IMB model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (reference number SBRE-18-675). The study results will be published in peer-reviewed journals and presented in academic conferences and workshops.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ChiCTR1900024804.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-033431","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T16:24:25Z","timestamp":1585067065000},"page":"e033431","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Examining and adapting the information\u2013motivation\u2013behavioural skills model of medication adherence among community-dwelling older patients with multimorbidity: protocol for a cross-sectional study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1415-8752","authenticated-orcid":false,"given":"Chen","family":"Yang","sequence":"first","affiliation":[{"name":"The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaozhao","family":"Hui","sequence":"additional","affiliation":[{"name":"The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dejian","family":"Zeng","sequence":"additional","affiliation":[{"name":"The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Liu","sequence":"additional","affiliation":[{"name":"The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana Tze Fan","family":"Lee","sequence":"additional","affiliation":[{"name":"The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,3,24]]},"reference":[{"key":"2025121402580329000_10.3.e033431.1","unstructured":"Academy of Medical Sciences . Multimorbidity: a priority for global health research, 2018. Available: https:\/\/acmedsci.ac.uk\/file-download\/99630838 [Accessed 31 July 2019]."},{"key":"2025121402580329000_10.3.e033431.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-014-0188-0","article-title":"Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China","volume":"12","author":"Wang","year":"2014","journal-title":"BMC Med"},{"key":"2025121402580329000_10.3.e033431.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2007.00213.x"},{"key":"2025121402580329000_10.3.e033431.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010035","article-title":"Medication-Related burden and patients' lived experience with medicine: a systematic review and metasynthesis of qualitative studies","volume":"6","author":"Mohammed","year":"2016","journal-title":"BMJ Open"},{"key":"2025121402580329000_10.3.e033431.5","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200209000-00009"},{"key":"2025121402580329000_10.3.e033431.6","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.17.1836"},{"key":"2025121402580329000_10.3.e033431.7","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03123"},{"key":"2025121402580329000_10.3.e033431.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-016982","article-title":"Economic impact of medication non-adherence by disease groups: a systematic review","volume":"8","author":"Cutler","year":"2018","journal-title":"BMJ Open"},{"key":"2025121402580329000_10.3.e033431.9","unstructured":"World Health Organization . Adherence to long-term therapies: evidence for action, 2003. Available: https:\/\/www.who.int\/chp\/knowledge\/publications\/adherence_report\/en\/ [Accessed 31 July 2019]."},{"key":"2025121402580329000_10.3.e033431.10","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.111.3.455"},{"key":"2025121402580329000_10.3.e033431.11","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s11606-017-4197-5","article-title":"Advantages to using social-behavioral models of medication adherence in research and practice","volume":"33","author":"Amico","year":"2018","journal-title":"J Gen Intern Med"},{"key":"2025121402580329000_10.3.e033431.12","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.diabres.2018.05.046","article-title":"Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model","volume":"142","author":"Nelson","year":"2018","journal-title":"Diabetes Res Clin Pract"},{"key":"2025121402580329000_10.3.e033431.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-6593-8","article-title":"Predictors of condom use behavior among men who have sex with men in China using a modified information-motivation-behavioral skills (IMB) model","volume":"19","author":"Jiang","year":"2019","journal-title":"BMC Public Health"},{"key":"2025121402580329000_10.3.e033431.14","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1080\/13691058.2015.1084375","article-title":"Predictors of condom use behaviour among male street labourers in urban Vietnam using a modified Information-Motivation-Behavioral skills (IMB) model","volume":"18","author":"Van Huy","year":"2016","journal-title":"Cult Health Sex"},{"key":"2025121402580329000_10.3.e033431.15","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.25.4.462"},{"key":"2025121402580329000_10.3.e033431.16","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3275"},{"key":"2025121402580329000_10.3.e033431.17","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.2147\/PPA.S117269","article-title":"Relationship between patients' knowledge and medication adherence among patients with hypertension","volume":"10","author":"Jankowska-Pola\u0144ska","year":"2016","journal-title":"Patient Prefer Adherence"},{"key":"2025121402580329000_10.3.e033431.18","doi-asserted-by":"crossref","first-page":"691","DOI":"10.2147\/PPA.S129088","article-title":"Patient knowledge and pulmonary medication adherence in adult patients with cystic fibrosis","volume":"11","author":"Lin","year":"2017","journal-title":"Patient Prefer Adherence"},{"key":"2025121402580329000_10.3.e033431.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2013.07.001"},{"key":"2025121402580329000_10.3.e033431.20","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.6.540"},{"key":"2025121402580329000_10.3.e033431.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2009.07.016"},{"key":"2025121402580329000_10.3.e033431.22","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-1828"},{"key":"2025121402580329000_10.3.e033431.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0080633","article-title":"Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns framework","volume":"8","author":"Horne","year":"2013","journal-title":"PLoS One"},{"key":"2025121402580329000_10.3.e033431.24","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-94"},{"key":"2025121402580329000_10.3.e033431.25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/2806341","article-title":"Medication belief and adherence among patients with epilepsy","volume":"2019","author":"Niriayo","year":"2019","journal-title":"Behav Neurol"},{"key":"2025121402580329000_10.3.e033431.26","doi-asserted-by":"crossref","first-page":"721","DOI":"10.2147\/PPA.S161151","article-title":"Primary nonadherence to chronic disease medications: a meta-analysis","volume":"12","author":"Lemstra","year":"2018","journal-title":"Patient Prefer Adherence"},{"key":"2025121402580329000_10.3.e033431.27","doi-asserted-by":"publisher","DOI":"10.1007\/11.606-014-2845-6"},{"key":"2025121402580329000_10.3.e033431.28","doi-asserted-by":"publisher","DOI":"10.1007\/s12160-014-9663-2"},{"key":"2025121402580329000_10.3.e033431.29","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.2147\/PPA.S165749","article-title":"Self-Efficacy for medication management: a systematic review of instruments","volume":"12","author":"Lamarche","year":"2018","journal-title":"Patient Prefer Adherence"},{"key":"2025121402580329000_10.3.e033431.30","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.pec.2019.02.022","article-title":"Health beliefs and medication adherence in patients with hypertension: a systematic review of quantitative studies","volume":"102","author":"Al-Noumani","year":"2019","journal-title":"Patient Educ Couns"},{"key":"2025121402580329000_10.3.e033431.31","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.hrtlng.2015.03.006","article-title":"Type D personality, self-efficacy, and medication adherence in patients with heart failure-A mediation analysis","volume":"44","author":"Wu","year":"2015","journal-title":"Heart Lung"},{"key":"2025121402580329000_10.3.e033431.32","doi-asserted-by":"publisher","DOI":"10.1177\/1090198107309459"},{"key":"2025121402580329000_10.3.e033431.33","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s10865-012-9405-5","article-title":"Does adherence-related support from physicians and partners predict medication adherence for vasculitis patients?","volume":"35","author":"Pepper","year":"2012","journal-title":"J Behav Med"},{"key":"2025121402580329000_10.3.e033431.34","doi-asserted-by":"publisher","DOI":"10.1177\/1359105315583369"},{"key":"2025121402580329000_10.3.e033431.35","first-page":"152","article-title":"Addressing the needs of patients with multiple chronic illnesses: the case of diabetes and depression","volume":"10","author":"Piette","year":"2004","journal-title":"Am J Manag Care"},{"key":"2025121402580329000_10.3.e033431.36","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-011-1704-y"},{"key":"2025121402580329000_10.3.e033431.37","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1093\/qjmed\/hcz058","article-title":"Medication adherence among patients with chronic diseases: a survey-based study in pharmacies","volume":"112","author":"J\u00fcngst","year":"2019","journal-title":"QJM"},{"key":"2025121402580329000_10.3.e033431.38","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000136"},{"key":"2025121402580329000_10.3.e033431.39","unstructured":"Mercer S , Chris S , Fortin M . ABC of multimorbidity. Somerset: John Wiley & Sons, Incorporated, 2014: 30\u20134."},{"key":"2025121402580329000_10.3.e033431.40","doi-asserted-by":"publisher","DOI":"10.1177\/1742395314559751"},{"key":"2025121402580329000_10.3.e033431.41","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-12-109"},{"key":"2025121402580329000_10.3.e033431.42","doi-asserted-by":"crossref","first-page":"175","DOI":"10.2147\/PPA.S151263","article-title":"Medication adherence and beliefs about medication in elderly patients living alone with chronic diseases","volume":"12","author":"Park","year":"2018","journal-title":"Patient Prefer Adherence"},{"key":"2025121402580329000_10.3.e033431.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2012.05.005"},{"key":"2025121402580329000_10.3.e033431.44","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318032937e"},{"key":"2025121402580329000_10.3.e033431.45","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2004.72252.x"},{"key":"2025121402580329000_10.3.e033431.46","first-page":"10s","article-title":"Factors associated with low adherence to medicine treatment for chronic diseases in Brazil","volume":"50","author":"Tavares","year":"2016","journal-title":"Rev Sa\u00fade P\u00fablica"},{"key":"2025121402580329000_10.3.e033431.47","doi-asserted-by":"crossref","first-page":"100","DOI":"10.3389\/fendo.2017.00100","article-title":"Medications adherence and associated factors among patients with type 2 diabetes mellitus in the Gaza strip, Palestine","volume":"8","author":"Elsous","year":"2017","journal-title":"Front Endocrinol"},{"key":"2025121402580329000_10.3.e033431.48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/4709645","article-title":"Medication adherence and coping strategies in patients with rheumatoid arthritis: a cross-sectional study","volume":"2019","author":"Berner","year":"2019","journal-title":"Int J Rheumatol"},{"key":"2025121402580329000_10.3.e033431.49","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.111.176859"},{"key":"2025121402580329000_10.3.e033431.50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2010.07.014"},{"key":"2025121402580329000_10.3.e033431.51","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldv043"},{"key":"2025121402580329000_10.3.e033431.52","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004694"},{"key":"2025121402580329000_10.3.e033431.53","doi-asserted-by":"publisher","DOI":"10.1037\/\/1082-989X.1.2.130"},{"key":"2025121402580329000_10.3.e033431.54","unstructured":"Browne MW , Cudeck R . Alternative ways of assessing model fit. In: Bollen KA , Long JS , eds. Testing structural equation models. Newbury Park, CA: Sage, 1993: 136\u201362."},{"key":"2025121402580329000_10.3.e033431.55","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-100","article-title":"Validation of an information-motivation-behavioral skills model of self-care among Chinese adults with type 2 diabetes","volume":"13","author":"Gao","year":"2013","journal-title":"BMC Public Health"},{"key":"2025121402580329000_10.3.e033431.56","doi-asserted-by":"publisher","DOI":"10.1891\/1061-3749.22.1.120"},{"key":"2025121402580329000_10.3.e033431.57","unstructured":"Shang Y . Influencing factors of immunosuppressive medications adherence among kidney transplant recipients [Master thesis]. Beijing University of Chinese Medicine, 2017."},{"key":"2025121402580329000_10.3.e033431.58","doi-asserted-by":"publisher","DOI":"10.1080\/08870449908407311"},{"key":"2025121402580329000_10.3.e033431.59","doi-asserted-by":"crossref","first-page":"e017293","DOI":"10.1136\/bmjopen-2017-017293","article-title":"Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China","volume":"7","author":"Wei","year":"2017","journal-title":"BMJ Open"},{"key":"2025121402580329000_10.3.e033431.60","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jpsychores.2019.03.184","article-title":"Utilization of the beliefs about medicine questionnaire and prediction of medication adherence in China: a systematic review and meta-analysis","volume":"122","author":"Nie","year":"2019","journal-title":"J Psychosom Res"},{"key":"2025121402580329000_10.3.e033431.61","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2010.0314."},{"key":"2025121402580329000_10.3.e033431.62","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s10461-019-02456-1","article-title":"Hiv disclosure to family members and medication adherence: role of social support and self-efficacy","volume":"24","author":"Mi","year":"2020","journal-title":"AIDS Behav"},{"key":"2025121402580329000_10.3.e033431.63","doi-asserted-by":"publisher","DOI":"10.1891\/106137407783095757"},{"key":"2025121402580329000_10.3.e033431.64","first-page":"321","article-title":"Psychometric properties of the Chinese version of the self-efficacy for appropriate medication use scale in patients with stroke","volume":"10","author":"Dong","year":"2016","journal-title":"Patient Prefer Adherence"},{"key":"2025121402580329000_10.3.e033431.65","doi-asserted-by":"publisher","DOI":"10.1080\/08870440290001502"},{"key":"2025121402580329000_10.3.e033431.66","first-page":"723","article-title":"The related factors of medication adherence in pafients undergoing continuous ambulatory peritoneal dialysis [Chinese]","volume":"18","author":"Zou","year":"2017","journal-title":"Chinese J Integr Tradit West Nephrol"},{"key":"2025121402580329000_10.3.e033431.67","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2025121402580329000_10.3.e033431.68","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l1476"},{"key":"2025121402580329000_10.3.e033431.69","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.genhosppsych.2014.05.021","article-title":"Reliability and validity of the Chinese version of the patient health questionnaire (PHQ-9) in the general population","volume":"36","author":"Wang","year":"2014","journal-title":"Gen Hosp Psychiatry"},{"key":"2025121402580329000_10.3.e033431.70","doi-asserted-by":"crossref","DOI":"10.1186\/1741-7015-10-68","article-title":"Development and description of measurement properties of an instrument to assess treatment burden among patients with multiple chronic conditions","volume":"10","author":"Tran","year":"2012","journal-title":"BMC Med"},{"key":"2025121402580329000_10.3.e033431.71","first-page":"559","article-title":"Current status of treatment burden of patients with noninfectious chronic diseases based on ordinal logistic regression [Chinese]","volume":"22","author":"Yang","year":"2019","journal-title":"Chinese Gen Med"},{"key":"2025121402580329000_10.3.e033431.72","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1111\/j.1524-4733.2005.00066.x","article-title":"Hierarchical construct validity of the treatment satisfaction questionnaire for medication (TSQM version II) among outpatient pharmacy consumers","volume":"8 Suppl 1","author":"Atkinson","year":"2005","journal-title":"Value Health"},{"key":"2025121402580329000_10.3.e033431.73","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1968.tb02103.x"},{"key":"2025121402580329000_10.3.e033431.74","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(92)90005-N"},{"key":"2025121402580329000_10.3.e033431.75","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.01935.x"},{"key":"2025121402580329000_10.3.e033431.76","unstructured":"Zhang H . A study on the methods and application of comprehensive assessment of healthcare for cadres [Doctoral thesis]. Army Medical University, 2010."},{"key":"2025121402580329000_10.3.e033431.77","first-page":"23","article-title":"Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures","volume":"8","author":"Schermelleh-Engel","year":"2003","journal-title":"Methods Psychol Res"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-033431","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T10:58:14Z","timestamp":1765709894000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-033431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":77,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,3,24]]},"published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1136\/bmjopen-2019-033431"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-033431","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}