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Given the associated risks of graft rejection, graft loss, and mortality, a clearer synthesis of underlying psychological factors is needed. This systematic review synthesized evidence on psychological factors associated with self-reported medication non-adherence among adult kidney transplant recipients, integrating quantitative and qualitative research to capture patients\u2019 perspectives.<\/jats:p>\n                  <jats:p>Following Joanna Briggs Institute guidelines, five electronic databases (Embase, PubMed, PsycINFO, Scopus, and Web of Science) were searched from inception to 5 May 2026. Eligible studies included quantitative and qualitative research involving adult recipients. Methodological quality was appraised using the Mixed Methods Appraisal Tool, and findings were integrated using a convergent integrated approach.<\/jats:p>\n                  <jats:p>Forty-four studies comprising 11,180 participants were included. Non-adherence prevalence ranged from 12.0% to 89.2%. Four overarching themes were identified: psychological distress, perceptions and beliefs, coping strategies, and social-contextual factors. Depressive symptoms and low social support were the most consistent correlates. Qualitative findings highlighted emotional burden, stigma, and regimen complexity as additional barriers.<\/jats:p>\n                  <jats:p>Medication non-adherence is multifactorial and context dependent. Integrating psychosocial screening and patient-reported outcomes into routine transplant care may improve adherence and long-term graft outcomes.<\/jats:p>","DOI":"10.1186\/s40359-026-05233-7","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T07:55:46Z","timestamp":1785138946000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological factors associated with medication non-adherence after kidney transplant: a systematic review"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2972-2952","authenticated-orcid":false,"given":"Hui Ling Michelle","family":"Neo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuhanesan N. 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