Medication Adherence in Burn Care: A Systematic Analysis of Barriers and Interventions Using the WHO Framework

Jiaqi Lou¹Ziyi Xiang²Xiaoyu Zhu³Jiliang Li¹Guoying Jin¹Shengyong Cui¹Neng Huang¹Xin Le^1*Youfen Fan^1*Qionghui Sun^1,4*

• ¹Ningbo No 2 Hospital Burn Department, Ningbo, China
• ²Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
• ³Ningbo University, Ningbo, China
• ⁴Department of Nursing, Ningbo No.2 Hospital, Ningbo, China

Abstract: Medication adherence in burn patients represents a complex clinical challenge shaped by intersecting biomedical, psychological, and sociocultural dynamics. Although advancements in burn care have substantially improved survival rates, the intricate pharmacological regimens essential for recovery— including antibiotics, analgesics, and metabolic modulators—frequently result in suboptimal adherence, particularly in outpatient settings. This systematic review applies the World Health Organization (WHO) framework across five adherence dimensions to analyze barriers and interventions specific to burn care. We systematically searched multiple databases and identified 78 studies meeting inclusion criteria. Our analysis reveals that medication adherence in burn care is influenced by a complex interplay of factors across all WHO dimensions. Socioeconomic barriers include limited health literacy (43% of caregivers), financial constraints, and cultural beliefs favoring traditional medicine (31% of Asian/African cohorts). Healthcare system barriers encompass inadequate access to specialized burn centers (68% of low-income countries lack such facilities) and workforce shortages. Condition-related challenges involve burn-induced hypermetabolism altering drug pharmacokinetics and psychological comorbidities (35-45% depression prevalence). Therapy-related complexities include polypharmacy (average 4.2 drug-drug interactions per patient) and demanding treatment regimens. Patient-related factors encompass cognitive impairments (12-18% of major burn cases) and trauma-related psychological barriers. Effective interventions identified include multidisciplinary care models, technology-enabled solutions (AI prediction models achieving 89% accuracy), culturally adapted approaches, and policy reforms. This review provides a comprehensive framework for developing targeted, multidimensional strategies to improve medication adherence in burn care across diverse settings and populations.