Cultural and Systemic Determinants of Medication Adherence Management: Mixed-Methods Evidence from Jordanian Healthcare Professionals

Anas Abed^1*Mohammad Abu Assab²Zainab Zakaraya¹Wael Abu Dayyih³Badriyah Alotaibi⁴Nawal Alsubaie⁴

• ¹Al-Ahliyya Amman University, Amman, Jordan
• ²Zarqa University, Az-Zarqa, Jordan
• ³Mutah University, Mu'tah, Jordan
• ⁴Princess Nourah bint Abdulrahman University College of Pharmacy, Riyadh, Saudi Arabia

Background: Medication adherence is a critical determinant of therapeutic outcomes in chronic disease management, particularly for patients with multimorbidity. In Jordan, little is known about how healthcare professionals promote adherence, or how cultural factors influence their practices. This study examined adherence management strategies among pharmacists and physicians, integrating quantitative and qualitative evidence to identify barriers, facilitators, and training needs. Methods: A mixed-methods, cross-sectional study was conducted with 390 HCPs (273 pharmacists, 117 physicians) recruited via convenience sampling from community and hospital settings across Jordan. Participants completed a structured, self-administered survey assessing demographic characteristics, adherence promotion strategies, assessment methods, barriers and facilitators. The survey instrument was a structured questionnaire developed from prior adherence literature and refined through pilot testing. A purposive subset of 20 survey participants (12 pharmacists, 8 physicians) participated in semi-structured interviews to explore these themes. The quantitative phase used convenience sampling across healthcare settings in Jordan, while qualitative participants were purposively selected from the survey pool to ensure diversity in profession and practice setting Quantitative data were analysed using descriptive statistics, chi-square tests, t-tests, and multivariable logistic regression. Qualitative data were analysed inductively using Braun and Clarke's thematic analysis. A convergent mixed-methods design was employed, integrating quantitative findings with qualitative themes during interpretation. Results: Pharmacists more frequently provided patient education (88.3% vs. 71.8%, p<0.001) and simplified regimens (65.2% vs. 47.9%, p=0.001) than physicians. Structured tools (pill counts, electronic monitoring) were infrequently used, while less structured methods such as self-reports and refill data were more common. Common barriers included time constraints, low health literacy, and medication costs. Cultural facilitators such as prayer-based reminders and family support were reported by over one-third of participants, particularly in community practice. Only 18.2% had received formal adherence training, which predicted greater use of structured interventions. Qualitative insights highlighted systemic resource limitations, the value of trust-based counselling, and the need for stronger interprofessional collaboration. Conclusion: Pharmacists play a leading role in adherence support in Jordan, leveraging patient education, regimen simplification, and culturally anchored strategies. However, both pharmacists and physicians face systemic and patient-level barriers, with limited training and collaboration hindering impact.