Table 2 Determinants of medication adherence in haemodialysis patients

  - Lack of understanding about medicines

“Well, I just don’t know what some of them are for.” (P1, male, 53 years, PSR NAD)

“I don’t know what’s really important and… if you missed [medication] once or twice it wouldn’t matter, I’ve no idea.” (P5, female, 58 years, PSR NAD)

“As far vitamins are no much point for me because it all gets dialysed out of here [pointing to the dialysis machine].” (P8, male, 71 years, PSR NAD)

  - Lack of benefit

“I don’t know if they doing any good? […] I thought well, you know, I am taking all this in the morning, um… are they doing any good? I don’t know.” (P5, female, 58 years, PSR NAD)

  - Safety concerns

“There’s one medicine that is a statin which I’m very unhappy about. It’s Atorvastatin. And, I’m unhappy about that… because they… they, ah, studies have shown that there are lots of side effects of that.” (P6, female, 74 years, PSR NAD)

  - Relative importance

“I think blood pressure one is important. Yes, I think that is important to keep my blood pressure down…” (P6, female, 74 years, PSR NAD)

  - Perceived need

“There’s something to do with my kidney and that. […] it’s not working very well. If I started not taking them, I could for been… you know in trouble. They all they are for a reason. Yeah.” (P15, male, 78 years, PSR AD)

  - Perceived effectiveness

“I put myself on that [medicine] because I didn’t have any arthritis or anything before I started [dialysis] and all of a sudden my fingers going, and I put it on that now for a month and it stopped the pain…” (P12, female, 80 years, PSR AD)

  - Motivation to live

“I don’t know how much longer I got to live. But I want to get up to 80. If I become 80, that will be the longest lived in all our family. And if I make 80… I’m the champion.” (P15, male, 78 years, PSR AD)

  - Positive attitude

“I got to take them as they keep me healthy. And I don’t have a problem with it.” (P21, male, 84 years, PSR AD)

  - General dislike

“I don’t like the fact that I need to take them… Not happy about taking medications but the alternatives not good.” (P13, female, 63 years, PSR NAD)

  - Disruption to daily routine

“Well it’s in the morning and night, I’m just used to doing that. It’s the middle one I have to take care of… I take it at night. Take two at night instead of three, spreading three during the day, which the doctor asked me to try, because it might be more effective. I haven’t yet succeeded.” (P8, male, 71 years, PSR NAD)

  - Inconvenience during travel

“People don’t make it difficult for me, but it’s the fact that I’ve, I travel, I like to travel of course make it difficult, because I’ve got to take all the stuffs with me, organize something every day or whatever. Yes, traveling.” (P6, female, 74 years, PSR NAD)

  - Accustomed regimen

“I got all these medications every day, morning, evening, night. So, I never forget it, now.” (P15, male, 78 years, PSR AD)

“I’ve been taking it for a long time and it’s just natural.” (P27, male, 79 years, PSR AD)

  - Unaccustomed regimen

“I’m supposed to take a medicine for my [restless leg], but I keep forgetting… So, um, I’ve only been told this few days ago and I haven’t got used to it, to taking it.” (P8, male, 71 years, PSR NAD)

  - Forgetfulness

“Well, I think that I’m much more, I don’t know, forgetful then I used to be, I can’t think this clearly… seems I pick but I don’t. Um. Remembering to take it. I think that’s the biggest thing.” (P6, female, 74 years, PSR NAD)

  - Stimuli or cues for action

“I have a little pill boxes, it holds all morning, noon and night… I just take whatever is required during dinner, or at meal in the night.” (P15, male, 78 years, PSR AD)

  - Visual allocation of pills

“I’ve got them [medicines] in the kitchen table, so I can’t forget.” (P10, female, 53 years, PSR AD)

  - Association with meals

“If I don’t have lunch, I don’t remember my medicines, always. Lunch is sort of tied to the medicines. So, if I wouldn’t eat, I wouldn’t take the medicines so regularly, I think.” (P6, female, 74 years, PSR NAD)

  - Role of support

“My wife makes sure I take them... she helps. She gets all medicines ready, tablets ready… she does all, mostly.” (P27, male, 79 years, PSR AD)

“Some medicines make me dizzy. It is a problem. Especially when I get no support at home. Coz my husband, he works at night, and I got to be careful. Coz I got no support at home.” (P7, female, 65 years, PSR NAD)

  - One-way communication

“[Asking Dr. about the need of so many medicines…] I saw doctor at the clinic last time and he said, “No, they are all good”. He went through one by one [medicines] and no, that’s good, you need that, you need that, so…” (P7, female, 65 years, PSR NAD)

  - Lack of engagement

“[Consultations are] never very long usually, you know. Just checks the figures, just look at your blood figures and everything’s ok and you know.” (P2, male, 61 years, PSR NAD)

  - Lack of time

“I really need to speak to the pharmacist. Um, but they’re very busy, but I will, I must speak to, I want to know what every medicines, especially 12 medicines in the morning are for.” (P5, female, 58 years, PSR NAD)

  - Support from HCT

“It’s always great with my GP. I’ve been going to him for 15 years and we’re quite informal and he’s very helpful and if I complained about what these things, he investigates them properly.” (P11, male, 84 years, PSR AD)

“You know, just, give all your tablets to the chemist and he’ll sort them out. Makes it so much easier. He puts them in [Webster-Pak] … for 2 weeks and you got a just twist and pop a tablets… so I don’t need to worry about what one of this, one of this, anymore.” (P16, male, 65 years, PSR AD)

  - Pressure to hide

“I forgot to say [doctor] about it [not taking phosphate binders]. Because, I think what they will gonna tell me is, I have to take it. I’m frightened obvious the doctor’s gonna say, which they probably will, because it’s very important, the phosphate, I know that.” (P5, female, 58 years, PSR NAD)

  - Being a good patient

“I don’t. I don’t know I take it because I’ve been told to take it, and I do that. But I don’t take it very seriously. And if I miss it, I don’t get panic, so.” (P8, male, 71 years, PSR NAD)

  - Personal control of treatment

“I discuss it with myself. Or, I go to [doctor] who gets upset because I decide to take more than what I’m prescribed. Like the Sifrol, it wasn’t holding, so I lifted the [dose] up to two. And checked it [in the internet] and it was okay to do that and then she [doctor] got most upset because she said it effects the kidney, and I said well they’re pretty shot already, and she said they can always get worse.” (P8, male, 71 years, PSR NAD)

  - Trust in HCT

“I take my medicines. They give me the right thing, so I just take them. Except when I’m allergic to.” (P10, female, 53 years, PSR AD)

“I keep taking them until my doctor takes me out of it. I just take the dose that’s on the charts I got.” (P25, male, 72 years, PSR AD)

  - Pill size

“I’ve got the one [medicine], got to cut it half, I’ve got a cut five or six in half so I’ve got half for in the morning and half at night.” (P9, female, 63 years, PSR NAD)

  - Palatability

“Some of them, as soon as you get them on the tongue…I swear it, dissolves straight away and it tastes disgusting! First thing in the morning they, oh! […] Just bitter, you know, one of them.” (P5, female, 58 years, PSR NAD)

 Medicine packaging

“One I have very hard to get it out. A little capsule, that for pain. Yeah. Very hard to put out. The capsules are completely crushed by the time it gets out of its thing! That’s the only problem.” (P11, male, 84 years, PSR AD)

 Side effects of medicines

“Sometimes they work, sometimes really make me sick. Makes me dizzy. It’s a bit stronger. I don’t take them. If they are not too strong, I’ll take them… but if they make me dizzy, I don’t.” (P7, female, 65 years, PSR NAD)

“I don’t like taking them, the [antibiotics], they give me toilet all the time.” (P29, male, 65 years, PSR NAD)

  - Acquiring script

“I’m taking a lot of pain tablets at the moment… I was taking patches, but you can’t get more than a month’s supply. So, that means going back on doctors, and when I get out of here [dialysis], I don’t want… to get to the doctors on my days off [from dialysis], so I’m just taking Panadol and Panadol with Codeine. But, is not really enough, to be honest.” (P2, male, 61 years, PSR NAD)

  - Clinic and pharmacy location

“Because I live out of town… and about 40 min from the chemist, just kind of be aware how many more medicines I’ve got, it’s nothing worse than running out and having to drive especially for that, yeah.” (P3, male, 44 years, PSR NAD)

“Some of the scripts you can’t get from [local pharmacy]. So, I’ve had issues actually getting them in the past… When my doctor goes on holidays, I can’t acquire a script without doing it a 100 km drive. [Dialysis staffs] refused to help me, and the doctors refused to give scripts over the phone. I can’t acquire a script over the phone…” (P1, male, 53 years, PSR NAD)

  Relative affordability

“Well, they’re quite expensive! So they do affect me, the cost. I don’t have a health care card. I’ve to pay the full subsidised price… I’ve retired and so I’m living of an allocated pension from my superannuation.” (P4, male, 56 years, PSR NAD)

“The only thing that worries me is, coz I’m in a wheel chair and I need to get to the hospital to get the scripts, it means for $ 30 to get in the taxi to go in there and pick up the script or I drive my mobility scooter all the way in there, which means 2 hours and an hour of each waiting to pick them up.” (P2, male, 61 years, PSR NAD)

 Symptom severity

“Have you seen me 12 months ago, I am on a 100% better [condition] after this year but last year and a year before, no, I didn’t really think I’m gonna make it. Not even everybody else also gonna make it either.” (P12, female, 80 years, PSR AD)

“I don’t notice any [improvement] from my medications, whatsoever.” (P1, male, 53 years, PSR NAD)