The study, published in Public Health in Practice, was conducted through a cross-sectional online survey administered between April and June 2021. Experts from healthcare, academic and governmental institutions, and patient associations were recruited through a purposive, network-based sampling strategy in which national ENABLE representatives identified colleagues with clinical, policy, or research expertise in adherence. The survey was piloted among 12 experts from five countries before deployment, and open-ended responses were analyzed using the qualitative framework method, in which pairs of researchers independently coded each response before reconciling their decisions through team consensus. The resulting codes were then quantified at the respondent level and compared across Western, Central, and Eastern European regions defined by the Global Burden of Disease classification.

The professional landscape of adherence support proved to be dominated by three groups. Physicians, including general practitioners, specialists, and clinical pharmacologists, were named by 90.7 percent of respondents as being involved in medication adherence management in their country. Pharmacists followed at 70.7 percent, and nurses at 55.7 percent. Beyond this core trio, involvement dropped sharply: other professionals such as medical technicians, physiotherapists, midwives, and social services were cited by just 10 percent, psychologists by 7.1 percent, and national health insurance institutes by 5 percent. Regional patterns varied, with nurses far more likely to be cited in Western Europe, where 72.1 percent of respondents mentioned them, compared with 41.3 percent in Central Europe, suggesting that the structure of national health systems shapes who takes responsibility for keeping patients on treatment.

When experts described what happens once a patient is identified as non-adherent, communication and education emerged as the most frequently reported intervention category in every region, cited by 83.6 percent of Western, 87.3 percent of Central, and 68.8 percent of Eastern European respondents. This category encompassed direct patient communication, patient education, peer support groups, self-care training programs, shared decision-making, motivational interviewing, and longer consultations. Follow-up and monitoring was the second most common category, reported by 60.7 percent of Western, 49.2 percent of Central, and 43.8 percent of Eastern European experts, and included closer follow-up visits, regimen simplification, dose-dispensing by pharmacies, and structured medication reviews.

The two remaining categories revealed a more fragmented picture. Collaborative and multidisciplinary approaches, such as involving other healthcare professionals, home care staff, or family caregivers, and technological solutions, including mobile apps, reminders, and pill organizers, were reported significantly less often by Central and Eastern European respondents than by their Western counterparts. Exploratory statistical testing using the Fisher–Freeman–Halton exact test, with p-values adjusted by the Benjamini–Hochberg procedure, found regional differences for both categories, each with an adjusted p-value of 0.046 and a Cramér’s V of roughly 0.24, indicating a modest but measurable association between region and intervention type. Western Europe’s more frequent use of collaborative models may reflect better-resourced systems, but the authors caution that professional boundaries and time constraints can limit multidisciplinary working even where infrastructure exists.

Perhaps the most consequential finding concerns which interventions experts actually believe work. Direct patient communication, encompassing motivational interviewing, shared decision-making, longer consultations, peer support, and patient training, was the single intervention most frequently perceived as successful, identified by 35 percent of all respondents. At the category level, communication and education again led in every region, cited as successful by 36.1 percent of Western, 46.0 percent of Central, and 50 percent of Eastern European experts. Collaborative approaches were seen as successful by 34.4 percent of Western respondents but only 20.6 percent of Central and 6.3 percent of Eastern respondents, while follow-up and monitoring was named by 19.7, 23.8, and 6.3 percent respectively. Notably, after adjustment for multiple comparisons, none of these regional differences in perceived success reached statistical significance, leaving the descriptive patterns suggestive rather than definitive.

The gap between availability and perceived effectiveness is itself revealing. Roughly eight in ten experts said direct patient communication was available in their country, yet only slightly more than a third judged it successful. The authors point out that communication is not inherently beneficial: a clinician who blames or reprimands a patient for missing doses is also communicating directly, and likely counterproductively, since patients who feel judged may disengage further. Limited consultation time, heavy workloads, variable communication skills, health literacy gaps, language barriers, and the compounding complexity of multimorbidity and polypharmacy all constrain how well conversations about medicines can translate into sustained behavior change. The finding echoes a broader evidence base showing that physician communication quality is one of the strongest modifiable predictors of adherence.

Technology, often heralded as the future of adherence support, played a surprisingly marginal role. Fewer than a third of experts reported technological solutions as available, and they were perceived as successful even less often. The authors attribute this limited uptake to practical barriers documented in prior research: uncertain reimbursement, poor integration with electronic health records and pharmacy systems, data privacy concerns, and uneven digital literacy and access among older or multimorbid patients, precisely the populations most likely to need adherence support. This aligns with systematic reviews that have found digital adherence tools to be only moderately effective on average, suggesting that apps and reminders are best understood as complements to, rather than substitutes for, human interaction.

The COVID-19 pandemic provided an unplanned stress test of how adherence support adapts under disruption, and the results were sobering. Some 40.7 percent of experts reported no specific medication adherence initiatives in their countries during the pandemic, although the authors urge caution since responses were retrospective and depended on respondents’ awareness of national or local programs. Among the adaptations that were reported, telemedicine, including e-prescriptions, led at 15.7 percent, followed by easier access to medicines through pharmacist services and home delivery at 7.9 percent, and informative campaigns, lectures, and webinars at 6.4 percent. Respondents from Central Europe described the widest range of initiatives, including vaccination-related actions and educational programs for healthcare professionals. The heterogeneity underscores, the authors argue, the need to build resilient and accessible adherence support that can withstand major healthcare disruptions rather than being improvised mid-crisis.

The study’s implications reach beyond academic classification. Because the analysis maps what is actually practiced rather than what trials recommend, it identifies concrete candidates for future implementation research: structured adherence checks embedded in routine visits, documentation in electronic records, monitored adherence indicators, and multidisciplinary teams that combine communication, behavioral, digital, and system-level approaches. The authors are candid about limitations, including possible selection bias from network-based recruitment, an Eastern European subsample of only 16 respondents from four countries, reliance on expert perception rather than objective effectiveness data, and the absence of probing possible in a self-administered survey. Yet the scale of the exercise, spanning 35 countries and coordinated through the COST Action ENABLE network, makes it an unusually comprehensive snapshot. Its central message is likely to resonate with clinicians and policymakers alike: before Europe invests in the next generation of adherence technology, it should first ensure that the oldest intervention, a trusted conversation between patient and professional, is done well, consistently, and everywhere.

Subject of Research: Expert-reported mapping of medication adherence interventions across 35 European countries

Article Title: Mapping medication adherence interventions across Europe: Expert perspectives from 35 countries

Article References: Mucherino, S., Aarnio, E., Qvarnström, M., Hafez, G., Kamusheva, M., Potočnjak, I., Trečiokiene, I., Mihajlović, J., Ekenberg, M., van Boven, J., & Leiva-Fernandez, F. (2026). Mapping medication adherence interventions across Europe: Expert perspectives from 35 countries. Public Health in Practice, 12, Article 100850. https://doi.org/10.1016/j.puhip.2026.100850

Image Credits: AI Generated

DOI: 10.1016/j.puhip.2026.100850

Keywords: medication adherence, Europe, ENABLE, patient communication, healthcare professionals, technological solutions, multidisciplinary care, COVID-19, survey research, public health, pharmacists, health systems