Understanding Medication Adherence in Patients With Primary Osteoporosis in China: A Qualitative Study Guided by the Integrated Theory of Health Behavior Change

AIM: To qualitatively analyse determinants of medication adherence in Chinese patients with PO using the Integrated Theory of Health Behavior Change (ITHBC). DESIGN: The study was conducted as a qualitative study using. The data is systematically analysed using thematic analysis method. We followed the COREQ Checklist to ensure rigour in our study. METHODS: This qualitative descriptive study, guided by the ITHBC, was conducted at a national medical center in China (November 2023-June 2024). Sixteen patients with PO were purposively sampled until data saturation. Semi-structured interviews were analysed using directed thematic analysis. RESULTS: Medication adherence was conceptualized as a dynamic, self-regulatory process shaped by three interconnected components: (i) Intrinsic drivers: Patients' illness perceptions, treatment beliefs and knowledge formed the cognitive and motivational foundation. (ii) External scaffold: Family support functioned as a multidimensional facilitator through instrumental, emotional, informational and financial aid. (iii) Systemic barriers: Healthcare system inefficiencies and daily routine disruptions depleted self-regulatory resources. Their interplay manifested in three emergent behavioural patterns: passive compliance, active engagement, and experiential learning. CONCLUSION: Medication adherence in Chinese patients with PO arises from interactions among individual cognition, family dynamics and systemic environment. The ITHBC provides a useful framework for understanding these mechanisms. Future interventions should address patient beliefs, mobilize family support and redesign healthcare systems to reduce barriers. PATIENT CONTRIBUTION: Sixteen patients diagnosed with primary osteoporosis participated in this qualitative study by sharing their personal experiences and perspectives through in-depth interviews. Their contributions provided essential insights into the facilitators and barriers to medication adherence, directly informing the study's findings and implications for nursing practice.