The 21 LTRs (6 female, 15 male) interviewed were aged between 32 and 68 years old, with a mean age of 49.61 years (SD, 11.07). Out of 21 LTRs, 47.6% were primary school graduates, 90.5% were married, 47.6% were running their own business, 76.2% were not working after transplantation and 52.4% had an income equal to their expenses. Time elapsing from transplantation was 2-3 years in 52.4% of the recipients, 57.2% of the recipients had a live donor, live donors were first degree relatives in 23.8% of the recipients, 33.4% of the recipients had HBV etiology and 47.6% of the recipients were using other medications and Tacrolimus (Table
1).
As a result of data analyses, three main themes; i.e. medication nonadherence, causes of medication nonadherence and expectations from nurses were obtained.
Main Theme 1: Medication nonadherence
Three subthemes emerged under the main theme of medication nonadherence; namely, skipping doses, delaying doses and misunderstanding medication.
Skipping doses: The LTRs reported to skip doses of their medications.
“When I don't take my medicine in the morning, I just take the dose in the evening.” "I haven't taken the doses of my medications in the evening for about one year.
Delaying doses: The recipients noted that they took their medication later than expected.
“…I am at work at the time when I have to take my medication. When I remember that I haven't taken it, I go home and take it. There is a delay of two hours.”
Taking wrong medication: The recipients reported that they mistook their medication with other medications.
“…There have been times when I take wrong medicine. I mistook a tablet used to treat stomach problems instead of my immunosuppressive medication yesterday”.
Main Theme 2: Causes of medication nonadherence
Six subthemes associated with causes of medication nonadherence emerged; forgetting, life style, health care system, insufficient knowledge, therapy requiring more than one medication and health beliefs.
Forgetting: The LTRs admitted that they experienced forgetfulness due to doing housework, work and social life and stress.
“…I forget to take my medication after breakfast due to fear of being late for work”. “…I forget to take my medicine when I get angry”. “Since I have a hectic work schedule and since I have to think about many things at a time, I forget to take my medicine”.
Life style: The LTRs reported to experience medication nonadherence due to changes in their daily routines led by changes in fulfilling their physiological needs such as not eating and sleeping on a regular basis, skipping meals due to lack of appetite, oversleeping, sleeplessness and tiredness and changes in social life such as living alone, poor time management, coming home late, waking up late in the morning due to not going to work and not having breakfast.
“I skip doses because I suffer from lack of appetite and that's why I can't take my medicine regularly.” “…Since I don't work, I go to bed late and get up late in the morning. For this reason, I can't take my medicine on time.” “… I can't think properly due to sleeplessness and tiredness….”
Health Care System: The LTRs commented that they experienced problems due to bureaucracy imposed by the health care system and that these problems caused medication nonadherence.
“I can't afford to buy some medications and I also have difficulties in obtaining my medications with my health insurance.
Insufficient Knowledge: The LTRs admitted that they experienced medication nonadherence since they did not wonder or did not know what not taking their medications causes, did not know side-effects of their medications, decided not to take their medications by themselves and misunderstood when to take their medications.
“… I just wondered whether I have complaints or not when I don't take my medication. That's why I stopped taking it”. “I think it isn't necessary to take the medication both in the morning and in the evening....”
Multiple medications use: One participant noted that since he had to take more than one medication, he took the wrong medicine. “…Because I have to take more than one medication, I took another drug instead of the one I was supposed to take”.
Health beliefs: The liver transplants did not take their medication when they felt good. They believed that nothing serious happens when they do not take it for a few days. Also, they believed that because long time elapsed since surgery and they did not find medication important, they experienced medication nonadherence.
“… Taking my medicine one or two hours after meals does not make any difference”. “I don't have any complaints when I don't take my medicine for two or three days …”. “ … It has been two years since transplantation… I feel well. That's why I think nothing bad happens if I don't take my medicine”.
Main Theme 3: Expectations from nurses
Three subthemes related to LTRs' expectations from nurses emerged: financial guidance, education and showing interest.
Financial guidance: The LTRs wanted to receive financial guidance from nurses. “… I need to get information from nurses about financial sources I can use to buy my medications”.
Education: The LTRs wanted to receive education to satisfy their needs for knowledge about effects and side-effects of their medication, time of taking their medication and duration of using their medication.
“... A meeting can be held with patients every two or three months. I want to receive information about doses and modes of medication, conditions likely to appear when the medication is not used, nutrition and return to social life. I would like to know whether return to work will cause any problems or not”. “…I wonder whether weight gain is due to medications or not …”.
Showing interest: The LTRs reported that they need to be shown interest.
The most important need of us is motivation”, “I will be glad if nurses show interest.”