Models from the psychological sciences may help to improve adherence to iron chelation therapy (ICT) among patients with beta-thalassemia, according to research published in Patient Preference and Adherence.

Beta-thalassemia is among the most common inherited genetic disorders, and approximately 25,000 of individuals born per year have the transfusion-dependent variety. Patients with transfusion-dependent thalassemia (TDT) may, furthermore, develop severe anemia leading to hepatosplenomegaly, bone marrow expansion, and extramedullary hematopoiesis.

In cases of TDT, patients generally receive regular transfusions from a young age, though over time these treatments may lead to iron overload. Many patients with TDT take ICT regularly, though adherence to treatment is variable. In the present review, researchers explored whether existing psychological models and relational theory may aid in improving treatment adherence in this patient population.

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The authors noted 3 models that aim to help explain nonadherence and promote treatment adherence. The first of these is the Medication Adherence Model, which explains nonadherence through the distinction between the active decision to cease taking medication and unintentional interruption of taking medication.

By contrast, the Health Belief Model focuses on the patient’s perspective, and distinguishes between individual views about the disease and its seriousness, modifying factors such as socioeconomic status, and the effects of these variables on the probability of non-adherence.

Finally, the 3-Factor Intervention Model entails listening to patient concerns and ensuring that their information is complete before providing clinical guidance about medication usage. This model involved creating a targeted medication plan based on individual concerns and understanding about both the disease and the relevant intervention.

The authors also considered the effects of attachment theory, which gives clinicians the perspective necessary to evaluate the patient-physician relationship when defining behavioral and medical interventions. They presented 2 relevant case studies exploring the impact these models and attachment theory may have on medication adherence.

“Working in a multi-professional team aids communication and different approaches to be used for patients to help improve their self-efficacy,” the authors noted. “Psychological support for families from the time of diagnosis to empower them to provide care for their child has a major impact in ensuring a good foundation for lifelong adherence to treatment.”

Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


Eziefula C, Shah FT, Anie KA. Promoting adherence to iron chelation treatment in beta-thalassemia patients. Patient Prefer Adherence. 2022;16:1423-1437. doi:10.2147/PPA.S269352