Analysis of 171 studies across two decades reveals 59 distinct barriers and facilitators affecting oral nutritional supplement adherence among malnourished patients. The research encompassed 42% randomized controlled trials and 20% qualitative studies, with cancer patients and older adults comprising the largest study populations at 34% and 35% respectively. Key adherence drivers include patient health status, intrinsic motivation, product tolerance and satisfaction, plus well-functioning healthcare routines and support systems.
This comprehensive mapping fills a critical gap in understanding why nutritional interventions often fail despite clinical necessity. While oral nutritional supplements are standard care for disease-related malnutrition, poor adherence rates have long plagued clinical outcomes. The identification of nearly 60 discrete factors suggests adherence is far more complex than previously recognized, extending beyond simple palatability concerns to encompass psychological, social, and healthcare delivery elements. For clinicians managing malnourished patients, this framework could enable more personalized intervention strategies. However, the review's broad scope across diverse patient populations may limit specific actionable insights. The finding that relatively few factors have robust evidence support across multiple studies suggests much adherence research remains preliminary, highlighting the need for more targeted investigations in specific patient subgroups.
