MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE.

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This study aims to explore medication adherence among the elderly. The findings aim to make a significant contribution to improving the adherence rate among elderly patients. Methods and analysis Data will be collected through interviews with two central questions, and probing will be used based on the participants’ responses. The collected data will be analysed thematically. Ethics and dissemination The proposal has been approved by the Research Ethics Committee of the University of Venda. Permission to conduct the study will be obtained from the Limpopo Department of Health, the Waterberg District, and the selected hospital. Autonomy, confidentiality, care for the vulnerable group, and informed consent will be maintained. Key findings will be disseminated through academic publications, community settings, policymakers, and healthcare providers in a selected hospital. 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F1000Research 2026, 15 :40 ( https://doi.org/10.12688/f1000research.175364.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] T Mavhungu https://orcid.org/0009-0004-1718-1861 1 , AG Mudau https://orcid.org/0000-0001-9022-5286 1 , TR Lebese 1 T Mavhungu https://orcid.org/0009-0004-1718-1861 1 , AG Mudau https://orcid.org/0000-0001-9022-5286 1 , TR Lebese 1 PUBLISHED 09 Jan 2026 Author details Author details 1 Department of Public Health, University of Venda, Thohoyandou, Limpopo, South Africa T Mavhungu Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing AG Mudau Roles: Data Curation, Formal Analysis, Funding Acquisition, Project Administration, Resources, Software, Supervision, Validation, Writing – Review & Editing TR Lebese Roles: Project Administration, Resources, Software, Supervision, Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Sociology of Health gateway. Abstract Introduction Medication adherence among elderly patients is crucial for maintaining their health and well-being; many face challenges that hinder their ability to follow prescribed regimens. This study aims to explore medication adherence among the elderly. The findings aim to make a significant contribution to improving the adherence rate among elderly patients . Methods and analysis Data will be collected through interviews with two central questions, and probing will be used based on the participants’ responses. The collected data will be analysed thematically. Ethics and dissemination The proposal has been approved by the Research Ethics Committee of the University of Venda. Permission to conduct the study will be obtained from the Limpopo Department of Health, the Waterberg District, and the selected hospital. Autonomy, confidentiality, care for the vulnerable group, and informed consent will be maintained. Key findings will be disseminated through academic publications, community settings, policymakers, and healthcare providers in a selected hospital. READ ALL READ LESS Keywords Keywords: chronic diseases, elderly, Medication adherence Corresponding Author(s) T Mavhungu ( [email protected] ) AG Mudau ( [email protected] ) TR Lebese ( [email protected] ) Close Corresponding authors: T Mavhungu, AG Mudau, TR Lebese Competing interests: There may be a potential conflict of interest, as the researcher may have previously provided nursing care to the participants. The study has been designed to mitigate any potential bias, ensuring that all findings and interpretations remain objective. Grant information: The University of Venda Research and Publication Committee will pay the publication fee. They have not made any contribution in preparing this article The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2026 Mavhungu T et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Mavhungu T, Mudau A and Lebese T. MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.12688/f1000research.175364.1 ) First published: 09 Jan 2026, 15 :40 ( https://doi.org/10.12688/f1000research.175364.1 ) Latest published: 16 Apr 2026, 15 :40 ( https://doi.org/10.12688/f1000research.175364.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction Medication adherence among elderly patients living with chronic diseases continues to be a significant challenge in health care. Medication adherence refers to the extent to which a patient’s behaviour corresponds with taking medicine optimally, and it is a key factor in achieving therapeutic goals and improving patient outcomes ( Specialist Pharmacy Service, 2023 ). Medication nonadherence is associated with poorer health outcomes when an individual fails to achieve the expected health benefits from medications related to a specific illness. Several studies have explored medication adherence among elderly patients with chronic diseases living in South Africa ( AbdELwhab et al., 2025 ; Gumede et al., 2024 ; Hung et al., 2020 ). They recommended different strategies to improve medication adherence among the elderly with chronic diseases. Chronic diseases can influence your ability to work and lifestyle; they have an impact on mental, physical, social, and financial aspects, and they may be a burden to the family members who are living with a chronic patient. Therefore, it is crucial to explore medication adherence among elderly patients with chronic disease(s). The World Health Organisation (2025) estimates that globally, the proportion of people aged 60 years or older will double by 2050. Most older people reside in low- and middle-income countries, such as South Africa. Population ageing is a public health concern that could negatively impact the South African economy and health system if the government fails to prepare for this change ( Sibanda et al., 2021 ). There is an increasing burden of the elderly population in many countries, with an estimated total of 2.37 billion people aged 65 years or older globally by 2100 ( Hung et al., 2020 ). The population of South Africa grew by 19,8% between 2011 and 2022. In 2022, the estimated total population of South Africa was 62,027,503 and included more than five million people aged 60 or older, which represents a 9,2% share of the overall South African population. The number of older persons increased across all provinces; Limpopo had a total population of 6,572,721, comprising 6.9% of the older population (65 years and above). The Waterberg district (Modimolle-Mookgophong municipality) had a total population of 130,113, comprising 9.8% of the elderly population ( SA STATS, 2023 ). The elderly face unique health challenges compared to young people; for example, noncommunicable diseases such as cardiac diseases, cancer, and diabetes are causes of morbidity among the elderly. The increased prevalence of comorbidities and the severity of diseases in old age will result in a higher demand for healthcare in the future. The decade of healthy ageing (2020-2030) provides an opportunity for a collaborative effort between the government and other stakeholders to enhance the health and well-being of the elderly ( Sibanda et al., 2021 ). Globally, non-communicable diseases killed at least 43 million people in 2021, equivalent to 75% of non-pandemic-related deaths ( World Health Organisation, 2025 ). South Africa is experiencing a growing proportion of the elderly population with rapid increases in the burden of non-communicable diseases. In South Africa, a significant portion of the elderly population, approximately 85%, has at least one chronic health condition, and 60% have two or more ( SA STATS, 2023 ). Rural areas in South Africa represent a smaller fraction of the population; however, they share a relatively higher burden of non-communicable diseases. SA represents one of the most rapidly ageing countries in sub-Saharan Africa. In South Africa, the burden of chronic diseases is significant, with deaths from cardiovascular disease, cancer, diabetes, and chronic respiratory diseases increasing by 58.7% over 20 years ( SA STATS, 2023 ). There are deaths due to major non-communicable diseases over 20 years, from 1997 to 2018, which are the following: cardiovascular diseases increased from 54,701 in1997 to 80,133 in 2018; cancer increased from 27,052 in 1997 to 43,613 in 2018; chronic lower respiratory diseases rose from 10,829 in 1997 to 13,579 in 2018, and diabetes increased from 10,846 in 1997 to 26,880 in 2018 (SATS SA, 2023). In 2018, females accounted for 65,845 deaths due to three non-communicable diseases, while males accounted for 54,556; the median age at death in years was 65 for males and 69 for females. KwaZulu-Natal, Gauteng, Western Cape, and Eastern Cape have some of the highest mortality rates due to non-communicable diseases; this may reflect their population, as they host almost two-thirds of South Africa’s population. About 50 % of adults struggle with medication adherence ( Nguyenal et al., 2024 ). Taking medication correctly may seem like a personal or straightforward matter. However, nonadherence or not taking medication as prescribed is a complicated and common problem, and people do not realise the actual damage or side effects of non-adherence. There are several reasons why people may be unable to take medication as directed. Medication adherence issues are common among elderly patients, regardless of whether they are treating acute or chronic diseases. The elderly are susceptible to several comorbidities requiring polypharmacy, and it may make them more likely to adhere to medication than younger patients; they are, therefore, likely to have more hospital readmissions, increased health spending, slow healing, etc. ( Varghese et al., 2024 ). ( Kvarnstrom et al., 2021 ) classified factors influencing medication adherence among elderly patients as patient-specific barriers, an illness-specific situation, medication-related issues, health care and system-related issues, as well as logical and financial factors. Several studies have explored medication adherence among elderly patients with chronic diseases and recommended strategies to improve adherence, including medication management, health education, supportive social networks, and ensuring continuity of care ( AbdElwhab et al., 2025 ; Gumede et al., 2024 ; Hung et al., 2020 ). However, there is a lack of context-specific research addressing medication adherence among elderly patients aged 60 years and above with chronic diseases in the Waterberg district, specifically around the Modimolle-Mookgopong municipality. Furthermore, there is a limited understanding of medication adherence and the facilitators affecting medication adherence among the elderly population within the district, which hinders the development of targeted interventions, resulting in a high rate of complications of chronic diseases, a high rate of readmissions, and high mortality due to medication non-adherence among the elderly. Therefore, this study aims to explore medication adherence among elderly patients receiving health care services in a selected hospital in the Waterberg district. Objectives • To investigate the experiences of medication adherence among elderly patients receiving health care services in a selected hospital of the Waterberg district. • To describe the perception of medication adherence among elderly patients receiving health care services in a selected hospital in the Waterberg district. Materials and methods Study design This qualitative study will employ a phenomenological design to explore medication adherence among elderly patients receiving healthcare services in a selected hospital in the Waterberg district. This design enables an in-depth understanding of the experiences and perceptions of medication adherence among elderly patients. Population The target population for this study comprises elderly patients aged 60 years and above residing in the Waterberg District who have been diagnosed with at least one chronic disease and are receiving healthcare services. Inclusion criteria The inclusion criteria for this study are elderly patients aged 60 years or above who have been diagnosed with at least one chronic disease and can provide informed consent. Exclusion criteria The exclusion criteria encompass patients with severe cognitive impairment or mental illness issues that hinder interview participation. Sample size The researcher is anticipating enrolling 15 to 30 participants. The saturation point will determine the final number of participants, ensuring that the diversity and depth of understanding of participants are adequately captured. Interview guide The primary data collection instrument for this qualitative study will be an unstructured interview guide with two central questions, developed to explore the perceptions and experiences of elderly patients with chronic disease(s) regarding medication adherence. The interview guide will be developed based on an extensive literature review on medication adherence and age-related factors influencing adherence behaviours. The questions will focus on exploring the experiences and describing the perceptions of medication adherence among elderly patients. Probing will be used to better understand medication adherence among elderly patients. The researcher will ensure that they understand the participant by paraphrasing, encouraging the participant to elaborate more, and listening attentively. The interview guide will be translated into the local language, Sepedi, to ensure that all participants can understand the questions clearly and contribute actively during data collection, thereby minimising language barriers and promoting effective communication. Recruitment The researcher will recruit participants from the outpatient department in the selected hospital. The researcher will greet and conduct introductions to patients in the outpatient department. Explain the purpose of being there and explain the aim, objectives, and target population of the study. Then ask for patients who fit the criteria and are willing to participate. Volunteer participants will be asked to come to a secluded area. A brief session will be done to explain the research objectives, procedures, and ethical considerations. Participants will be asked to sign a consent form, and they will be told that they can withdraw from participating at any time without prejudice. Clarification of any questions or concerns raised by participants will be provided. During data collection, field notes will be documented through written notes. To capture non-verbal expressions, such as gestures, facial expressions, and body language, researchers will take detailed observational notes immediately following interactions. An audio recording will be used to capture an interview, and the recorded data will be transcribed verbatim by the participant. Ethical consideration Ethical approval for this study was obtained from Research Ethics Committee of the University of Venda (clearance number: FHS/25/PH/15/1509). Data analysis Thematic analysis will be used to interpret the qualitative data collected from the interviews. This method enables the identification, analysis, and reporting of themes within the data, providing a rich understanding of the participants’ experiences and perceptions. Qualitative data analysis software such as NVivo may be used to facilitate data coding and organisation, ensuring systematic analysis and traceability of themes. Procedures TRANSCRIPTION All interviews will be transcribed verbatim to ensure accuracy and facilitate detailed analysis. FAMILIRAZATION The researcher will thoroughly read and re-read the transcripts to immerse themselves in the data. CODING Initial codes will be generated systematically across the dataset, focusing on meaningful segments related to medication adherence. THEME DEVELOPMENT Similar codes will be collected into tentative themes that capture significant aspects of participants’ experiences. REVIEWING THEMES Themes will be reviewed and refined to ensure they accurately reflect the data and are distinct. DEFINING AND NAMING THEMES Clear definitions will be developed for each theme, and illustrative quotes will be selected to exemplify key findings. REPORTING The final themes will be interconnected to provide a comprehensive narrative on medication adherence among the elderly with chronic diseases. Dissemination The researcher will prepare a comprehensive research report to be submitted to a peer-reviewed journal, focusing on public health, the organisation of community meetings, or collaboration with local health communities to communicate findings. The researcher will conduct a presentation session or workshop for healthcare providers at FH Odendaal Hospital and local clinics to share the findings. The researcher will also prepare a policymakers’ brief summarising key findings and recommendations. Discussion Self-reported Medication nonadherence appears to be common in older adults with multimorbidity and polypharmacy. Depression, necessity and concerns should be considered when assessing medication non-adherence in practice ( Felix & Henriques, 2021 ). ( Horvat et al., 2024 ) indicated the barriers of medication adherence among the elderly in three categories, which are medication-related barriers where the elderly face several challenges, such as medication instructions, forgetting to renew medication supplies, taking multiple medications, changes in medication regimens, managing the timing and dosage of various drugs, The other category is patient-related barriers, wherein the elderly experience physical difficulties, decline in general fitness and cognitive abilities, health literacy, and common challenges such as vision, hearing, and understanding, The third barrier is related to the healthcare systems or personnel, where the elderly face challenges such as poor communication from healthcare providers. ( Kvarnstrom et al., 2021 ) also highlighted the barriers to medication adherence and classified them into patient-specific barriers, medication-specific barriers, illness-specific barriers, health and system-specific barriers, social and culture-specific barriers, logical and financial barriers. ( Maffoni et al., 2020 ) Identified barriers such as patients’ beliefs and concerns about treatment, patients’ beliefs about polypharmacy and prioritisation, patients’ experience and capabilities, prescriber-patient relationship, health literacy, treatment characteristics, and complexity. Study status This study is currently an ongoing process of collecting data. Permission to conduct research from the Limpopo Department of Health, Waterberg district, and the selected hospital has been obtained. Data and software availability Data supporting this study will be made available upon request after the research is completed, ensuring adherence to ethical standards. Data will be available from the corresponding author [email protected] on reasonable request. Access will be granted to researchers who provide clear research purpose and methodology, agree to comply with the University of Venda’s data sharing policies and ethical approval. Underlying data No data is associated with this article. Acknowledgements I would like to express my sincere gratitude to my supervisor, Dr. Mudau AG, and co-supervisor, Prof Lebese TR, as well as to the elderly participants who contributed to this research, and to the healthcare providers at the selected hospital. References AbdElwhab DY, Eldin AS, Saleh M, et al. : Nursing intervention program to improve adherence of elderly patients with chronic diseases toward their medication. Journal of health care research. 2025; 2 (1): 1–20. Publisher Full Text Felix IB, Henriques A: Medication adherence and related determinants in older people with multimorbidity: A cross-sectional study. Nurs. Forum. 2021; 56 (4): 834–843. Publisher Full Text Gumede SB, et al. : Barriers and Facilitators to Medication Adherence Among Vulnerable Elderly: A Focus Group Study. National Library of Medicine. 2024; 27 (6): 5. Horvat M, Erzen I, Vrbnjak D: Barriers and facilitators to medication adherence among the vulnerable elderly: A focus group study. healthcare. 2024; 12 (1723). Publisher Full Text Hung J, Hx H, Zheng Z, et al. : Medication adherence among the older adults: challenges and recommendations. Hong Kong Med. J. 2020; 26 (26(6)): 476–478. Publisher Full Text Kvarnstrom K, Westerholm A, Lira H, et al. : Factors contributing to medication adherence in patients with a chronic condition: A scoping review of Qualitative Research. Pharmaceutics. 2021; 13 (100): 6. Publisher Full Text Maffoni M, Traversoni S, Costa E, et al. : Medication adherence in older adults with chronic multimorbidity: A systematic review of qualitative studies on patients’ experiences. European generic medicine. 2020; 2 (00313): 4–6. Nguyen A, et al. : Medherent: Improve medication adherence in older adults with contextually sensitive alerts through an application that adheres to you. Science direct. 2024; 2 (1): 1–7. Publisher Full Text Service, S. P: Defining and understanding medication adherence. Adherence, Primary care, Training and development. 2023 20 December; p. 2. Sibanda M, Mayer JC, Mahlaba KJ, et al. : Promoting healthy ageing in South Africa through vaccination of the elderly. Frontiers. 2021; 9 (635266): 2. Publisher Full Text SA STATS: SA‘s elderly population is increasing steadily. Statistics South Africa; 2023. [Accessed 15 August 2025]. Reference Source Varghese D, Ishida C, Patel P, et al. : Polypharmacy. Stat Pearls. National Library of Medicine; 2024. Reference Source World Health Organization: Non-communicable diseases.2025. [Accessed 28 September 2025]. Reference Source Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 09 Jan 2026 ADD YOUR COMMENT Comment Author details Author details 1 Department of Public Health, University of Venda, Thohoyandou, Limpopo, South Africa T Mavhungu Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Writing – Original Draft Preparation, Writing – Review & Editing AG Mudau Roles: Data Curation, Formal Analysis, Funding Acquisition, Project Administration, Resources, Software, Supervision, Validation, Writing – Review & Editing TR Lebese Roles: Project Administration, Resources, Software, Supervision, Validation Competing interests There may be a potential conflict of interest, as the researcher may have previously provided nursing care to the participants. The study has been designed to mitigate any potential bias, ensuring that all findings and interpretations remain objective. Grant information The University of Venda Research and Publication Committee will pay the publication fee. They have not made any contribution in preparing this article The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 16 Apr 2026, 15:40 https://doi.org/10.12688/f1000research.175364.2 version 1 Published: 09 Jan 2026, 15:40 https://doi.org/10.12688/f1000research.175364.1 Copyright © 2026 Mavhungu T et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Mavhungu T, Mudau A and Lebese T. MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.12688/f1000research.175364.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 09 Jan 2026 Views 0 Cite How to cite this report: Alhindi Y. Reviewer Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r452694 ) The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-452694 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Apr 2026 Yosra Alhindi , Umm Al-Qura University, Makkah, Saudi Arabia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.193343.r452694 General Comments: This study protocol addresses an important and timely public health issue—medication adherence among elderly patients with chronic diseases. The topic is highly relevant given the increasing burden of multimorbidity and population ageing, particularly in low- and middle-income ... Continue reading READ ALL General Comments: This study protocol addresses an important and timely public health issue—medication adherence among elderly patients with chronic diseases. The topic is highly relevant given the increasing burden of multimorbidity and population ageing, particularly in low- and middle-income settings such as South Africa. The manuscript is generally well structured, and the use of a qualitative phenomenological design is appropriate for exploring lived experiences and perceptions of medication adherence. However, several aspects of the manuscript require clarification and strengthening to enhance methodological rigor, clarity, and scientific contribution. In its current form, the manuscript is potentially publishable after major revisions. Major Comments: 1. Title: The title clearly reflects the topic and population; however, it lacks methodological transparency. Since this is a study protocol employing a qualitative phenomenological design, the study type should be explicitly stated. Recommendation: Revise the title to include terms such as “A Qualitative Phenomenological Study Protocol.” 2. Abstract: The abstract provides a basic overview but lacks sufficient methodological detail and includes an overstatement of expected outcomes. - The study design is not explicitly mentioned. - The methods section is too brief. - The statement implying improvement in adherence rates is inappropriate for an observational qualitative study. Recommendation: - Clearly state the study design. - Include population, sample size, and data collection methods. - Rephrase outcomes to reflect exploration rather than impact. 3. Introduction: The introduction provides relevant background but requires refinement: - Some sections are repetitive. - The discussion of noncommunicable diseases is overly broad. - The research gap is not clearly articulated. Recommendation: - Reduce redundancy. - Focus specifically on medication adherence in elderly populations. - Clearly define the knowledge gap. 4. Objectives: The objectives are appropriate but somewhat generic. Recommendation: - Align objectives with phenomenological inquiry. - Include exploration of barriers and facilitators. 5. Methods: a. Study Design: Clarify whether the phenomenological approach is descriptive or interpretive and justify its use. b. Sampling Strategy: Specify the sampling method (e.g., purposive sampling) and explain participant selection. c. Inclusion Criteria: Include a requirement that participants have been on medication for a minimum duration (e.g., 3 months). d. Data Collection: Provide more detail on interview domains and whether the interview guide will be pilot-tested. e. Data Analysis: Specify the analytical framework (e.g., Braun & Clarke thematic analysis) and describe how rigor will be ensured. f. Ethical Considerations: Clarify how confidentiality, anonymization, and data storage will be managed. 6. Discussion: The discussion section contains repetition and includes findings from previous studies rather than focusing on the expected contribution of the protocol. Recommendation: - Focus on anticipated contributions. - Avoid redundancy with the introduction. Conclusion: The manuscript addresses a relevant topic with an appropriate qualitative design. However, significant revisions are required to improve clarity, methodological transparency, and overall quality before it can be considered for indexing. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: pharmacogy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Alhindi Y. Reviewer Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r452694 ) The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-452694 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Yulianti T. Reviewer Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r461351 ) The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-461351 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 12 Mar 2026 Tri Yulianti , Universitas Muhammadiyah Surakarta, Surakarta, Central Java, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.193343.r461351 The research to be conducted is very interesting regarding medication adherence among elderly people in the Waterberg region. However, several things need to be considered to improve the clarity of the research to be conducted. In ... Continue reading READ ALL The research to be conducted is very interesting regarding medication adherence among elderly people in the Waterberg region. However, several things need to be considered to improve the clarity of the research to be conducted. In the title section, to differentiate this article from published articles from research results, specific research methods can be included, such as protocols for qualitative or phenomenological research. Abstract: The last sentence in the introduction states that the study's findings can improve adherence rates, which seems inappropriate given that it is an observational study. The contribution that can be made from the results of this study can be conveyed; e.g., health workers can tailor services to the problems faced by elderly patients or develop interventions to improve medication adherence. The objectives in the abstract can be adjusted to align with the manuscript, not only to explore medication adherence in the elderly but also to examine the experiences and perceptions of medication adherence among elderly patients. In the methods section, the research design to be used can be explained. Information about the population to be studied, sample size, inclusion criteria, and data collection methods can be added to improve clarity for readers. Article: In the introduction section, the first and fifth paragraphs repeat information on existing research on medication adherence in Africa. Such repetition of information should be avoided. It would be better to present the results of previous research and its limitations, as well as information that has not yet been obtained regarding medication adherence among older adults in Africa, thereby highlighting the importance of this research. Then, the fourth and fifth paragraphs contain information that is more relevant to the general population. Since this is an article for geriatric patients, it could be made more specific to their conditions. In the methods section, for inclusion criteria, note that this study focuses on medication adherence; therefore, patients must have been regularly using the medication for at least 3 months to ensure they are indeed those who use it. Also, for the types of chronic diseases studied, the diseases can be specified more precisely. For the sample size information, it is necessary to explain when the data can reach saturation. Please state whether sampling techniques were used in this study, e.g., purposive sampling. In the interview guide, it can be explained which domains or aspects will be studied with patients, e.g., medication knowledge, barriers and facilitators, patient beliefs, and medication-taking habits. It is necessary to explain who will conduct the interviews and whether they are competent to do the interviews, because the depth of the data collected depends on the interviewers. In the discussion section, the author discusses medication adherence in relation to various factors identified in previous studies, many of which are not entirely relevant. The author could have presented the expected results of the study and the future contributions to be made. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: pharmacy practice-based studies, clinical pharmacy, and medication management. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Yulianti T. Reviewer Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r461351 ) The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-461351 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Alfaqeeh M. Reviewer Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r461352 ) The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-461352 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Feb 2026 Mohammed Alfaqeeh , Universitas Padjadjaran, West Java, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.193343.r461352 Comments to Authors General Comments This study protocol addresses an important and timely public health issue, medication adherence among elderly patients with chronic diseases in the Waterberg District, Limpopo Province. The topic is relevant ... Continue reading READ ALL Comments to Authors General Comments This study protocol addresses an important and timely public health issue, medication adherence among elderly patients with chronic diseases in the Waterberg District, Limpopo Province. The topic is relevant given the growing burden of multimorbidity and population ageing in South Africa. The protocol is generally well structured, ethically approved, and proposes an appropriate qualitative phenomenological design; however, some areas require clarification to enhance methodological rigor and transparency. In particular, the authors should more clearly specify the phenomenological orientation, justify the sampling strategy, provide greater detail on the interview and translation procedures, and strengthen the description of thematic analysis and strategies to ensure trustworthiness. With moderate revision, this protocol has strong potential to contribute meaningful contextual insights into medication adherence among elderly patients in this setting. ---------------------------- Title The title clearly identifies the topic (medication adherence), target population (elderly patients), and geographic context (Waterberg District, Limpopo Province), which helps readers immediately understand the scope of the study. However, as this is a study protocol using a qualitative phenomenological approach , the title would benefit from explicitly indicating the study design. Including terms such as “a qualitative study protocol” or “a phenomenological study protocol” would improve methodological transparency and align with reporting standards for protocols, allowing readers and indexers to immediately distinguish this work from a completed empirical study. Additionally, the phrase “a selected hospital” is somewhat vague. If confidentiality is not required, consider specifying the type of facility (e.g., district hospital) to enhance contextual clarity. If anonymity must be maintained, a brief justification may be helpful within the manuscript. Suggested revision: Medication Adherence Among Elderly Patients Receiving Healthcare Services in Waterberg District, Limpopo Province: A Qualitative Phenomenological Study Protocol. ---------------------------- Abstract The abstract gives a clear overview of the topic and intended exploration of medication adherence among elderly patients. It should explicitly state the study design (qualitative phenomenological study/protocol) to distinguish it from a completed study. The methods description is too brief; consider adding: study population (elderly ≥60 years with chronic disease), study setting, anticipated sample size (15–30 participants), sampling approach and use of in-depth interviews. The phrase suggesting the study will “improve adherence rate” may overstate the scope; reword to emphasize understanding experiences, barriers, and facilitators rather than implying impact. ---------------------------- Introduction The introduction provides relevant background on medication adherence and the growing burden of chronic disease among the elderly globally and in South Africa. Demographic statistics are detailed; however, they are presented sequentially. Consider synthesizing them to highlight the key message (ageing population → increased chronic disease burden → adherence challenges). Some sections are overly broad (e.g., general discussion of noncommunicable diseases). These could be condensed to maintain a stronger focus on medication adherence in the elderly. The local context (Waterberg District) is introduced, but the rationale for selecting this specific setting should be strengthened (e.g., service delivery challenges, rural characteristics, or lack of prior qualitative evidence). The literature review lists studies but does not clearly identify the knowledge gap. Explicitly state what is not yet understood (e.g., lived experiences, contextual barriers, health-system influences). Consider ending the introduction with a clear transition linking the identified gap directly to the study aim. ---------------------------- Objectives The objectives are relevant to a qualitative inquiry and appropriately focus on exploring experiences and perceptions of medication adherence among elderly patients. The objectives could be more aligned with phenomenological research by emphasizing understanding the lived experience of medication adherence rather than using general terms. Consider adding a statement indicating the intention to identify barriers and facilitators influencing adherence, if this is part of the analytical focus described elsewhere in the protocol. ---------------------------- Methods Study Design The use of a qualitative phenomenological design is appropriate for exploring experiences and perceptions of medication adherence among elderly patients. However, the protocol does not specify which phenomenological approach is being followed (e.g., descriptive vs. interpretive). Clarifying the philosophical orientation would strengthen methodological rigor. Consider briefly explaining why phenomenology is the most suitable design for this research question, beyond stating that it allows in-depth understanding. It would also be helpful to indicate whether the study follows any qualitative reporting framework (e.g., COREQ or SRQR) to enhance transparency and credibility. Population and Eligibility Criteria The target population (elderly patients aged ≥60 years with at least one chronic disease receiving healthcare services) is clearly defined. Inclusion and exclusion criteria are appropriate; excluding individuals with severe cognitive impairment is reasonable for interview-based research. However, the sampling strategy is not specified. Clarify whether participants will be selected using purposive, convenience, or maximum variation sampling, and justify the choice. Consider explaining how diversity will be ensured (e.g., gender, type of chronic disease, duration of treatment). Since recruitment occurs at the outpatient department, discuss whether this may exclude more frail or home-bound elderly individuals and how this might influence transferability. Sample Size The proposed sample size of 15–30 participants, guided by data saturation, is generally appropriate for a phenomenological study. However, the concept of data saturation should be briefly defined, including how the researcher will determine that saturation has been reached (e.g., no new themes emerging across consecutive interviews). Clarify whether recruitment will stop strictly at saturation or within the predefined range (15–30 participants). Consider justifying the proposed range by referencing qualitative methodological literature to strengthen rigor. Interview Guide and Data Collection The use of unstructured interviews with probing is appropriate for a phenomenological study exploring lived experiences. However, stating that the guide includes only “two central questions” is vague. Consider briefly outlining the nature or domains of these questions (e.g., daily medication routines, challenges, support systems). Clarify whether the interview guide will be pilot-tested and refined before full data collection. The translation of the guide into Sepedi is appropriate; however, explain whether back-translation or validation will be performed to ensure conceptual equivalence. Field notes are mentioned; specify how they will be integrated into the analysis. Since the researcher may have previously provided care to participants, consider explaining how interviewer bias and power dynamics will be minimized. Data Analysis Comment to Authors The use of thematic analysis is appropriate for identifying patterns in participants’ experiences and perceptions. The protocol outlines general steps (transcription, familiarisation, coding, theme development), which is helpful; however, it should reference a specific analytical framework (e.g., Braun & Clarke’s approach) to enhance methodological transparency. Clarify who will perform the coding and whether more than one researcher will be involved to improve dependability. Describe how disagreements in coding or theme interpretation will be resolved. Consider explaining strategies to ensure trustworthiness, such as credibility (member checking), dependability (audit trail), confirmability (reflexive notes), and transferability (thick description). Ethical Considerations Comment to Authors Ethical approval from the University of Venda Research Ethics Committee is clearly stated, which strengthens the protocol’s ethical compliance. The protocol mentions informed consent, confidentiality, and voluntary participation; however, consider briefly explaining: how confidentiality will be maintained (e.g., anonymisation, secure data storage) how audio recordings and transcripts will be protected how participants will be identified using codes rather than names It would also be useful to mention whether participants may withdraw their data after the interview if they choose to do so. ---------------------------- Discussion Much of the content repeats barriers already cited in the introduction. Consider condensing this section to avoid redundancy. Since this is a protocol, the discussion should focus more on: the anticipated contribution of the study how it will address the identified knowledge gap and how findings may inform practice or policy in the local context Avoid presenting literature findings in a way that appears to pre-empt or predict your study results. If retained, this section could instead be reframed as “Expected Contribution” or integrated into the introduction. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Public health researcher trained in epidemiology and health economics, focusing on communicable and non-communicable diseases, vaccine policy, ageing populations, and evidence-based health decision-making. Experienced in systematic evidence synthesis, pharmacoeconomic modelling, and translating research findings into policy recommendations. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Alfaqeeh M. Reviewer Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r461352 ) The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-461352 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 09 Jan 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 16 Apr 26 read read Version 1 09 Jan 26 read read read Mohammed Alfaqeeh , Universitas Padjadjaran, West Java, Indonesia Tri Yulianti , Universitas Muhammadiyah Surakarta, Surakarta, Indonesia Yosra Alhindi , Umm Al-Qura University, Makkah, Saudi Arabia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Yulianti T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Apr 2026 | for Version 2 Tri Yulianti , Universitas Muhammadiyah Surakarta, Surakarta, Central Java, Indonesia 0 Views copyright © 2026 Yulianti T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The author has done an excellent job of revising the manuscript, making the research methods much clearer. Competing Interests No competing interests were disclosed. Reviewer Expertise pharmacy practice-based studies, clinical pharmacy, and medication management. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Yulianti T. Peer Review Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.198298.r475699) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-40/v2#referee-response-475699 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Alfaqeeh M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Apr 2026 | for Version 2 Mohammed Alfaqeeh , Universitas Padjadjaran, West Java, Indonesia 0 Views copyright © 2026 Alfaqeeh M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review the revised manuscript. The authors have addressed the previous comments well and have significantly improved the clarity and methodological rigor of the study protocol. The revised version is clearer, more comprehensive, and suitable for indexing in its current form. No further comments . Competing Interests No competing interests were disclosed. Reviewer Expertise Public health researcher trained in epidemiology and health economics, focusing on communicable and non-communicable diseases, vaccine policy, ageing populations, and evidence-based health decision-making. Experienced in systematic evidence synthesis, pharmacoeconomic modelling, and translating research findings into policy recommendations. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Alfaqeeh M. Peer Review Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.198298.r475700) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-40/v2#referee-response-475700 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Alhindi Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Apr 2026 | for Version 1 Yosra Alhindi , Umm Al-Qura University, Makkah, Saudi Arabia 0 Views copyright © 2026 Alhindi Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions General Comments: This study protocol addresses an important and timely public health issue—medication adherence among elderly patients with chronic diseases. The topic is highly relevant given the increasing burden of multimorbidity and population ageing, particularly in low- and middle-income settings such as South Africa. The manuscript is generally well structured, and the use of a qualitative phenomenological design is appropriate for exploring lived experiences and perceptions of medication adherence. However, several aspects of the manuscript require clarification and strengthening to enhance methodological rigor, clarity, and scientific contribution. In its current form, the manuscript is potentially publishable after major revisions. Major Comments: 1. Title: The title clearly reflects the topic and population; however, it lacks methodological transparency. Since this is a study protocol employing a qualitative phenomenological design, the study type should be explicitly stated. Recommendation: Revise the title to include terms such as “A Qualitative Phenomenological Study Protocol.” 2. Abstract: The abstract provides a basic overview but lacks sufficient methodological detail and includes an overstatement of expected outcomes. - The study design is not explicitly mentioned. - The methods section is too brief. - The statement implying improvement in adherence rates is inappropriate for an observational qualitative study. Recommendation: - Clearly state the study design. - Include population, sample size, and data collection methods. - Rephrase outcomes to reflect exploration rather than impact. 3. Introduction: The introduction provides relevant background but requires refinement: - Some sections are repetitive. - The discussion of noncommunicable diseases is overly broad. - The research gap is not clearly articulated. Recommendation: - Reduce redundancy. - Focus specifically on medication adherence in elderly populations. - Clearly define the knowledge gap. 4. Objectives: The objectives are appropriate but somewhat generic. Recommendation: - Align objectives with phenomenological inquiry. - Include exploration of barriers and facilitators. 5. Methods: a. Study Design: Clarify whether the phenomenological approach is descriptive or interpretive and justify its use. b. Sampling Strategy: Specify the sampling method (e.g., purposive sampling) and explain participant selection. c. Inclusion Criteria: Include a requirement that participants have been on medication for a minimum duration (e.g., 3 months). d. Data Collection: Provide more detail on interview domains and whether the interview guide will be pilot-tested. e. Data Analysis: Specify the analytical framework (e.g., Braun & Clarke thematic analysis) and describe how rigor will be ensured. f. Ethical Considerations: Clarify how confidentiality, anonymization, and data storage will be managed. 6. Discussion: The discussion section contains repetition and includes findings from previous studies rather than focusing on the expected contribution of the protocol. Recommendation: - Focus on anticipated contributions. - Avoid redundancy with the introduction. Conclusion: The manuscript addresses a relevant topic with an appropriate qualitative design. However, significant revisions are required to improve clarity, methodological transparency, and overall quality before it can be considered for indexing. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise pharmacogy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Alhindi Y. Peer Review Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r452694) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-452694 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Yulianti T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 12 Mar 2026 | for Version 1 Tri Yulianti , Universitas Muhammadiyah Surakarta, Surakarta, Central Java, Indonesia 0 Views copyright © 2026 Yulianti T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The research to be conducted is very interesting regarding medication adherence among elderly people in the Waterberg region. However, several things need to be considered to improve the clarity of the research to be conducted. In the title section, to differentiate this article from published articles from research results, specific research methods can be included, such as protocols for qualitative or phenomenological research. Abstract: The last sentence in the introduction states that the study's findings can improve adherence rates, which seems inappropriate given that it is an observational study. The contribution that can be made from the results of this study can be conveyed; e.g., health workers can tailor services to the problems faced by elderly patients or develop interventions to improve medication adherence. The objectives in the abstract can be adjusted to align with the manuscript, not only to explore medication adherence in the elderly but also to examine the experiences and perceptions of medication adherence among elderly patients. In the methods section, the research design to be used can be explained. Information about the population to be studied, sample size, inclusion criteria, and data collection methods can be added to improve clarity for readers. Article: In the introduction section, the first and fifth paragraphs repeat information on existing research on medication adherence in Africa. Such repetition of information should be avoided. It would be better to present the results of previous research and its limitations, as well as information that has not yet been obtained regarding medication adherence among older adults in Africa, thereby highlighting the importance of this research. Then, the fourth and fifth paragraphs contain information that is more relevant to the general population. Since this is an article for geriatric patients, it could be made more specific to their conditions. In the methods section, for inclusion criteria, note that this study focuses on medication adherence; therefore, patients must have been regularly using the medication for at least 3 months to ensure they are indeed those who use it. Also, for the types of chronic diseases studied, the diseases can be specified more precisely. For the sample size information, it is necessary to explain when the data can reach saturation. Please state whether sampling techniques were used in this study, e.g., purposive sampling. In the interview guide, it can be explained which domains or aspects will be studied with patients, e.g., medication knowledge, barriers and facilitators, patient beliefs, and medication-taking habits. It is necessary to explain who will conduct the interviews and whether they are competent to do the interviews, because the depth of the data collected depends on the interviewers. In the discussion section, the author discusses medication adherence in relation to various factors identified in previous studies, many of which are not entirely relevant. The author could have presented the expected results of the study and the future contributions to be made. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise pharmacy practice-based studies, clinical pharmacy, and medication management. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Yulianti T. Peer Review Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r461351) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-461351 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Alfaqeeh M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Feb 2026 | for Version 1 Mohammed Alfaqeeh , Universitas Padjadjaran, West Java, Indonesia 0 Views copyright © 2026 Alfaqeeh M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Comments to Authors General Comments This study protocol addresses an important and timely public health issue, medication adherence among elderly patients with chronic diseases in the Waterberg District, Limpopo Province. The topic is relevant given the growing burden of multimorbidity and population ageing in South Africa. The protocol is generally well structured, ethically approved, and proposes an appropriate qualitative phenomenological design; however, some areas require clarification to enhance methodological rigor and transparency. In particular, the authors should more clearly specify the phenomenological orientation, justify the sampling strategy, provide greater detail on the interview and translation procedures, and strengthen the description of thematic analysis and strategies to ensure trustworthiness. With moderate revision, this protocol has strong potential to contribute meaningful contextual insights into medication adherence among elderly patients in this setting. ---------------------------- Title The title clearly identifies the topic (medication adherence), target population (elderly patients), and geographic context (Waterberg District, Limpopo Province), which helps readers immediately understand the scope of the study. However, as this is a study protocol using a qualitative phenomenological approach , the title would benefit from explicitly indicating the study design. Including terms such as “a qualitative study protocol” or “a phenomenological study protocol” would improve methodological transparency and align with reporting standards for protocols, allowing readers and indexers to immediately distinguish this work from a completed empirical study. Additionally, the phrase “a selected hospital” is somewhat vague. If confidentiality is not required, consider specifying the type of facility (e.g., district hospital) to enhance contextual clarity. If anonymity must be maintained, a brief justification may be helpful within the manuscript. Suggested revision: Medication Adherence Among Elderly Patients Receiving Healthcare Services in Waterberg District, Limpopo Province: A Qualitative Phenomenological Study Protocol. ---------------------------- Abstract The abstract gives a clear overview of the topic and intended exploration of medication adherence among elderly patients. It should explicitly state the study design (qualitative phenomenological study/protocol) to distinguish it from a completed study. The methods description is too brief; consider adding: study population (elderly ≥60 years with chronic disease), study setting, anticipated sample size (15–30 participants), sampling approach and use of in-depth interviews. The phrase suggesting the study will “improve adherence rate” may overstate the scope; reword to emphasize understanding experiences, barriers, and facilitators rather than implying impact. ---------------------------- Introduction The introduction provides relevant background on medication adherence and the growing burden of chronic disease among the elderly globally and in South Africa. Demographic statistics are detailed; however, they are presented sequentially. Consider synthesizing them to highlight the key message (ageing population → increased chronic disease burden → adherence challenges). Some sections are overly broad (e.g., general discussion of noncommunicable diseases). These could be condensed to maintain a stronger focus on medication adherence in the elderly. The local context (Waterberg District) is introduced, but the rationale for selecting this specific setting should be strengthened (e.g., service delivery challenges, rural characteristics, or lack of prior qualitative evidence). The literature review lists studies but does not clearly identify the knowledge gap. Explicitly state what is not yet understood (e.g., lived experiences, contextual barriers, health-system influences). Consider ending the introduction with a clear transition linking the identified gap directly to the study aim. ---------------------------- Objectives The objectives are relevant to a qualitative inquiry and appropriately focus on exploring experiences and perceptions of medication adherence among elderly patients. The objectives could be more aligned with phenomenological research by emphasizing understanding the lived experience of medication adherence rather than using general terms. Consider adding a statement indicating the intention to identify barriers and facilitators influencing adherence, if this is part of the analytical focus described elsewhere in the protocol. ---------------------------- Methods Study Design The use of a qualitative phenomenological design is appropriate for exploring experiences and perceptions of medication adherence among elderly patients. However, the protocol does not specify which phenomenological approach is being followed (e.g., descriptive vs. interpretive). Clarifying the philosophical orientation would strengthen methodological rigor. Consider briefly explaining why phenomenology is the most suitable design for this research question, beyond stating that it allows in-depth understanding. It would also be helpful to indicate whether the study follows any qualitative reporting framework (e.g., COREQ or SRQR) to enhance transparency and credibility. Population and Eligibility Criteria The target population (elderly patients aged ≥60 years with at least one chronic disease receiving healthcare services) is clearly defined. Inclusion and exclusion criteria are appropriate; excluding individuals with severe cognitive impairment is reasonable for interview-based research. However, the sampling strategy is not specified. Clarify whether participants will be selected using purposive, convenience, or maximum variation sampling, and justify the choice. Consider explaining how diversity will be ensured (e.g., gender, type of chronic disease, duration of treatment). Since recruitment occurs at the outpatient department, discuss whether this may exclude more frail or home-bound elderly individuals and how this might influence transferability. Sample Size The proposed sample size of 15–30 participants, guided by data saturation, is generally appropriate for a phenomenological study. However, the concept of data saturation should be briefly defined, including how the researcher will determine that saturation has been reached (e.g., no new themes emerging across consecutive interviews). Clarify whether recruitment will stop strictly at saturation or within the predefined range (15–30 participants). Consider justifying the proposed range by referencing qualitative methodological literature to strengthen rigor. Interview Guide and Data Collection The use of unstructured interviews with probing is appropriate for a phenomenological study exploring lived experiences. However, stating that the guide includes only “two central questions” is vague. Consider briefly outlining the nature or domains of these questions (e.g., daily medication routines, challenges, support systems). Clarify whether the interview guide will be pilot-tested and refined before full data collection. The translation of the guide into Sepedi is appropriate; however, explain whether back-translation or validation will be performed to ensure conceptual equivalence. Field notes are mentioned; specify how they will be integrated into the analysis. Since the researcher may have previously provided care to participants, consider explaining how interviewer bias and power dynamics will be minimized. Data Analysis Comment to Authors The use of thematic analysis is appropriate for identifying patterns in participants’ experiences and perceptions. The protocol outlines general steps (transcription, familiarisation, coding, theme development), which is helpful; however, it should reference a specific analytical framework (e.g., Braun & Clarke’s approach) to enhance methodological transparency. Clarify who will perform the coding and whether more than one researcher will be involved to improve dependability. Describe how disagreements in coding or theme interpretation will be resolved. Consider explaining strategies to ensure trustworthiness, such as credibility (member checking), dependability (audit trail), confirmability (reflexive notes), and transferability (thick description). Ethical Considerations Comment to Authors Ethical approval from the University of Venda Research Ethics Committee is clearly stated, which strengthens the protocol’s ethical compliance. The protocol mentions informed consent, confidentiality, and voluntary participation; however, consider briefly explaining: how confidentiality will be maintained (e.g., anonymisation, secure data storage) how audio recordings and transcripts will be protected how participants will be identified using codes rather than names It would also be useful to mention whether participants may withdraw their data after the interview if they choose to do so. ---------------------------- Discussion Much of the content repeats barriers already cited in the introduction. Consider condensing this section to avoid redundancy. Since this is a protocol, the discussion should focus more on: the anticipated contribution of the study how it will address the identified knowledge gap and how findings may inform practice or policy in the local context Avoid presenting literature findings in a way that appears to pre-empt or predict your study results. If retained, this section could instead be reframed as “Expected Contribution” or integrated into the introduction. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Public health researcher trained in epidemiology and health economics, focusing on communicable and non-communicable diseases, vaccine policy, ageing populations, and evidence-based health decision-making. Experienced in systematic evidence synthesis, pharmacoeconomic modelling, and translating research findings into policy recommendations. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Alfaqeeh M. Peer Review Report For: MEDICATION ADHERENCE AMONG ELDERLY PATIENTS RECEIVING HEALTH CARE SERVICES IN A SELECTED HOSPITAL OF WATERBERG DISTRICT, LIMPOPO PROVINCE. [version 1; peer review: 3 approved with reservations] . F1000Research 2026, 15 :40 ( https://doi.org/10.5256/f1000research.193343.r461352) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-40/v1#referee-response-461352 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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