Pillbox and patient-oriented manual interventions to improve medication knowledge, attitudes, and practices among older adults with multimorbidity in Shanghai, China

Multimorbidity and polypharmacy are major challenges for older adults with multimorbidity (OAM) in China, yet demand-side interventions remain limited. This study aimed to assess the effectiveness of pillbox (PB) and patient-oriented manual (POM) interventions in improving medication knowledge (MK), attitudes (MA), and practices (MP) in Shanghai, China. A quasi-experimental pre–post study with a control group was conducted in 11 community health service centers in Jinshan District, Shanghai, between August 2023 and February 2024. Eligible older adults were recruited by family doctor teams, which implemented the intervention primarily using two tools: the PB and the POM. Outcomes included MK, MA, and MP. Intervention effects and heterogeneity across participant characteristics were examined using propensity score matched difference-in-differences (PSM-DID) models. A total of 1,406 OAM participated. After the intervention, the proportion rated as “good” increased from 29.6% to 57.1% for MK, 24.5% to 48.8% for MA, and 47.1% to 73.9% for MP. PSM-DID analyses showed significant intervention effects for MK (OR = 3.14), MA (OR = 2.38), and MP (OR = 3.01). Heterogeneity analyses showed stronger effects on MK among participants covered by urban and rural resident insurance (P = 0.043). For MP, effects weakened with increasing age (P = 0.044) but strengthened with increasing medication burden, with the strongest effects observed at moderate levels of polypharmacy (P = 0.012). PB and POM interventions significantly improved MK, MA, and MP among OAM. Variation in intervention effects across participant characteristics underscored the need for tailored, patient-centered strategies integrated into routine family doctor services to promote rational medication use.