Aims The aim of this study was to identify perceived barriers to medication adherence in early adolescents within a school environment. By way of background, 20% of adolescents have a chronic medical condition and the complexity and cost of their treatment is rising.1 2 Adolescents commonly demonstrate poor adherence to prescribed medication; medication adherence in this group is undermined by concerns about side effects and the potential for medication to have a detrimental impact on lifestyle.3 4 Currently there is a paucity of evidence on the adolescent adherence and the management and administration of medicine within a school environment.2

Methods Following ethical approval from the University of Strathclyde and North and South Lanarkshire Education authority, 23 school pupils aged between 12 and 14 years participated in five focus groups in November 2010. Respondents were purposively sampled with respect to gender, age, and socioeconomic characteristics of the school. A semi-structured topic guide was developed on the basis of published literature. Focus groups were digitally recorded and transcribed verbatim. Transcripts were independently coded by the researchers using an inductive approach to thematic analysis.

Results Barriers to medication adherence could be linked to concerns about, ‘image’, the perceptions of others and bullying. Participants, who did not routinely take medication, hypothesised that do so in school would result in stigma and persecution. Participants provided examples to support this, for example diabetic children had been labelled as problem drug users by peers. Consequently respondents reported that avoiding attention of this type was more important to them than adhering to medication. Participants, who did take medication routinely, reported non-adherence due to fear of being bullied and to prevent the effects medication had on their appearance. Other participants reported hiding medication from peers.

Conclusions Prescribers and educators need to consider how to foster medication adherence in schools. Ideally medication devices and dosing regimens should allow students to administer medication inconspicuously. School environments and processes should also permit discreet medication administration.