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We sought to define an occupational therapy intervention to promote medication management and to evaluate the acceptability and effectiveness of the intervention.Nineteen adults with chronic health conditions and poor medication adherence participated in a two-group, blinded, randomized study. They received either an occupational therapy or a standard care intervention. We used a qualitative method to measure participants' changes in medication management through an interview regarding participants' perceptions and behaviors.The occupational therapy intervention group reported greater improvements in medication management and implemented twice as many new adaptive strategies as the standard care group. Participants indicated that interventions related to advocacy, education, assistive technology, environmental modifications, self-monitoring, and good rapport were the active ingredients of the intervention.Occupational therapy is an acceptable intervention for medication management, and it can lead to self-perceived improvements and the adoption of new medication management behaviors. Further research is warranted.