Barriers to medication adherence in patients prescribed medicines for the prevention of cardiovascular disease: A conceptual framework to support intervention development

Abstract

ObjectivesTo identify barriers to medication adherence in patients prescribedmedicines for the prevention of cardiovascular disease and map these to theTheoretical Domains Framework (TDF), to produce a conceptual frameworkfor developing a questionnaire-based medication adherence tool.MethodsA scoping review of barriers to medication adherence in long-termconditions was conducted to generate an initial pool of barriers. After prelimi-nary mapping to the TDF, these barriers were presented to two focus groups ofpatients prescribed medicines for the prevention of cardiovascular disease(n=14) to stimulate discussion. The group discussions enabled the patients’interpretations of the adherence barriers to be determined, provided validityfrom the patient perspective and identified additional barriers unrepresented inthe scoping review.Key findingsThe preliminary pool of adherence barriers was identified from 47studies across a range of long-term conditions. The majority of TDF domainswere represented by these literature-identified barriers except ‘social/professionalrole and identity’ and ‘behavioural regulation’. Barrier mapping was largelyendorsed by focus group participants, who also contributed additional barriers,including those relating to not having a ‘system’ in place for managing theirmedicines and the negative emotions evoked by medicine taking.ConclusionThe TDF enabled full exploration of adherence barriers includingthose relating to emotions which have received limited attention in the litera-ture. This work has provided a conceptual framework for developing a ques-tionnaire to identify an individual’s adherence barriers which may then becoupled with appropriate behaviour change techniques to deliver a theory-based intervention tailored for individual need.