Adherence Barriers to Treatment of Patients with Cardiovascular Diseases: A Qualitative Study

Mozhgan Kalantarzadeh, Hojatollah Yousefi, Mousa Alavi, Jahangir Maghsoudi

Abstract


Background: Adherence to treatment is highly important in the management of Cardiovascular Diseases (CVD). Barriers to effective and long‑term adherence to treatment by the patient make achieving care and treatment goals challenging. The aim of this study was to identify the adherence barriers to the treatment plan in patients with CVD.

Materials and Methods: A qualitative content analysis study was conducted to explore the experience of patients, family caregivers, and healthcare professionals (n = 35) using qualitative content analysis. The study was carried out between 2019 and 2020 in Isfahan, Iran. Purposive sampling was performed. Data collection was conducted through in‑depth interviews and semi‑structured until data saturation. Graneheim and Landman content analysis was performed simultaneously with data collection.

Results: After data analysis, 3 themes and 6 categories were identified and named. Themes (and categories) include “Patients unreadiness to change” (misunderstanding of conditions and consequences and deterrence cultural practices and beliefs); “gap in healthcare services” (lack of adequate support for patients and discordance between healthcare professionals); and “limited access to healthcare services” (limited physical access and financial burden).

Conclusions: The findings of the present study can provide a framework for healthcare professionals to employ preventive strategies, reduce disease complications, decrease unhealthy behaviours, and increase prolonged adherence to treatment recommendations in patients with CVD.



Keywords


Barriers, cardiovascular diseases, patient adherence, qualitative research

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References


Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics—2021 update: A report from the American heart association. Circulation 2021;143:e254 743.

Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age sex specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: A systematic analysis for the global burden of disease study 2017. Lancet 2018;392:1736 88.

Alwan A. Global Status Report on Noncommunicable Diseases 2010. World Health Organization; 2011.

Sarrafzadegan N, Mohammmadifard N. Cardiovascular disease in Iran in the last 40 years: Prevalence, mortality, morbidity, challenges and strategies for cardiovascular prevention. Arch Iran Med 2019;22:204 10.

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American college of cardiology/American heart association task force on clinical practice guidelines. Circulation 2019;140:e596 646.

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The sixth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European association for cardiovascular prevention & rehabilitation (EACPR). Eur Heart J 2016;37:2315 81.

Sabaté E, Sabaté E. World Health Organization. ( 2003) . Adherence to long-term therapies : evidence for action / [ edited

by Eduardo Sabaté] . World Health Organization. https://apps. who.int/iris/handle/10665/42682.

Kolandaivelu K, Leiden BB, O’Gara PT, Bhatt DL. Non adherence to cardiovascular medications. Eur Heart J 2014;35:3267 76.

Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, et al. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European society of cardiology ESC EORP EUROASPIRE V registry. Eur J Prev Cardiol 2019;26:824 35.

Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, et al. Adherence to cardiovascular therapy: A meta analysis of prevalence and clinical consequences. Eur Heart J 2013;34:2940 8.

Paryad E, Kazemnezhad Leili E, Booraki S, Sadeghi Meibodi A, Nassiri Sheikhani N. Study status of care adherence and its related factors in patients undergoing. J Holist Nurs Midwifery 2015;25:34 45.

Hare DL, Toukhsati SR, Johansson P, Jaarsma T. Depression and cardiovascular disease: A clinical review. Eur Heart J 2014;35:1365 72.

Zhang Y, Chen Y, Ma L. Depression and cardiovascular disease in elderly: Current understanding. J Clin Neurosci 2018;47:1 5. doi: 10.1016/j.jocn. 2017.09.022.

Hennein R, Hwang SJ, Au R, Levy D, Muntner P, Fox CS, et al. Barriers to medication adherence and links to cardiovascular disease risk factor control: The Framingham Heart Study. Intern Med J 2018;48:414 21.

Forsyth P, Richardson J, Lowrie R. Patient reported barriers to medication adherence in heart failure in Scotland. Int J Pharm Pract 2019;27:443 50.

Ferguson C, Inglis SC, Newton PJ. Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: Patient and provider perspectives. J Clin Nurs 2017;26:4325 34.

Kalantarzadeh M, Alavi M, Yousefi H, Maghsoudi J, Hungerford C, Cleary M. Coping with chronic cardiovascular disease in Iran: A qualitative study. Nurs Health Sci 2021;23:843 51.

Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105 12.

Sandelowski MJ. Justifying Qualitative Research, Research in Nursing & Health 2008;31:193-5.

Speziale HS, Streubert HJ, Carpenter DR. Qualitative Research in Nursing: Advancing the Humanistic Imperative. Lippincott Williams & Wilkins; Philadelphia; 2011.

Marshall IJ, Wolfe CD, McKevitt C. Lay perspectives on hypertension and drug adherence: Systematic review of qualitative research. BMJ 2012;345:e3953. doi: 10.1136/bmj. e3953.

Rashidi A, Kaistha P, Whitehead L, Robinson S. Factors that influence adherence to treatment plans amongst people living with cardiovascular disease: A review of published qualitative research studies. Int J Nurs Stud 2020;110:103727. doi: 10.1016/j.ijnurstu. 2020.103727.

Junehag L, Asplund K, Svedlund M. Perceptions of illness, lifestyle and support after an acute myocardial infarction. Scand J Caring Sci 2014;28:289 96.

Shamali M, Østergaard B, Konradsen H. Living with heart failure: Perspectives of ethnic minority families. Open Heart 2020;7:e001289. doi: 10.1136/openhrt 2020 001289.

Ashoorkhani M, Majdzadeh R, Gholami J, Eftekhar H, Bozorgi A. Understanding non adherence to treatment in hypertension: A qualitative study. Int J Community Based Nurs Midwifery 2018;6:314 23.

Holt EW, Rung AL, Leon KA, Firestein C, Krousel Wood MA. Medication adherence in older adults: A qualitative study. Educ Gerontol 2014;40:198 211.

Kumar K, Greenfield S, Raza K, Gill P, Stack R. Understanding adherence related beliefs about medicine amongst patients of South Asian origin with diabetes and cardiovascular disease patients: A qualitative synthesis. BMC Endocr Disord 2016;16:24.

Kressin NR, Elwy AR, Glickman M, Orner MB, Fix GM, Borzecki AM, et al. Beyond medication adherence: The role of patients’ beliefs and life context in blood pressure control. Ethn Dis 2019;29:567 76.

Najimi A, Mostafavi F, Sharifirad G, Golshiri P. Barriers to medication adherence in patients with hypertension: A qualitative study. J Educ Health Promot 2018;7:24. doi: 10.4103/jehp. jehp_65_16.

Gallacher K, May CR, Montori VM, Mair FS. Understanding patients’ experiences of treatment burden in chronic heart failure using normalization process theory. Ann Fam Med 2011;9:235 43.

Meiqari L, Nguyen TP, Essink D, Zweekhorst M, Wright P, Scheele F. Access to hypertension care and services in primary health care settings in Vietnam: A systematic narrative review of existing literature. Global Health Action 2019;12:1610253. doi: 10.1080/16549716.2019.1610253.

Cutrona SL, Choudhry NK, Stedman M, Servi A, Liberman JN, Brennan T, et al. Physician effectiveness in interventions to improve cardiovascular medication adherence: A systematic review. J Gen Intern Med 2010;25:1090 6.

Kvarnström K, Airaksinen M, Liira H. Barriers and facilitators to medication adherence: A qualitative study with general practitioners. BMJ Open 2018;8:e015332.


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