An Interpretative Phenomenological Analysis of the Experience of Taking Medication to Prevent a Further Heart Attack

Abstract

Background Following an acute myocardial infarction, patients are prescribed a regime of cardio-protective medication to prevent recurrent cardiovascular events and mortality. Adherence to medication is poor in this patient group, and not fully understood. Current interventions have made limited improvements but are based upon presumed principles. Aim To describe the phenomenon of medicine-taking for an individual taking medication for secondary prevention for an AMI. Method Interpretative Phenomenological Analysis was used to analyse transcripts of semi-structured interviews with participants. Themes were generated for each participant, then summarised across participants. Results Five key themes were produced; the participants needed to compare themselves to others, showed that knowledge of their medicines was important to them, discussed how the future was an unknown entity for them, had assimilated their medicines into their lives, and expressed how an upset to their routine reduced their ability to take medication. Conclusion Participants described complex factors and personal adaptations to taking their medication. This suggests that a patient-centred approach is appropriate for adherence work, and these themes could inform clinical practice to better support patients in their medicine adherence.

Barriers and facilitators to medication adherence in patients after PCI surgery: A mixed-methods systematic review

“…The nal evaluation of this system included 15 studies [26][27][28][29][30][31][32][33][34][35][36][37][38] , published between 2011 and 2021, conducted across various countries including the United States, Germany, the United Kingdom, China, South Korea, Pakistan, Poland, Qatar, Vietnam, and Norway, encompassing a total of 5619 participants.…”

“…This category encompasses psychological capabilities related to medication adherence in patients after PCI surgery [15] (knowledge, and psychological skills involved in necessary thought processes such as comprehension, reasoning, etc.). Barriers: Insu cient knowledge about medication: 4 studies [27,31,36,37] indicated that patients with insu cient knowledge of medication actions and side effects are at higher risk of poor adherence. Facilitators: Higher education level: Results from 3 studies [27,33,39] consistently showed a positive correlation between education level and adherence.…”

“…Higher health literacy: 2 studies [30,31] suggested that health literacy is a positive predictor of medication adherence in patients after PCI surgery. Incorporating medication behaviors into daily life: One qualitative study [37] suggested that incorporating medication behaviors into daily life is an effective medication management strategy.…”

“…Distance from home to hospital: A study [32] found that patients living less than 50km from the hospital had poorer adherence to anti-platelet therapy. Interference with daily life: One qualitative study [37] indicated that patients may miss medication doses when faced with disruptions in daily life such as traveling or busy work schedules. Place of residence: Residing in rural areas is a predictor of dual anti-platelet therapy non-adherence [33] .…”

“…This category includes re ective motivations related to medication adherence in patients after PCI surgery [15] (including planning and evaluation), containing three factors such as perceived necessity, future concerns, and making coping plans. Barriers: Concerns about the future: 2 included studies [26,37] explored the relationship between future concerns and medication adherence, where Allen LaPointe et al [26] found that concerns were independently associated with adherence to secondary prevention medications; Another qualitative study indicated that patients have uncertainty about future heart health, with some patients worrying about heart disease recurrence, which encourages them to adhere to medication, while others believe that they have been taking medication for a long time and missing one dose will not have adverse effects, which may lead to medication non-adherence. Facilitators: Perceived necessity: Results from 2 studies [26,35] showed that perceived necessity is independently associated with medication adherence in patients after PCI surgery; Mondesir [34] found that patients who believe that taking medication is important for working and maintaining health are more likely to adhere to long-term medication.…”