Identifying determinants of medication adherence following myocardial infarction using the Theoretical Domains Framework and the Health Action Process Approach

• Published in: Psychology & health 2017-10, Vol.32 (10), p.1176-1194
• Main Authors: Presseau, Justin, Schwalm, J.D., Grimshaw, Jeremy M., Witteman, Holly O., Natarajan, Madhu K., Linklater, Stefanie, Sullivan, Katrina, Ivers, Noah M.
• Format: Article
• Language: English
• Subjects: Aged; Female; Health Action Process Approach; Health Knowledge, Attitudes, Practice; Heart attacks; Humans; Intention; Male; medication adherence; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Middle Aged; myocardial infarction; Myocardial Infarction - prevention & control; Myocardial Infarction - psychology; Patient compliance; Psychological Theory; Social Support; Theoretical Domains Framework
• ISSN: 0887-0446; 1476-8321
• DOI: 10.1080/08870446.2016.1260724

Background: Despite evidence-based recommendations, adherence with secondary prevention medications post-myocardial infarction (MI) remains low. Taking medication requires behaviour change, and using behavioural theories to identify what factors determine adherence could help to develop novel adherence interventions. Objective: Compare the utility of different behaviour theory-based approaches for identifying modifiable determinants of medication adherence post-MI that could be targeted by interventions. Methods: Two studies were conducted with patients 0-2, 3-12, 13-24 or 25-36 weeks post-MI. Study 1: 24 patients were interviewed about barriers and facilitators to medication adherence. Interviews were conducted and coded using the Theoretical Domains Framework. Study 2: 201 patients answered a telephone questionnaire assessing Health Action Process Approach constructs to predict intention and medication adherence (MMAS-8). Results: Study 1: domains identified: Beliefs about Consequences, Memory/Attention/Decision Processes, Behavioural Regulation, Social Influences and Social Identity. Study 2: 64, 59, 42 and 58% reported high adherence at 0-2, 3-12, 13-24 and 25-36 weeks. Social Support and Action Planning predicted adherence at all time points, though the relationship between Action Planning and adherence decreased over time. Conclusions: Using two behaviour theory-based approaches provided complimentary findings and identified modifiable factors that could be targeted to help translate Intention into action to improve medication adherence post-MI.