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Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies

Crayton, E; Fahey, M; Ashworth, M; Besser, SJ; Weinman, J; Wright, AJ; (2017) Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies. Annals of Behavioral Medicine , 51 (6) pp. 833-845. 10.1007/s12160-017-9906-0. Green open access

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Abstract

Background: Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. To improve adherence, its determinants must be understood. To date, no systematic review has mapped identified determinants into the Theoretical Domains Framework (TDF) in order to establish a more complete understanding of medication adherence. Purpose: The aim of this study was to identify psychological determinants that most influence stroke survivors’ medication adherence. Methods: In line with the prospectively registered protocol (PROSPERO CRD42015016222), five electronic databases were searched (1953–2015). Hand searches of included full text references were undertaken. Two reviewers conducted screening, dat a extraction and quality assessment. Determinants were mapped into the TDF. Results: Of 32,825 articles, 12 fulfilled selection criteria (N = 43,984 stroke survivors). Tested determinants mapped into 8/14 TDF domains. Studies were too heterogeneous for meta-analysis. Three TDF domains appeared most influential. Negative emotions (‘Emotions’ domain) such as anxiety and concerns about medications (‘Beliefs about Consequences’ domain) were associated with reduced adherence. Increased adherence was associated with better knowledge of medications (‘Knowledge’ domain) and stronger beliefs about medication necessity (‘Beliefs about Consequences’ domain). Study quality varied, often lacking information on sample size calculations. Conclusions: This review provides foundations for evidence-based intervention design by establishing psychological determinants most influential in stroke survivors’ medication adherence. Six TDF domains do not appear to have been tested, possibly representing gaps in research design. Future research should standardise and clearly report determinant and medication adherence measurement to facilitate meta-analysis. The range of determinants explored should be broadened to enable more complete understanding of stroke survivors’ medication adherence.

Type: Article
Title: Psychological Determinants of Medication Adherence in Stroke Survivors: a Systematic Review of Observational Studies
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s12160-017-9906-0
Publisher version: http://doi.org/10.1007/s12160-017-9906-0
Language: English
Additional information: Copyright © 2017, The Author(s) Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: https://discovery.ucl.ac.uk/id/eprint/10048612
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