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Abstract
ABSTRACT Background Antenatal adherence to aspirin prophylaxis is key to reducing the occurrence of a major pregnancy complication: pre-eclampsia (PE). Up to 75% of pregnant women at increased risk of pre-eclampsia do not take aspirin as prescribed. Little research has been done to understand the psychological determinants of aspirin adherence in pregnancy. This qualitative study aimed to explore barriers and facilitators to aspirin adherence in women at increased risk of PE using version 2 of Theoretical Domains Framework (TDF). Methods Fourteen women from the North-East of England who declared various levels of non-adherence to aspirin (0–5 of 7 prescribed tablets/week) were interviewed 4–18 months after delivery, using the TDF as a guide. Semi-structured interviews were digitally recorded and transcribed verbatim. A thematic framework analysis was used. Results Women exhibited both intentional and unintentional non-adherence and faced multiple barriers at a personal and environmental level. They struggled to initiate, implement and persist in taking medication as prescribed. Women expressed inadequate knowledge about PE and aspirin; they struggled to identify as ‘medication takers’ and relate to the risk factors for PE as identified by the midwife. Significant barriers within the health-care environment were identified; women had difficulties obtaining medication and perceived conflict amongst health care professionals regarding medication safety. Conclusion A combination of inadequate knowledge, lack of identification with the risk factors and beliefs about consequences of taking medication were interlinked with other domains, such as environmental context and resonate with the Necessity-Concerns Framework.
Highlights
Pre-eclampsia (PE) affects 2–5% of all pregnancies (Duley, 2009) and can lead to devastating outcomes; it is the second leading cause of maternal death (Saving Mothers’ Lives, 2011) with an estimated global death toll of 60,000 women per year (Khan, Wojdyla, Say, Gülmezoglu, & Van Look, 2006)
As we aimed to describe and interpret what is happening in particular settings, i.e. what barriers and facilitators women face in adherence with aspirin, a thematic framework analysis (TFA) was selected to analyse the data
The results presented under each of the Theoretical Domains Framework (TDF) domains can be examples of either barriers or facilitators of adherence
Summary
Pre-eclampsia (PE) affects 2–5% of all pregnancies (Duley, 2009) and can lead to devastating outcomes; it is the second leading cause of maternal death (Saving Mothers’ Lives, 2011) with an estimated global death toll of 60,000 women per year (Khan, Wojdyla, Say, Gülmezoglu, & Van Look, 2006). In line with the NICE guideline ‘Hypertension in pregnancy: diagnosis and management’ (ACOG Practice Bulletin, 2019); in England, women with one major risk factor (chronic hypertension, previous PE, Type 1/Type 2 diabetes mellitus, autoimmune and chronic kidney disease) or more than two minor risk factors (first pregnancy, family history of PE, body mass index (BMI) of ≥35 kg/m2, multiple pregnancy and age ≥40 years) are considered to be at higher risk of PE and are offered prophylactic aspirin therapy (National Institute for Health and Care Excellence, 2019) (75–150 mg taken at bedtime) This is based on high-quality evidence of the effectiveness of a low-dose aspirin for the prevention of PE when started before the 16th week of pregnancy (Roberge et al, 2017a). Conclusion: A combination of inadequate knowledge, lack of identification with the risk factors and beliefs about consequences of taking medication were interlinked with other domains, such as environmental context and resonate with the Necessity-Concerns Framework
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