Modifiable Factors Associated with Non-Adherence to Secondary Ischaemic Stroke Prevention Strategies.

BACKGROUND: Secondary stroke-prevention strategies proven to reduce stroke recurrence include pharmaceutical agents and lifestyle modifications. AIMS: We aimed to study factors associated with adherence to medications and lifestyle modifications amongst ischaemic stroke and transient ischaemic attack (TIA) patients. METHODS: In a prospective cohort study, we surveyed 200 outpatients attending stroke clinic at a Singaporean tertiary hospital. We determined medication knowledge and lifestyle modification adherence through direct questioning. We also administered the Beliefs About Medicines Questionnaire, Trust in Physician Scale, Patient Health Questionnaire and Hospital Anxiety and Depression Scale. Multivariable logistic regression models were used to identify factors associated with adherence. RESULTS: The rates of adherence to medications, smoking cessation, dietary modification, and exercise were 52.3%, 71.0%, 80.0% and 78.5% respectively. Subjects who lacked medication knowledge (OR=3.47; 95% CI=1.55-7.74) or possessed negative medication beliefs (OR=1.20; 95% CI=0.72-0.96) were less likely to be adherent to medications. TIA as an index event (OR=5.04; 95% CI=1.39-18.32), younger age (OR=1.04; 95% CI=1.01-1.08) and higher income (OR=2.40; 95% CI=1.09-5.25) were also associated with medication non-adherence. There were no associations between adherence to medications and lifestyle modifications. Dietary adherence was independently associated with exercise adherence (OR=17.2; 95% CI=3.21-92.22). CONCLUSIONS: Our findings of suboptimal adherence to medications and lifestyle modifications show that many stroke patients are not benefitting from proven secondary stroke prevention strategies. We identified medication knowledge and medication beliefs as potential target areas for studies to improve medication adherence.

Impact of beliefs about medication on the relationship between trust in physician with medication adherence after stroke.

OBJECTIVE: To investigate the relationship between medication adherence, trust in physician and beliefs about medication among stroke survivors. To determine whether beliefs about medication would mediate the relationship between trust in physician and medication adherence. METHODS: A sample of 200 patients with a diagnosis of ischemic stroke or transient ischemic attack (TIA) completed a one-time survey, including the shortened Medication Adherence Report Scale (MARS-5), Beliefs about Medicines Questionnaire (BMQ), and Trust in Physician Scale (TIPS). RESULTS: Our study found that medication adherence was associated with trust in physician (p = 0.019) and four factors of beliefs about medication (BMQ1-Necessity: p < 0.001; BMQ2-Concerns: p = 0.024; BMQ3-Overuse: p = 0.016; BMQ4-Harm: p < 0.001). Furthermore, we found monthly income of survivors moderated the relationship between trust in physician and medication adherence (p = 0.007, CI(95%): [-0.822, -0.132]). CONCLUSIONS: The beliefs about medication mediating the relationship between trust in physician and medication adherence were different based on the stroke survivors' income bracket. PRACTICE IMPLICATIONS: Interventions being developed to improve medication adherence may benefit from improving stroke survivors' trust in physician and addressing their beliefs about medication. In addition, healthcare providers are advised to take monthly income into consideration to effectively address stroke survivors' concerns regarding prescribed medications to mitigate stroke recurrence.