Abstract/Summary

Following an acute myocardial infarction (AMI), patients are prescribed a regime of cardio-protective medicines to prevent recurrent cardiovascular events and mortality. This is recommended in international guidelines as clinical evidence shows improved long-term outcomes for patients who receive optimal therapy. Medication adherence in this patient group is poor, and current interventions such as physical memory aids or psychological motivational patient interviews have made improvements, but a single practical intervention with a significant effect to improve adherence has yet to be developed and implemented. Medication adherence comes from a complex set of behaviours, and this study aimed to better understand the beliefs and experiences of medicine-taking in this group of patients. Semi-structured interviews were conducted with people who take medication to prevent a further AMI, recruited from cardiovascular support groups and also within the University. Data was analysed using three methods in order to obtain multiple perspectives and a richer, more in-depth set of results. Interpretative phenomenological analysis was used to better understand the experience from a patient’s perspective, grounded theory analysis was used to model the processes involved in adherence to medication following AMI, and narrative analysis to illustrate the personal, social and system related interactions that people attach to their medication-taking behaviours. The phenomenological analysis found participants compared themselves to other patients, knowledge was important to them, the future was an unknown, and they described how they built a medication-taking into their lifestyle. The grounded theory study found that participants built a routine on returning home, by which they aimed towards achieving a continuing stability phase, but they balanced the medication-related pros and cons that they encountered, which led up to reaching a crisis point where they required medical assistance. The narrative analysis highlighted the personal and detailed stories that participant experienced, and found a similar shape to the grounded theory study. It added upon this, to highlight that participants considered medication taking as a cumulative protection, and weren’t concerned about single missed doses. These results detailed what the medication-taking experience was like for these participants and offered suggestions of the changes that were required of them to achieve adherence. The level of detail described by participants and individual meaning suggests that intervention work is indicated on a personal basis. However, themes were present, such as the development of side effects leading up to a crisis event, which could help prepare patients more generally to plan for this event taking place. The results of this study could assist with understanding the problem of non-adherence in this group and inform the design of an appropriate intervention to improve medication adherence following an AMI.