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Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: analysis of survivors and caregivers views from an online stroke forum
  1. James Jamison1,
  2. Stephen Sutton1,
  3. Jonathan Mant1,
  4. Anna De Simoni2
  1. 1 Primary Care Unit, Department of Public Health and Primary Care, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
  2. 2 Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to James Jamison; jj285{at}


Objective To identify barriers and facilitators of medication adherence in patients with stroke along with their caregivers.

Design Qualitative thematic analysis of posts about secondary prevention medications, informed by Perceptions and Practicalities Approach.

Setting Posts written by the UK stroke survivors and their family members taking part in the online forum of the Stroke Association, between 2004 and 2011.

Participants 84 participants: 49 stroke survivors, 33 caregivers, 2 not stated, identified using the keywords ‘taking medication’, ‘pills’, ‘size’, ‘side-effects’, ‘routine’, ‘blister’ as well as secondary prevention medication terms.

Results Perceptions reducing the motivation to adhere included dealing with medication side effects, questioning doctors’ prescribing practices and negative publicity about medications, especially in regard to statins. Caregivers faced difficulties with ensuring medications were taken while respecting the patient’s decisions not to take tablets. They struggled in their role as advocates of patient’s needs with healthcare professionals. Not experiencing side effects, attributing importance to medications, positive personal experiences of taking tablets and obtaining modification of treatment to manage side effects were facilitators of adherence. Key practical barriers included difficulties with swallowing tablets, dealing with the burden of treatment and drug cost. Using medication storage devices, following routines and getting help with medications from caregivers were important facilitators of adherence.

Conclusions An online stroke forum is a novel and valuable resource to investigate use of secondary prevention medications. Analysis of this forum highlighted significant barriers and facilitators of medication adherence faced by stroke survivors and their caregivers. Addressing perceptual and practical barriers highlighted here can inform the development of future interventions aimed at improving adherence to secondary prevention medication after stroke.

  • ke
  • caregiver
  • medication adherence
  • online forum

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  • Contributors ADS conceived of the study, is the Chief Investigator, contributed to the data analysis and commented on the manuscript. JM is a co-investigator on the study, wrote and commented on the manuscript. SS is a co-investigator on the study, wrote and commented on the manuscript. JJ contributed to the study design, conducted the data analysis and prepared the manuscript for submission. All authors agreed on the final draft of the submitted manuscript.

  • Funding DS is funded by a National Institute for Health Research (NIHR) Academic Clinical Lectureship. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health. JJ was supported by a research grant from The Stroke Association and the British Heart Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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