Related Experiment Video
Updated: Oct 31, 2025
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Exploring Barriers to Medication Adherence Using COM-B Model of Behaviour Among Patients with Cardiovascular Diseases
Pallavi Mishra1, Ajay S Vamadevan1,2, Ambuj Roy3
1Health Systems Unit, Centre for Chronic Disease Control, New Delhi, India.
Insights
Medication adherence in atherosclerotic cardiovascular disease patients is hindered by factors like cost, access, and health system issues in low- and middle-income countries. Addressing these requires strengthening healthcare systems and understanding patient beliefs for better health outcomes.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiovascular diseases (CVDs) caused 17.9 million deaths globally in 2016, posing a significant public health challenge.
- Medication non-adherence is a critical issue impacting patient outcomes, particularly in low- and middle-income countries (LMICs).
- Atherosclerotic cardiovascular disease (ASCVD) management is complex and influenced by various patient and system-level factors.
Purpose of the Study:
- To explore factors influencing medication adherence among ASCVD patients in India and Ghana.
- To identify health system and patient-level barriers to medication adherence in LMICs.
- To provide insights for improving medication adherence strategies in cardiovascular disease management.
Main Methods:
- Qualitative study involving 35 in-depth interviews with ASCVD patients.
- Conducted at two tertiary care hospitals in India and Ghana.
- Thematic analysis using the Capability Opportunity and Motivation (COM-B) framework.
Main Results:
- Capability factors (disease comprehension, schedule adherence) and opportunity factors (cost, insurance, access) significantly impacted adherence.
- Motivation factors (mood, beliefs, outcome expectations) also contributed to non-adherence.
- Health system factors, including healthcare experience, trust, and reliance on alternative medicine, played a dominant role.
Conclusions:
- Health system factors are dominant influences on medication adherence in India and Ghana.
- While patient satisfaction with government hospitals was noted in India, systemic issues like limited consultation time and pharmacy stock affected adherence.
- Strengthening health systems and exploring patient belief systems are crucial for improving medication adherence in LMICs.
Introduction:
In 2016, cardiovascular diseases (CVDs) led to 17.9 million deaths worldwide, representing 31% of all global deaths. CVDs are the leading cause of mortality worldwide and significant barriers to achieving the sustainable development goals. Modern medicines have been significant in improving health outcomes. However, non-adherence to medication is one of the reasons behind adverse health-related outcomes among patients suffering from atherosclerotic cardiovascular disease in low- and middle-income countries.
Patients And Methods:
This qualitative study was conducted at two tertiary care hospitals in India and Ghana. A total of 35 in-depth interviews were conducted with atherosclerosis cardiovascular disease (ASCVD) patients. The data were analysed thematically using the Capability Opportunity and Motivation (COM-B) framework.
Findings:
The findings were summarised under three important broad themes of the COM-B framework: capability, opportunity and behaviour. Under capability, comprehension of disease, medication schedule, and unplanned travel affected adherence among patients. Cost of medication, insurance and access were the critical factors under opportunity, which negatively influenced medication adherence. Mood, beliefs about treatment and outcome expectations under motivation led to non-adherence among patients. Apart from these factors, some important health system factors such as health care experience and trust in the facilities and reliance on alternative medication also affected adherence in both countries.
Conclusion:
This study has highlighted that the health system factors have dominantly influenced adherence to medication in India and Ghana. In India, we found participants to be satisfied with their health care provided at the government hospitals. However, limited time for consultation, lack of well-stocked pharmacy and unclear prescription negatively influenced adherence among participants in India and Ghana. The study emphasises that the health system needs to be strengthened, and the patients' belief system needs to be explored to address the issue of medication adherence in LMICs.
More Related Videos
Related Concept Videos
01:21Barriers to Effective Communication II
Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...
01:23Factors Affecting Drug Distribution: Physiological Barriers
The capillary endothelial barrier allows only smaller molecules below 600 Da (Daltons) to pass through. It also restricts drugs like heparin that are bound to blood components, limiting their movement within the bloodstream.
The...
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:28Drug Therapy
Antianxiety Medications
01:15Drug Dosing: Geriatric Patients
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...