Model Development on Adherence to Aspirin in Pregnancy: A Co-Produced Qualitative Systematic Review and...

Low-dose aspirin is proven to reduce the incidence of pre-eclampsia, yet adherence remains low. This systematic review synthesises qualitative evidence on barriers and facilitators to low-dose aspirin adherence in pregnancy and uses a co-production approach to develop an explanatory model of this complex behaviour. The overall aim is to contribute to the development of a theory of adherence, targeting this health issue.

Data sources: A search of electronic databases (Medline, Web of Science, CINAHL, PsycINFO, Embase, Scopus, Open Grey, Google Scholar, Prospero), charity and professional organisations' archives was conducted using predefined terms. Citation searching was also performed. Searches were not time-limited or language-specific and completed in November 2024.

Studies, which included qualitative data on low-dose aspirin determinants of adherence in pregnancy were included.

Quality was assessed using the Critical Appraisal Skills Programme checklist. A meta-ethnography approach with reciprocal translation and line-of-argument synthesis was used. The co-production approach was utilised to streamline future intervention development by engaging key stakeholders in evidence synthesis, enabling them to translate evidence into action, support implementation and overcome the subjectivity inherent in meta-ethnography. Co-production activities followed the nominal group technique and structured discussions.

Out of 3757 items identified through systematic searches of published studies and grey literature, six studies were included in the review. No studies were excluded based on quality. Four 3rd-order constructs with a total of 10 sub-themes were identified: informational gap, verbal and non-verbal health system communication, personal assets and autonomous control. In an explanatory model, we demonstrate that women are advised to take low-dose aspirin in a context of lack of information and misconceptions (informational gap) with patchy and inconsistent messages from the health care system. Women ultimately control their decision about the use of low-dose aspirin, however, the arrival at a decision depends on the utilisation of individual assets (unique personal or social characteristics inherited or acquired).

Improving the quality and delivery of information for women and their support networks can reduce the strain on personal resources and make this essential preventive treatment more accessible and equitable.

A group consisting of representatives from two national charities and a service user worked alongside an academic team, contributing to all aspects of this work, including formulating the research question, participating in the selection of the search terms, conducting screening of the abstracts, data extraction, quality assessment, synthesis, drafting a graphic representation and this manuscript.