A qualitative study of barriers and facilitators to low-dose aspirin adherence in pregnancy

To explore barriers and facilitators to low-dose aspirin (LDA) adherence among pregnant participants of low socioeconomic status through application of a theoretical framework of behavior change.

This study occurred between April and July 2023 at an urban tertiary care center's prenatal clinic, which serves participants of low socioeconomic status. This study was nested in the pre-implementation phase of a planned universal LDA quality improvement program. Participants were individually interviewed in their native language (English or Spanish) using questions based on the Theoretical Domains Framework. Analysis was completed using an integrated approach using grounded theory and a priori themes from the established framework, which revealed the most salient themes and subthemes. Participants also took the Patient Medication Adherence Scale, which quantitatively assessed medication adherence as well as knowledge surrounding medication use.

Twenty-four participants were interviewed, with the majority (n = 19, 79.2%) being multiparous, in the third trimester (n = 17, 70.8%), and native English speaking (n = 20, 83.3%). Adherence scores were overall high, at 41.29 (SD 2.73) out of 45 possible points. Seven domains within the Theoretical Domains Framework elucidated major themes and subthemes. Barriers to LDA use included confusion and misinformation regarding the indication for LDA use in pregnancy, seeing little utility in its use, forgetfulness, feeling unwell, and limited trust with a rotating group of providers. Facilitators included patient desire to improve pregnancy outcomes and prevent maternal disease, adequate clinic resources and personnel, and key social support persons.

Using insights gained on barriers and facilitators to LDA adherence across multiple behavioral domains, we propose a three-pronged approach to guide LDA quality improvement efforts with a focus on patient education, provider communication, and clinical resources. Future work should systematically evaluate the impact of patient-informed interventions on LDA adherence in this patient population.