Improving medication adherence in stroke survivors

: Development of a novel and acceptable intervention 

Abstract

Medications are recommended for the secondary prevention of stroke and have shown good efficacy, yet adherence is suboptimal. To date, most interventions targeting medication adherence in stroke survivors have shown limited effectiveness. Therefore, this thesis aimed to develop a novel, evidence-based and theory driven behaviour change intervention targeting medication adherence in stroke survivors.
Three key studies were conducted. A systematic review identified psychological determinants of medication adherence in stroke survivors. Then, an extensive intervention development process was undertaken, utilising the Behaviour Change Wheel (BCW), a guide to intervention development. Finally, semi-structured interviews were conducted with stroke survivors (n=16) and health care professionals (HCPs; n=19), to explore acceptability of the potential intervention components. Framework analysis was employed to analyse results and the intervention design was refined and finalised. All studies were underpinned by the Theoretical Domains Framework (TDF).

Three TDF domains (‘Knowledge’,‘Beliefs about consequences’, and ‘Emotions’), were found to have most influence on medication adherence. Employing the BCW, five intervention functions, five policy categories and 11 BCTs were identified and explored for acceptability with stroke survivors and HCPs. The qualitative interviews revealed that habit formation, supported by action planning, self-monitoring of the behaviour and information about health consequences were the most acceptable BCTs. Participants felt that the intervention should be delivered within the NHS, with written and verbal modes of delivery perceived as acceptable.

Use of the TDF, BCW and consideration of intended intervention context has supported the development of a novel and acceptable intervention. Further research is required to test intervention feasibility.

Date of Award	2018
Original language	English
Awarding Institution	King's College London
Supervisor	Alison Wright (Supervisor) & Mark Ashworth (Supervisor)