Medication adherence in cardiovascular patients: A qualitative meta-synthesis of perceptions and experiences.

Purpose

To identify, synthesize and critically appraise the quality of qualitative studies examining perceptions and experiences of medication adherence among patients with cardiovascular diseases.

Methods

This meta-synthesis was conducted and reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement, the Joanna Briggs Institute meta-aggregation method, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed, Embase, CINAHL, Web of Science, and Cochrane databases was conducted from inception to January 13, 2025. The quality of included studies was critically appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

Results

Of 2576 records screened, 27 studies (n = 804 patients) met the inclusion criteria. Three core themes emerged:(1) patient-centered beliefs, including beliefs about the necessity and effectiveness of medications, cultural and spiritual influences, trust and communication with healthcare professionals, and knowledge gaps and misconceptions; (2) practical and emotional challenges such as forgetfulness and routine disruption, perceived or actual side effects, access and cost barriers, emotional burden, identity concerns, and medication regimen complexity; and (3) interpersonal support systems and intrapersonal strategies, whereby family and social support, healthcare professionals, reminder tools, routines, and habit formation facilitated sustained adherence. The Conceptual Behavioral Model (CBM) generated from this synthesis illustrates how medication adherence in cardiovascular diseases is shaped through reciprocal interactions between these three themes.

Conclusion

Medication adherence among patients with cardiovascular diseases is a dynamic, behaviourally complex process shaped by the interaction of patient-centered beliefs, practical and emotional challenges, and interpersonal and intrapersonal support mechanisms. The Conceptual Behavioural Model (CBM) provides a theory-integrative framework to guide the development of patient-centered adherence interventions. Future research is needed to explore cultural, emotional, and psychological factors influencing adherence to promote long-term adherence to cardiovascular medications. STUDY REGISTRATION PROSPERO Protocol registration ID: CRD420250654719.