“Nobody wants to rock the boat”: a grounded theory study of taking medication to prevent a further heart attack

Abstract Introduction Following an acute myocardial infarction (AMI), patients are prescribed a daily regime of five medications to prevent secondary cardiovascular events, however medication adherence in this patient group has been measured at only 66%.1 Sub-optimal leads increased mortality, morbidity and healthcare system costs. Current interventions such as monitored dosage systems, phone message reminders pharmacist consultations have made some improvements but largely based on presumptions about than formal evidence. Studying the experience medication-taking following AMI, personal requirement adjustment that is required enable could arguably generate evidence needed support future field. Aim The aim study was use grounded theory methodology create model explaining process AMI. Methods ethical approval (UREC 18/36), semi-structured interviews were conducted with thirteen people (based South-East England) taking least one AMI episode past. person, online or via telephone audio-recorded. These recordings transcribed verbatim analysed according constructed theory.2 NVivo software used organise display coded data produce process. Results Patients took because they wanted continue living their lives. They saw offering them protection, alongside diet exercise. hospital discharge, incorporated into routines home. mealtimes bedtime prompt, kept located close these activities. described rarely missing doses recognised being away from cause omission. In stable stage, considered unproblematic; ‘just got it’. professional trust established medical team basis for directions, conferred authority make decisions treatment, not wanting initiate changes themselves; ‘rock boat’. main change experiencing adverse bodily effects, ascribed by side effects. small noticeable prompt further investigation information- seeking, after which presented team, who instigated changes. There background dislike medication, eased knowledge action biomedical results. intentionally adherent drawn question treatment when ‘side effects’ misunderstanding arose. Discussion/Conclusion Medication-taking driven desire live, so accommodate routine fit lives, can disturb intention routine. This reinforced relationships professionals. Resistance alleviated Practitioners education, test results shared decision-making points relationship strengthen behaviours. References 1. Ma TT, Wong IC, Man KK, Chen Y, Crake T, Ozkor MA, Ding LQ, Wang ZX, Zhang L, Wei L. Effect evidence-based therapy prevention disease: Systematic review meta-analysis. PLoS One. 2019;14(1):e0210988. 2. Charmaz K. Constructing theory. Sage; 2014.