Medication adherence early after stroke: using the Perceptions and Practicalities framework to explore stroke survivors’, informal carers’ and nurses’ experiences of barriers and solutions

Background: Secondary prevention medication after stroke reduces risk of recurrence, but adherence is often poor. Stroke survivors’, carers’ and nurses’ perspectives of early post-stroke medication adherence are unexplored. Aim: to explore stroke survivors’, carers’ and nurses’ views and experiences about adhering to medication early after post-stroke hospital discharge. Methods: Qualitative individual and group interviews, utilizing the Perceptions and Practicalities framework. Nine people <2 months post-stroke, three carers, and fifteen nurses from one UK stroke unit participated. Interviews were digitally recorded, transcribed and thematically analysed. Results: There were four main themes with two subthemes. 1) Perceptions of medication taking after stroke. Factors affecting adherence included depression, imperceptible benefits, and concerns about adverse effects. 2) Perceptions about those at higher risk of poor medication adherence. Nurses suggested that poor adherence might be more likely in those living alone or with previous nonadherence. 3) Practicalities of taking medication early after stroke; these included post-stroke disabilities, cognition, polypharmacy, and lack of information. 4a) Practicalities of addressing poor medication adherence during the hospital stay. Solutions included multidisciplinary co-ordination, but nurses and stroke survivors described suboptimal use of opportunities to promote adherence. 4b) Practicalities of addressing poor medication adherence post-discharge. Solutions included modifications and support from carers, but stroke survivors reported difficulties in evolving systems for taking medications. Conclusions: Stroke survivors and informal carers lack knowledge and support needed to manage medication early after discharge. Nurses’ opportunities to promote medication adherence are under-exploited. Medication adherence strategies to support stroke survivors early after discharge are needed.