Patient Preference and Adherence (Aug 2023)

Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review

  • Ruksakulpiwat S,
  • Benjasirisan C,
  • Ding K,
  • Phianhasin L,
  • Thorngthip S,
  • Ajibade AD,
  • Thampakkul J,
  • Zhang AY,
  • Voss JG

Journal volume & issue
Vol. Volume 17
pp. 2161 – 2174

Abstract

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Suebsarn Ruksakulpiwat,1 Chitchanok Benjasirisan,1 Kedong Ding,2 Lalipat Phianhasin,1 Sutthinee Thorngthip,3 Anuoluwapo D Ajibade,4 Jai Thampakkul,5 Amy Y Zhang,6 Joachim G Voss6 1Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand; 2Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA; 3Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 4College of Art and Science, Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA; 5Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA; 6Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USACorrespondence: Suebsarn Ruksakulpiwat, Email [email protected]: Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke.Objective: To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH.Methods: This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative.Results: Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients.Conclusion: Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.Keywords: ischemic stroke, medication adherence, social determinants of health, systematic review

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