Aspirin non-adherence in pregnant women at risk of preeclampsia (ANA): a qualitative study

BACKGROUND: Antenatal adherence to aspirin prophylaxis is key to reducing the occurrence of a major pregnancy complication: pre-eclampsia (PE). Up to 75% of pregnant women at increased risk of pre-eclampsia do not take aspirin as prescribed. Little research has been done to understand the psychological determinants of aspirin adherence in pregnancy. This qualitative study aimed to explore barriers and facilitators to aspirin adherence in women at increased risk of PE using version 2 of Theoretical Domains Framework (TDF). METHODS: Fourteen women from the North-East of England who declared various levels of non-adherence to aspirin (0-5 of 7 prescribed tablets/week) were interviewed 4-18 months after delivery, using the TDF as a guide. Semi-structured interviews were digitally recorded and transcribed verbatim. A thematic framework analysis was used. RESULTS: Women exhibited both intentional and unintentional non-adherence and faced multiple barriers at a personal and environmental level. They struggled to initiate, implement and persist in taking medication as prescribed. Women expressed inadequate knowledge about PE and aspirin; they struggled to identify as 'medication takers' and relate to the risk factors for PE as identified by the midwife. Significant barriers within the health-care environment were identified; women had difficulties obtaining medication and perceived conflict amongst health care professionals regarding medication safety. CONCLUSION: A combination of inadequate knowledge, lack of identification with the risk factors and beliefs about consequences of taking medication were interlinked with other domains, such as environmental context and resonate with the Necessity-Concerns Framework.