Barriers and Facilitators to Treatment Adherence in Patients with Peripheral Artery Disease: A Qualitative Study of Patients with PAD, Relatives and Healthcare Professionals

Background: Peripheral artery disease (PAD) is a chronic atherosclerotic condition, affecting 20% of adults over 60 in the UK. Guideline-recommended therapy (pharmacotherapy and lifestyle change) has been shown to reduce major cardiovascular and limb events and increase life expectancy; however, adherence is low. Currently, there is a paucity of patient-centred interventions that address all aspects of adherence. Our previous research highlighted that patients' perceptions of their disease and its treatment strongly influence adherence. However, the views of relatives and healthcare professionals (HCPs) have not been previously explored. Purpose: To explore the views, experiences, perceived barriers and facilitators to adherence to guideline recommended therapy from the perspectives of patients with PAD, their relatives and HCPs. Methods: Semi-structured qualitative interviews were conducted with patients with PAD, their relatives and HCPs. Participants were purposively sampled to capture a wide range of perspectives. The Perceptions and Practicalities Approach framed the topic guide and guided analysis. Interviews were recorded, transcribed verbatim, and analysed thematically (inductively and deductively). Stakeholder groups of patients, public and clinicians supported the pilot testing of the topic guide and the data analysis. Results: Fifteen patients (eight men and seven women, aged 48-82, 8/15 White British), four relatives (all women) and 18 HCPs (five from primary and 13 from secondary care) were interviewed. Seven themes were identified: (1) Knowledge & understanding, (2) Treatment concerns, (3) Motivation, (4) HCP influence, (5) Social & physical context, (6) Everyday reality, (7) Healthcare system factors. Patients, relatives and HCPs did not always align on perceptions. Conclusion: Our findings illustrate that patients' adherence to PAD treatment is a complex process shaped by their personal understanding, motivation and daily lives, as well as support from HCPs and the wider system. To enhance adherence, future interventions should focus on improving patient education, addressing misconceptions about the necessity of conservative treatment, fostering individual motivation through practical goal setting, and strengthening collaborative care across the healthcare system.