Patient beliefs and experiences of adhering to medical therapies for cardiovascular comorbidities, before non-cardiac elective surgery in South Africa: a mixed-methods study
1
School of Medicine, University of Leeds, Leeds, United Kingdom
2
Leeds Institute of Health research, University of Leeds, Leeds, United Kingdom
3
Department of Anaesthesia and perioperative medicine, Groote Schuur Hospital, Cape Town, South Africa
4
Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
5
Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
6
Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Cardiovascular comorbidities increase perioperative risk in patients undergoing non-cardiac surgery. Optimizing medication adherence in this population is critical; yet adherence remains low in many low- and middle-income countries (LMICs), where health beliefs, systemic barriers, and healthcare communication bring significant challenges. This study aimed to explore the acceptability of validated patient-reported questionnaires and to investigate the beliefs and experiences influencing adherence to cardiovascular medication prior to surgery in a South African tertiary hospital.
METHODS:
A mixed-methods study was conducted using semi-structured interviews with 21 patients taking cardiovascular medication prior to vascular surgery. Participants completed four validated self-report questionnaires: Brief Illness Perception Questionnaire (BIPQ), Beliefs about Medicines Questionnaire (BMQ), SHARED decision-making questionnaire, and SURE decisional conflict scale. Questionnaire responses were summarized with descriptive statistics. Thematic analysis of interview data was conducted using Braun and Clarke’s six-step framework.
RESULTS:
Most participants perceived their illness as chronic (71%) and their treatment as effective (86%), yet 71% reported high concern and 43% reported emotional distress. Belief in the need for medication was strong (100%), but 67% worried about long-term side effects and 47% described their medication as a "mystery." Shared decision-making appeared limited: only 33% recalled being asked for their views. Thematic analysis revealed seven major themes: understanding illness and treatment, health professional interactions, service access, social support, individual factors, routines/habits.
CONCLUSIONS:
Patient-reported tools were acceptable and highlighted complex, interrelated factors associated with adherence. Integrating these tools into preoperative care may help identify at-risk patients and support person-centered perioperative planning in LMICs.
Cardiovascular comorbidities increase perioperative risk in patients undergoing non-cardiac surgery. Optimizing medication adherence in this population is critical; yet adherence remains low in many low- and middle-income countries (LMICs), where health beliefs, systemic barriers, and healthcare communication bring significant challenges. This study aimed to explore the acceptability of validated patient-reported questionnaires and to investigate the beliefs and experiences influencing adherence to cardiovascular medication prior to surgery in a South African tertiary hospital.
METHODS:
A mixed-methods study was conducted using semi-structured interviews with 21 patients taking cardiovascular medication prior to vascular surgery. Participants completed four validated self-report questionnaires: Brief Illness Perception Questionnaire (BIPQ), Beliefs about Medicines Questionnaire (BMQ), SHARED decision-making questionnaire, and SURE decisional conflict scale. Questionnaire responses were summarized with descriptive statistics. Thematic analysis of interview data was conducted using Braun and Clarke’s six-step framework.
RESULTS:
Most participants perceived their illness as chronic (71%) and their treatment as effective (86%), yet 71% reported high concern and 43% reported emotional distress. Belief in the need for medication was strong (100%), but 67% worried about long-term side effects and 47% described their medication as a "mystery." Shared decision-making appeared limited: only 33% recalled being asked for their views. Thematic analysis revealed seven major themes: understanding illness and treatment, health professional interactions, service access, social support, individual factors, routines/habits.
CONCLUSIONS:
Patient-reported tools were acceptable and highlighted complex, interrelated factors associated with adherence. Integrating these tools into preoperative care may help identify at-risk patients and support person-centered perioperative planning in LMICs.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
