Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UK.

Abstract

Placental dysfunction is estimated to affect 10% of pregnancies and is associated with adverse perinatal outcomes. Low-dose aspirin (LDA) reduces placental dysfunction risk. However, adherence to LDA is suboptimal in pregnant women and may reduce its effectiveness. We aimed to explore the barriers and facilitators to LDA adherence in pregnant women with placental dysfunction risk. Qualitative semi-structured individual interviews were undertaken, and data were inductively thematically analysed. A single NHS Trust in South West England, UK. Pregnant women aged>18, recommended daily LDA for pregnancy indications. We purposively recruited those with a range of adherence patterns (non-adherent, suboptimally adherent, adherent). 15 women participated (93% white British, 73% university educated). Five were adherent (6-7 doses per week), five suboptimally adherent (4-5 doses per week) and five non-adherent (<u><</u>3 doses per week). Indications for LDA were pre-eclampsia risk, low PAPP-A and previous intrauterine growth restriction. Four themes and related subthemes were identified addressing motivational and implementation issues. Motivational barriers and facilitators included (1) risk perceptions: participants described limited understanding of their indications for LDA and the maternal and fetal impacts of placental dysfunction, feeling stigmatised by their body mass index being an indicator for LDA and perceiving it to be unlikely they would experience serious consequences of placental dysfunction. Facilitators were direct/indirect experiences of placental dysfunction. (2) Concerns about taking LDA, including bleeding risk. (3) Interactions with healthcare professionals: participants described receiving limited information from healthcare professionals, with limited attention given to LDA compared with other antenatal recommendations. Distrust and trust in healthcare professionals impacted non-adherence/adherence. Implementation barriers were (4) difficulties with establishing habits, tailing off and difficulties swallowing. Established habits and swallowing LDA whole supported taking it. We identified motivational and implementation-related barriers and facilitators to LDA adherence in a clinical sample of women with placental dysfunction risk. Women require more information to enhance understanding and inform their decision, and require support to establish effective habits. Theory-informed behaviour change techniques could address these barriers. Adherence barriers and facilitators should be explored in minority ethnicity and economically deprived women, and healthcare staff providing LDA-related care to inform optimally effective interventions.