Barriers to medication adherence for secondary stroke prevention in rural communities in Cameroon: a qualitative study.

Abstract

Stroke survivors in rural communities may face unique challenges in accessing and adhering to medications for secondary prevention. This qualitative study aimed to explore the factors associated with medication adherence among stroke survivors in rural settings. We conducted semi-structured interviews with 15 stroke survivors, 5 caregivers, and 5 healthcare providers in rural communities. We conducted thematic analysis of the data using a grounded theory approach. Six key themes emerged: access (subthemes: inefficient/non-existent healthcare services, limited access to health facilities, shortages of medications), medication-related (subthemes: side effects and polytherapy), patient-level (subthemes: beliefs and knowledge about stroke and medications, attitudes and motivation towards treatment), health system and provider-related (subthemes: quality of patient-provider communication and counselling, shortages of healthcare workers, healthcare workers' knowledge of stroke and medication), economic and environmental barriers (subthemes: poverty, lack of transportation and political conflict), and socio-cultural barriers (subthemes: stigma and social isolation and cultural practices). The barriers to adherence to medications for secondary stroke prevention in the studied rural communities were multifactorial and mostly resulted from preventable health and socioeconomic factors. A multistrategic approach including enhancement of patient education, streamlining medication changes, rural healthcare worker training on secondary stroke prevention, patient counselling and addressing concerns and side effects, community outreach and education to raise awareness about stroke prevention, and the use of single-pill combination therapy can address these barriers and ensure long-term adherence.