# Healthcare Professionals’ Perspectives on Barriers and Facilitators to Medication Adherence Post Myocardial Infarction: A Qualitative Study Using the Theoretical Domains Framework

## TL;DR

Healthcare professionals in Ireland shared insights into what helps or hinders patients from taking medications properly after a heart attack, highlighting the need for better teamwork and patient-focused care.

## Contribution

The study reveals how healthcare professionals' experiences in the post-MI setting shape adherence challenges and suggests where targeted interventions could be most effective.

## Key findings

- Analysis identified 15 facilitators, 13 barriers, and 7 dual-role determinants influencing medication adherence.
- HCPs emphasized abrupt care transitions, polypharmacy, and emotional vulnerability as key challenges in post-MI adherence.
- Multidisciplinary, tailored, and system-level solutions are needed to improve adherence support.

## Abstract

Medication adherence following myocardial infarction (MI) is essential for effective secondary prevention, yet adherence rates remain suboptimal. Healthcare professionals (HCPs) are central to promoting adherence through clinical decision-making, patient education, and ongoing behavioural support. Understanding how HCPs perceive and experience the factors’ influencing adherence is key to developing effective, context-specific interventions. This study explored HCPs’ perspectives on medication adherence post-MI and identified behavioural determinants influencing medication management across the care pathway. A qualitative descriptive study was conducted using semi-structured interviews with HCPs in the southwest of Ireland. Participants included hospital pharmacists, community pharmacists, general practitioners (GPs), cardiologists, and nurses, recruited through purposive, convenience, and snowball sampling. Interviews were recorded, transcribed verbatim, and analysed using directed content analysis guided by the Theoretical Domains Framework (TDF). Twelve HCPs (eight female) were interviewed between December 2024 and May 2025, including four pharmacists, two GPs, three cardiologists and three nurses. Interviews lasted 30–50 min (mean 41 min). Analysis identified 15 facilitators, 13 barriers, and 7 dual-role determinants across 10 TDF domains. Novel contributions include demonstrating how HCPs’ real-world experiences contextualise adherence issues in the distinct post-MI setting characterised by abrupt care transitions, polypharmacy, and emotional vulnerability and identifying where HCPs feel most constrained and where their expertise could directly inform targeted intervention design. HCPs’ insights reveal complex, context-specific behavioural determinants influencing post-MI medication adherence and highlight the need for multidisciplinary, tailored, and system-level solutions. Enhancing collaboration, supporting patient-centred communication, and addressing resource barriers could empower HCPs to deliver more effective, personalised adherence support and inform the development of targeted intervention strategies.