Exploring Barriers to Medication Adherence Using COM-B Model of Behaviour Among Patients with Cardiovascular Diseases in Low- and Middle-Income Countries: A Qualitative Study

Figures & data

Table 1 Participant Characteristics

	India	Ghana
IDIs	16	19
FGDs	1	3
Male participant	10	9
Female participant	06	10
Mean age	51.37	61.74
known Ischaemic Heart Disease (IHD)	8	2
Ischemic stroke	4	13
Myocardial infarction	3	1
Coronary Artery Bypass Graft (CABG)	1	0
Cardiomyopathy	0	1
Acute Coronary Syndrome (ACS)	0	1
Multivalvular Heart Disease	0	1

Table 2 Major Analytical Themes and Sub-Themes: Expanding the *COM-B Framework

Capability	Motivation	Opportunity	Overall Adherence Element and Health System Factors
The individual’s physical and psychological capacity to engage in the behaviour Psychological Capacity to engage in the necessary thought process Comprehension of disease and treatment Cognitive functioning (eg memory, capacity for judgement, thinking) Executive function (eg capacity to plan) Medicine and Daily Routine Medication Schedule Physical Capacity to engage in the necessary physical process Physical capability to adapt to lifestyle changes (eg diet or social behaviour) Dexterity Unplanned Travel and Fatigue	All brain process that energises and direct behaviour Reflective Evaluations and plans Perception of illness (eg cause, chronic vs acute etc.) Beliefs about treatment (eg necessity, efficacy, concerns about current or future adverse events, general aversion to taking medicines) Patients’ Perception of Health Outcome expectancies Fear of Recurrence of Event Self-efficacy Automatic Emotions and impulses arising from associative learning and/or innate dispositions Stimuli or cues for action Mood state/disorder (eg depression and anxiety)	All factors lining outside the individual that makes the performance of the behaviour possible or prompt it Physical Cost Access (eg availability of medication) Health Insurance Availability of medication Packaging Physical characteristics of medicine (eg taste, smell, size, shape, route of administration) Regimen complexity Frequent Change in Medication Lack of Clarity in Prescription Social support HCP-patient relationship/communication Limited Time for Consultation Social The cultural milieu that dictates the way we think about things The stigma of the disease, fear of disclosure Religious/cultural beliefs	These contextual factors are specific to LMICs Adherence Element Reasons for adherence Reasons for non-adherence Health systems element Health care experience and trust in the facilities Reliance on alternative medication

Notes: Adapted from Jackson C, Barber N, Eliasson L, Weinman J. Applying COM-B to medication 980adherence: a suggested framework for research and intervention. EurJ Health Psychol. 2014;16:7–17. Copyright (c) 2016 Christina Jackson, Lina Eliasson, Nick Barber, John Weinman. This work is licensed under a Creative Commons Attribution 4.0 International License.¹⁸