• Elise Crayton, Marion Fahey, Mark Ashworth, Sarah Jane Besser, John Weinman, and Alison J Wright.
• Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, 6th Floor, Addison House, Guy's Campus, London, SE1 1UL, UK. elise.crayton@kcl.ac.uk.
• Ann Behav Med. 2017 Dec 1; 51 (6): 833-845.

BackgroundMedications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. To improve adherence, its determinants must be understood. To date, no systematic review has mapped identified determinants into the Theoretical Domains Framework (TDF) in order to establish a more complete understanding of medication adherence.PurposeThe aim of this study was to identify psychological determinants that most influence stroke survivors' medication adherence.MethodsIn line with the prospectively registered protocol (PROSPERO CRD42015016222), five electronic databases were searched (1953-2015). Hand searches of included full text references were undertaken. Two reviewers conducted screening, data extraction and quality assessment. Determinants were mapped into the TDF.ResultsOf 32,825 articles, 12 fulfilled selection criteria (N = 43,984 stroke survivors). Tested determinants mapped into 8/14 TDF domains. Studies were too heterogeneous for meta-analysis. Three TDF domains appeared most influential. Negative emotions ('Emotions' domain) such as anxiety and concerns about medications ('Beliefs about Consequences' domain) were associated with reduced adherence. Increased adherence was associated with better knowledge of medications ('Knowledge' domain) and stronger beliefs about medication necessity ('Beliefs about Consequences' domain). Study quality varied, often lacking information on sample size calculations.ConclusionsThis review provides foundations for evidence-based intervention design by establishing psychological determinants most influential in stroke survivors' medication adherence. Six TDF domains do not appear to have been tested, possibly representing gaps in research design. Future research should standardise and clearly report determinant and medication adherence measurement to facilitate meta-analysis. The range of determinants explored should be broadened to enable more complete understanding of stroke survivors' medication adherence.

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