Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review

Suebsarn Ruksakulpiwat; Chitchanok Benjasirisan; Kedong Ding; Lalipat Phianhasin; Sutthinee Thorngthip; Anuoluwapo D Ajibade; Jai Thampakkul; Amy Y Zhang; Joachim G Voss

doi:10.2147/PPA.S420059

Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review

Patient Prefer Adherence. 2023 Aug 30:17:2161-2174. doi: 10.2147/PPA.S420059. eCollection 2023.

Authors

Suebsarn Ruksakulpiwat¹, Chitchanok Benjasirisan¹, Kedong Ding², Lalipat Phianhasin¹, Sutthinee Thorngthip³, Anuoluwapo D Ajibade⁴, Jai Thampakkul⁵, Amy Y Zhang⁶, Joachim G Voss⁶

Affiliations

¹ Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
² Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA.
³ Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
⁴ College of Art and Science, Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA.
⁵ Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA.
⁶ Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.

Abstract

Introduction: Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke.

Objective: To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH.

Methods: This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative.

Results: Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients.

Conclusion: Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.

Keywords: ischemic stroke; medication adherence; social determinants of health; systematic review.

Publication types

Review

Grants and funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Mahidol University, Thailand, supported the article processing charge.