title: Identifying determinants of medication adherence following myocardial infarction using the Theoretical Domains Framework and the Health Action Process Approach.
abstract: BACKGROUND
  Despite evidence-based recommendations, adherence with secondary prevention medications post-myocardial infarction (MI) remains low. Taking medication requires behaviour change, and using behavioural theories to identify what factors determine adherence could help to develop novel adherence interventions.
  
  
  OBJECTIVE
  Compare the utility of different behaviour theory-based approaches for identifying modifiable determinants of medication adherence post-MI that could be targeted by interventions.
  
  
  METHODS
  Two studies were conducted with patients 0-2, 3-12, 13-24 or 25-36 weeks post-MI. Study 1: 24 patients were interviewed about barriers and facilitators to medication adherence. Interviews were conducted and coded using the Theoretical Domains Framework. Study 2: 201 patients answered a telephone questionnaire assessing Health Action Process Approach constructs to predict intention and medication adherence (MMAS-8).
  
  
  RESULTS
  Study 1: domains identified: Beliefs about Consequences, Memory/Attention/Decision Processes, Behavioural Regulation, Social Influences and Social Identity. Study 2: 64, 59, 42 and 58% reported high adherence at 0-2, 3-12, 13-24 and 25-36 weeks. Social Support and Action Planning predicted adherence at all time points, though the relationship between Action Planning and adherence decreased over time.
  
  
  CONCLUSIONS
  Using two behaviour theory-based approaches provided complimentary findings and identified modifiable factors that could be targeted to help translate Intention into action to improve medication adherence post-MI.
authors.affiliation: a Clinical Epidemiology , Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada.|b School of Epidemiology, Public Health and Preventive Medicine , University of Ottawa , Ottawa , Canada.
authors.forename: Justin
authors.identifier: http://orcid.org/0000-0002-2132-0703
authors.initials: J
authors.lastname: Presseau
authors.affiliation: c Population Health Research Institute , McMaster University , Hamilton , Canada.
authors.forename: J D
authors.identifier: http://orcid.org/0000-0003-2516-4952
authors.initials: JD
authors.lastname: Schwalm
authors.affiliation: a Clinical Epidemiology , Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada.|d Department of Medicine , University of Ottawa , Ottawa , Canada.
authors.forename: Jeremy M
authors.identifier: http://orcid.org/0000-0001-8015-8243
authors.initials: JM
authors.lastname: Grimshaw
authors.affiliation: e Department of Family and Emergency Medicine , Laval University , Quebec City , Canada.|f Research Centre of the Centre Hospitalier Universitaire de Québec , Quebec City , Canada.
authors.forename: Holly O
authors.identifier: http://orcid.org/0000-0003-4192-0682
authors.initials: HO
authors.lastname: Witteman
authors.affiliation: c Population Health Research Institute , McMaster University , Hamilton , Canada.
authors.forename: Madhu K
authors.identifier: http://orcid.org/0000-0001-6372-1348
authors.initials: MK
authors.lastname: Natarajan
authors.affiliation: a Clinical Epidemiology , Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Linklater
authors.affiliation: a Clinical Epidemiology , Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada.
authors.forename: Katrina
authors.identifier: http://orcid.org/0000-0002-7936-4602
authors.initials: K
authors.lastname: Sullivan
authors.affiliation: g Women's College Hospital , Toronto , Canada.|h Department of Family and Community Medicine , University of Toronto , Toronto , Canada.
authors.forename: Noah M
authors.identifier: http://orcid.org/0000-0003-2500-2435
authors.initials: NM
authors.lastname: Ivers
mesh_terms: D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control* / Q000523:psychology; D011582:Psychological Theory; D012944:Social Support; D016903:Drug Monitoring
keywords: Health Action Process Approach; Theoretical Domains Framework; medication adherence; myocardial infarction