Factors that influence adherence to aspirin therapy in the prevention of preeclampsia amongst high-risk pregnant women: A mixed method analysis
Factors that influence adherence to aspirin therapy in the prevention of preeclampsia amongst high-risk pregnant women: A mixed method analysis
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DOI：
10.1371/journal.pone.0229622
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发表时间：
2020-02-27
期刊：
影响因子：
3.7
通讯作者：
Makris, Angela
中科院分区：
文献类型：
--
作者：
Shanmugalingam, Renuka;Mengesha, Zelalem;Makris, Angela
研究背景妊娠期不坚持用药越来越受到重视，往往会导致更高的可预防的母婴发病率和死亡率。在高危孕妇中，不坚持使用预防性阿司匹林与先兆子痫、早产和宫内生长受限的发生率较高有关。本研究旨在从女性的角度了解影响孕妇服用阿司匹林依从性的因素。目的本研究旨在从女性的角度了解影响孕妇服用阿司匹林的因素。研究设计采用序贯-探索性设计的混合方法，对最近需要产前预防性服用阿司匹林的高危妊娠妇女进行定量(n=122)和定性(n=6)调查。招募的妇女在澳大利亚西南部悉尼地方卫生区内的三个高危怀孕诊所之一接受产前护理。定量研究是通过电子匿名调查进行的，定性研究是通过面对面访谈进行的。将获得的数据与女性服用阿司匹林的依从性进行相关性分析，结果发现，从女性的角度来看，影响她们孕期服用阿司匹林依从性的两个关键主题是：(1)避孕药负担和非故意遗漏(2)与卫生保健提供者(HCP)的沟通和关系。服药负担及其相关的非故意遗漏都与依从性降低密切相关(Phi=0.8，p=0.02，Phi=0.8，p<；0.01)，而提醒策略的使用将意外遗漏和改善的依从性降至最低(Phi=0.9，p<；0.01)。HCP之间的持续沟通和良好的患者-HCP关系与依从性的提高密切相关(Phi=0.7，p=0.04，F=0.9，p=<；0.01)，更重要的是，研究发现在缓解可能对怀孕期间阿司匹林依从性产生负面影响的因素方面发挥了重要作用。结论本研究确定了对高危孕妇依从性产生积极和负面影响的因素。IS强调了认识到怀孕期间避孕药负担的影响的重要性，以及就提醒战略的效用向妇女提供咨询的必要性，以尽量减少非故意遗漏。重要的是，它强调了通过有效和一致的沟通建立积极的患者-HCP关系的重要性，以实现预期的孕产妇和胎儿结局。
BackgroundNon-adherence with medications in pregnancy is increasingly recognized and often results in a higher rate of preventable maternal and fetal morbidity and mortality. Non-adherence with prophylactic aspirin amongst high-risk pregnant women is associated with higher incidence of preeclampsia, preterm delivery and intrauterine growth restriction. Yet, the factors that influences adherence with aspirin in pregnancy, from the women's perspective, remains poorly understood.ObjectiveThe study is aimed at understanding the factors, from the women's perspective, that influenced adherence with prophylactic aspirin in their pregnancy.Study designA sequential-exploratory designed mixed methods quantitative (n = 122) and qualitative (n = 6) survey of women with recent high-risk pregnancy necessitating antenatal prophylactic aspirin was utilized. Women recruited underwent their antenatal care in one of three highrisk pregnancy clinics within the South Western Sydney Local Health District, Australia. The quantitative study was done through an electronic anonymous survey and the qualitative study was conducted through a face-to-face interview. Data obtained was analysed against women's adherence with aspirin utilizing phi correlation (f) with significance set at < 0.05.ResultsTwo key themes, from the women's perspective, that influenced their adherence with aspirin in pregnancy were identified; (1) pill burden and non-intention omission (2) communication and relationship with health care provider (HCP). Pill burden and its associated non-intentional omission, both strongly corelated with reduced adherence (Phi = 0.8, p = 0.02, Phi = 0.8, p< 0.01) whilst the use of reminder strategies minimized accidental omission and improved adherence (Phi = 0.9, p< 0.01). Consistent communication between HCPs and a good patient-HCP relationship was strongly associated with improved adherence (Phi = 0.7, p = 0.04, F = 0.9, p = < 0.01) and more importantly was found to play an important role in alleviating factors that had potentials to negatively influence adherence with aspirin in pregnancy.ConclusionThis study identified factors that both positively and negatively influenced adherence with aspirin amongst high-risk pregnant women. Is highlights the importance in recognizing the impact of pill burden in pregnancy and the need to counsel women on the utility of reminder strategies to minimize non-intentional omission. Importantly, it emphasizes on the importance of a positive patient-HCP relationship through effective and consistent communication to achieve the desired maternal and fetal outcomes.