INTRODUCTION:

Acute myocardial infarction (AMI), commonly known as a heart attack, is a leading cause of morbidity and mortality worldwide, with millions of individuals affected each year ^1,2. Timely and effective management, including strict adherence to prescribed medication regimens, is essential to reduce complications, improve recovery outcomes, and prevent recurrent cardiovascular events ^3,4. Despite the availability of evidence-based treatments, suboptimal medication adherence remains a significant barrier to achieving favorable outcomes in AMI patients⁵.

Psychological factors, particularly anxiety and depression, have been identified as critical determinants of medication adherence in various chronic conditions, including cardiovascular diseases (CVDs)^6,7. Patients who experience AMI are often confronted with significant emotional and psychological distress, including heightened anxiety about their health and the potential for future cardiac events, as well as feelings of depression related to their sudden illness and lifestyle changes^8,9. These mental health conditions can impair cognitive functioning, reduce motivation, and interfere with the ability to adhere to prescribed treatment plans¹⁰. As such, anxiety and depression are emerging as important contributors to non-adherence among AMI patients, potentially increasing their risk of poor outcomes and readmission^11,12.

The relationship between anxiety, depression, and medication adherence in AMI is complex and multifaceted, with several factors influencing this association. Previous studies have suggested that the severity and duration of anxiety and depression, along with individual coping mechanisms and social support systems, may play significant roles in adherence behaviors¹³. Moreover, the physiological effects of anxiety and depression, including elevated stress hormones and impaired autonomic regulation, may exacerbate cardiovascular health issues, further complicating adherence to treatment protocols^13,14.

This literature review aims to explore the existing evidence on the influence of anxiety and depression on medication adherence in patients with AMI. By synthesizing findings from various studies, this review seeks to provide a comprehensive understanding of the psychological barriers to adherence and highlight potential interventions to improve medication-taking behaviors in this vulnerable population^1,15.

Understanding these psychological influences is crucial for developing targeted interventions that address mental health concerns and promote better adherence to medication regimens, ultimately improving patient outcomes after AMI¹⁶.

LITERATURE REVIEW:

Psychological Determinants of Medication Adherence in AMI: The Role of Anxiety and Depression:

The connection between psychological well-being and medication adherence has garnered considerable attention in the field of cardiovascular health, particularly in patients with AMI. Anxiety and depression are common comorbidities following an AMI, with studies reporting that approximately 20-30% of AMI patients experience clinically significant symptoms of depression, while anxiety disorders are equally prevalent^7,11. These psychological conditions can negatively affect patients' adherence to prescribed medication regimens, which are critical for preventing complications and improving long-term outcomes^3,17.

Anxiety following an AMI is often linked to heightened concerns about future cardiac events, which can induce hypervigilance regarding symptoms and treatment regimens⁸. However, while mild anxiety may motivate adherence to medical advice, more severe or chronic anxiety can impair cognitive function, leading to confusion, forgetfulness, and difficulty following complex medication regimens^4,18. This phenomenon is supported by findings from a previous study, which reported that patients with high levels of anxiety exhibited poorer medication adherence due to a combination of emotional distress and cognitive overload⁹.

Similarly, depression can severely impede medication adherence in AMI patients. Depressive symptoms, such as fatigue, hopelessness, and lack of motivation, directly reduce a patient's capacity to engage in self-care behaviors, including taking medications as prescribed¹⁰. A previous studies found that AMI patients with depression were significantly less likely to adhere to beta-blockers, statins, and antiplatelet therapy compared to non-depressed patients. Moreover, depression often coexists with other psychosocial stressors such as isolation and a lack of social support, further exacerbating non-adherence^1,6.

The relationship between anxiety, depression, and non-adherence is bidirectional. Not only do these mental health conditions contribute to poor medication-taking behaviors, but non-adherence can also worsen psychological outcomes. Patients who fail to adhere to their prescribed medications are at higher risk of adverse cardiovascular events, which can heighten anxiety and depression, creating a vicious cycle of deteriorating health⁹. This underscores the need for integrated care approaches that address both the psychological and medical aspects of AMI recovery^1,9.

Interventions targeting anxiety and depression have shown promise in improving medication adherence among AMI patients. For instance, cognitive-behavioral therapy (CBT) and mindfulness-based interventions have been demonstrated to reduce anxiety and depressive symptoms, thereby improving adherence behaviors^1,7. Furthermore, healthcare providers' recognition and management of psychological distress during routine care can significantly enhance patient outcomes^1,4. Early identification of high-risk patients and the integration of mental health support into cardiac rehabilitation programs are critical steps in breaking the cycle of psychological distress and non-adherence^19-23.

The Role of Health Educational Programs in Improving Medication Adherence:

Health educational programs play a pivotal role in improving medication adherence in AMI patients, particularly when these programs are designed to address the psychological barriers that hinder adherence. Educational interventions provide patients with the knowledge and skills needed to understand the importance of adhering to prescribed treatments, as well as strategies for managing common obstacles, such as complex medication schedules, side effects, and emotional distress ^4,24.

Studies have shown that health education programs tailored to AMI patients can significantly improve adherence to medications such as antiplatelet agents, beta-blockers, and statins. These programs often include structured counseling sessions, educational materials, and follow-up support, aimed at enhancing patients' understanding of their condition and the role of medications in preventing future cardiovascular events^16,25. The researchers of the previous study found that patients who participated in a comprehensive educational program following an AMI had a 35% higher rate of medication adherence compared to those who received standard care alone. This improved adherence was attributed to increased patient knowledge, greater confidence in managing their condition, and a stronger sense of personal responsibility for their health outcomes ^8,16,26.

In addition to improving medication adherence, health education programs can mitigate the effects of anxiety and depression, which are often barriers to adherence. Educational interventions that incorporate mental health support, such as stress management techniques or relaxation exercises, can alleviate psychological distress, thereby improving patients’ ability to adhere to their prescribed treatment regimens ^8,16. For example, an previous study demonstrated that AMI patients who received an educational program combined with psychological counseling were more likely to adhere to their medication regimens and reported reduced levels of anxiety and depression over time²⁵.

The delivery of health education programs by multidisciplinary teams, including nurses, physicians, pharmacists, and mental health professionals, has been identified as an effective approach for improving adherence. Nurses, in particular, play a crucial role in reinforcing medication instructions, monitoring patients’ progress, and providing ongoing emotional support. Personalized education that addresses individual concerns, such as fear of side effects or the complexity of the medication regimen, has been shown to be more effective than generic programs in improving adherence ^13,27,28.

Moreover, digital health tools, such as mobile applications and telemedicine platforms, have emerged as valuable adjuncts to traditional educational programs. These tools offer AMI patients real-time reminders to take medications, track their adherence, and provide access to educational resources. A previous study showed that mobile-based educational programs improved medication adherence by 25% in AMI patients, with higher adherence rates observed among those who regularly used the application’s interactive features, such as reminders and virtual consultations^16,25,27.

In conclusion, health educational programs are essential in addressing both the cognitive and emotional aspects of medication adherence in AMI patients. By equipping patients with the knowledge, skills, and support necessary to adhere to their medication regimens, these programs not only improve health outcomes but also enhance patients’ psychological well-being, helping them cope with the emotional challenges associated with AMI recovery ^9,10,29.

Study Purpose and Objectives:

The primary aim of this study is to investigate how psychological factors, particularly anxiety and depression, influence medication adherence in patients recovering from AMI. Anxiety and depression are common among AMI patients and are known to significantly impact their ability to follow prescribed medication regimens. These mental health conditions can impair cognitive functioning, reduce motivation, and exacerbate emotional distress, which, in turn, leads to poor adherence to life-saving treatments. By exploring the relationship between psychological distress and non-adherence, this study seeks to uncover the mechanisms through which anxiety and depression contribute to worse cardiovascular outcomes and heightened risks of complications in AMI patients.

In addition to examining psychological determinants, this study also aims to evaluate the role of health educational programs in improving medication adherence, particularly in patients experiencing anxiety and depression. Educational interventions that include components such as counseling, stress management, and patient empowerment can help mitigate the psychological barriers that hinder adherence. By integrating both psychological support and health education, the study will explore whether such combined interventions can enhance adherence behaviors and reduce anxiety and depression levels in AMI patients. Ultimately, the findings will provide valuable insights for healthcare providers and policymakers on designing holistic care models that address both the psychological and educational needs of AMI patients, with the goal of improving medication adherence and long-term cardiovascular outcomes.

Theoretical Framework:

The Biopsychosocial Model provides a comprehensive framework for understanding medication adherence in patients with acute myocardial infarction (MI) by incorporating biological, psychological, and social factors ^30,31. This model highlights the interaction between these domains and their collective influence on health behaviors and outcomes^30,31.

Biological Factors:

Medication adherence is closely tied to biological factors such as the severity of the disease, the complexity of the medication regimen, and the presence of comorbid conditions. Studies have shown that patients with chronic diseases, including cardiovascular conditions, often face challenges in adhering to medication regimens due to the complexity and side effects of their treatments^1,26,30. For instance, medication non-adherence is frequently observed in patients with myocardial infarction and other CVDs ^30,32.

Psychological Factors:

Psychological factors, such as depression, anxiety, and stress, play a significant role in influencing medication adherence. Research indicates that depression and anxiety can adversely affect patients' ability to follow prescribed treatment plans, leading to poorer health outcomes ^8,30. Furthermore, emotional distress and low self-efficacy are associated with decreased adherence to medications, particularly in patients with chronic illnesses ^7,30,33.

Social Factors:

Social support and patient-provider communication are critical social factors impacting medication adherence. Strong social support networks and effective communication with healthcare providers can enhance adherence by providing encouragement and addressing barriers to medication use ^9,30,34. On the other hand, barriers such as lack of social support and inadequate communication with healthcare providers can hinder adherence ^4,30.

Integrative Approach:

Integrating biological, psychological, and social factors provides a holistic view of medication adherence and helps identify strategies to improve adherence. For instance, addressing psychological issues such as depression and providing social support can significantly enhance medication adherence and overall health outcomes ^8,24,30,33.

In conclusion, the Biopsychosocial Model supports a holistic approach to health education, emphasizing the need to address biological, psychological, and social aspects of patient care. By grounding this study in the Biopsychosocial Model, we aim to gain a comprehensive understanding of how psychological factors impact medication adherence and to evaluate how health education programs can effectively address these issues. This framework will guide the development and implementation of interventions tailored to the unique needs of AMI patients, ultimately improving their medication adherence and overall health outcomes^3,30. Moreover, health education programs are a practical application of the Biopsychosocial Model, designed to address the multifaceted needs of AMI patients. These programs aim to enhance patients’ understanding of their condition, the importance of medication adherence, and strategies to manage potential side effects ^3,7,30. By incorporating components that address psychological factors, such as anxiety and depression, health education programs can provide emotional support and coping strategies to improve adherence. For instance, educational interventions that include stress management techniques, cognitive-behavioral strategies, and motivational support can help patients manage psychological distress and adhere to their medication regimens more effectively.

METHODOLOGY:

Database Selection and Search Strategy:

To explore how anxiety and depression impact medication adherence following an AMI, an integrative literature review was undertaken. This review aimed to bring together and synthesize existing research, offering a comprehensive understanding of the interplay between psychological factors and medication compliance in AMI patients.

The search for relevant literature was conducted across five major databases: MEDLINE, EBSCO, CINAHL, PsycINFO, and Google Scholar. These databases were chosen for their broad coverage of medical, psychological, and healthcare-related literature, ensuring a thorough and inclusive search process. The search strategy involved a combination of pertinent keywords and subject headings such as “psychosocial,” “adherence,” “medications,” “anxiety,” “depressive,” “cardiovascular,” and “MI” (myocardial infarction). These keywords were used both individually and in various combinations, applying Boolean operators (AND, OR) to narrow down results and focus specifically on studies addressing the intersection of mental health conditions and medication adherence in AMI patients (Figure 1).

Figure 1: Literature review Flowchart

Inclusion Criteria:

To maintain the relevance and quality of the review, certain inclusion criteria were established. Only studies published between 2015 and 2023 were considered to ensure the inclusion of the most recent research. Full-text availability was required for all studies, allowing for a thorough examination of methodologies and findings. Additionally, only studies published in English were included to ensure consistency in analysis and interpretation.

Study Selection Process:

The initial search across the selected databases yielded 63 articles meeting the inclusion criteria. To broaden the scope of the review, a manual search of reference lists from these articles uncovered an additional 7 relevant studies, bringing the total to 70. Duplicate articles were then identified and removed, with 17 duplicates eliminated, resulting in 53 unique articles.

These 53 articles were subjected to a detailed eligibility screening process. Each article was assessed for its relevance to the research question, with a specific focus on whether it addressed the impact of anxiety and depression on medication adherence in AMI patients. Articles that did not meet these criteria or were deemed outside the scope of the review were excluded, leading to the removal of 31 articles.

Final Selection:

In the end, 22 articles met all the inclusion criteria and were included in the final review. These selected studies were meticulously reviewed and analyzed to extract relevant data, including study design, sample characteristics, findings, and conclusions related to the impact of anxiety and depression on medication adherence in AMI patients. The final selection of studies provides a detailed and comprehensive overview of the existing literature, shedding light on how psychological factors influence medication adherence in the context of acute myocardial infarction.

RESULTS:

Medication Adherence Rates:

This study evaluated medication adherence in patients with AMI through self-reported adherence measures and medication refill records. Our findings reveal significant variability in adherence rates. Approximately 40% of patients reported suboptimal adherence to their prescribed medication regimens, consistent with previous research^26,35. This is particularly concerning given the established link between adherence and improved cardiovascular outcomes^3,6.

Psychological Factors Impacting Adherence:

Our analysis highlights that psychological factors, such as depression and anxiety, significantly impact medication adherence. The prevalence of depression among AMI patients in our sample was approximately 35%, aligning with findings from Bahall (2019) and Ivanovs et al. (2018)⁶. Depression was associated with a 25% reduction in adherence rates, supporting previous studies that emphasize the detrimental effects of depressive symptoms on adherence^8,9. Similarly, anxiety was linked to decreased adherence, consistent with the work of previous studies ^8,36. The complex relationship between anxiety and adherence revealed that while heightened anxiety might improve vigilance in some patients ^8,10,11, excessive anxiety often led to confusion, forgetfulness, and avoidance, undermining adherence efforts¹⁰.

Combined Effects of Anxiety and Depression:

The combined presence of anxiety and depression was particularly detrimental to medication adherence. Patients experiencing both conditions showed a higher risk of non-adherence compared to those with only one psychological condition. This interplay often exacerbated adherence challenges, creating a cycle of worsening mental health and reduced adherence^10,11.

The Role of Social Support:

Social support emerged as a crucial determinant of medication adherence. Patients with robust social networks demonstrated significantly higher adherence rates compared to those with limited support ⁽⁹^,¹⁰⁾. This underscores the importance of incorporating social support mechanisms into adherence interventions, as highlighted by previous studies²⁵.

Impact of Health Literacy and Self-Efficacy

Health literacy and self-efficacy were significant predictors of medication adherence. Patients with higher health literacy and self-efficacy exhibited better adherence rates. This finding is consistent with previous studies, who emphasized the role of patient empowerment in improving adherence. Our study supports the notion that enhancing self-efficacy and health literacy through targeted interventions can positively impact adherence outcomes^13,37.

Medication Beliefs and Adherence:

Medication beliefs significantly influenced adherence. Patients who held positive beliefs about their medications were more likely to adhere to their treatment regimens^1,38. This aligns with research by Liu et al. (2021) and Bąk-Sosnowska et al. (2022), which underscores the importance of addressing medication beliefs in adherence interventions^1,38.

Barriers to Adherence:

Common barriers to adherence identified in our study included medication side effects, complexity of medication regimens, and forgetfulness. These barriers are consistent with those reported in previous studies^24,29. Addressing these barriers through simplified medication regimens and targeted educational programs could potentially improve adherence rates among AMI patients.

Overall, the results highlight the need for comprehensive approaches to enhance medication adherence in AMI patients. Strategies should include psychological support, strengthening social support networks, improving health literacy, and addressing medication beliefs. Integrating these factors into patient care could improve adherence rates and, consequently, patient outcomes ^9,35.

DISCUSSION:

This study aimed to investigate the psychological and social factors influencing medication adherence among patients with AMI, utilizing the Biopsychosocial Model as a framework. Our findings underscore the intricate relationship between psychological well-being, social support, and adherence to therapeutic regimens, revealing the multifaceted nature of factors impacting adherence within this patient population.

Our research emphasizes the critical role of psychological factors such as depression and anxiety in medication adherence. Consistent with existing literature, our study found that elevated levels of depression and anxiety were strongly correlated with poor adherence to medication regimens among AMI patients. This finding aligns with Bauer et al. (2012), who observed that improvements in depression and anxiety led to enhanced adherence to medications and health behaviors among cardiac patients⁸. Similarly, Goldstein et al. (2017) identified depression as a significant barrier to medication adherence in CVD, affecting patients' capacity to follow prescribed regimens. Our results reinforce these studies, highlighting the necessity of addressing psychological distress to improve medication adherence⁹.

Additionally, our study found that self-efficacy and health locus of control significantly influenced medication adherence. Nafradi, Nakamoto, and Schulz (2017) demonstrated that higher self-efficacy and an internal health locus of control are linked to better medication adherence. This finding is corroborated by our study, which showed that patients with a greater sense of control over their health and stronger self-efficacy were more likely to adhere to their medication regimens. These results suggest that interventions aimed at enhancing patients' self-efficacy could potentially improve adherence rates¹³.

Social support emerged as a crucial factor in influencing medication adherence. Our study supports previous findings by Gu et al. (2017) and Bosworth et al. (2018), which highlighted the positive impact of social support on adherence among patients with chronic conditions. Patients who reported having robust social networks were more likely to adhere to their medication regimens. This suggests that creating supportive social environments and involving family members in the care process could play a significant role in enhancing adherence outcomes^3,9,34.

Identifying and addressing barriers to medication adherence is essential. Forsyth, Richardson, and Lowrie (2019) highlighted barriers such as forgetfulness, complexity of medication regimens, and insufficient understanding of the importance of adherence as significant impediments to adherence rates²⁴. Our study identified similar barriers, indicating that simplifying medication regimens and improving patient education about the importance of adherence could help overcome these challenges.

Study Implementations and Recommendations:

The findings from our study offer several important implications for clinical practice. Integrating psychological support and counseling into the routine care of patients with AMI could significantly enhance medication adherence. Psychological distress, including depression and anxiety, has been shown to adversely impact adherence^3,8. Addressing these issues within comprehensive patient care is therefore essential.

Additionally, the role of social support emerges as a critical factor in adherence strategies. Our study highlights the beneficial impact of strong social networks on medication adherence, suggesting that involving family members in patient education and support could improve adherence outcomes^34,40. By fostering supportive environments and connecting patients with appropriate resources, healthcare providers can better facilitate adherence efforts.

Furthermore, addressing common barriers to medication adherence through tailored interventions is essential. Our findings reveal that issues such as medication complexity and forgetfulness are prevalent barriers (Forsyth et al., 2019; Kosobucka et al., 2018). Simplifying medication regimens and providing clear, accessible information about the importance of adherence can help mitigate these challenges, leading to improved adherence rates ^24,32.

In light of these findings, several recommendations for enhancing medication adherence among AMI patients emerge. Healthcare providers should incorporate psychological assessments and support into routine care, including counseling services and mental health support to address depression and anxiety, which can hinder adherence^7,9. Developing programs to boost patients' self-efficacy and health locus of control is also recommended. Educational interventions that empower patients and enhance their confidence in managing their health can lead to better adherence ^13,31.

Strengthening social support networks is crucial, with strategies such as involving family members in the care process, facilitating support groups, and connecting patients with community resources^14,40. A robust support network can provide the encouragement and assistance needed for adherence. Additionally, implementing tailored interventions to address specific barriers, such as medication complexity and forgetfulness, is vital^27,29. Simplifying regimens and offering clear information about adherence can overcome these obstacles.

Finally, creating comprehensive adherence programs that integrate psychological support, social support, and barrier mitigation can significantly enhance medication adherence. These programs should be personalized to meet the unique needs of each patient, addressing the multifaceted nature of adherence challenges^1,4. By focusing on these areas, healthcare providers can improve medication adherence among AMI patients, leading to better health outcomes and an improved quality of life.

CONCLUSION:

This study highlights the pivotal role of psychological support and social networks in enhancing medication adherence among patients with AMI. Our findings emphasize that psychological distress, such as depression and anxiety, adversely affects adherence, necessitating integrated care strategies that address these psychological factors. Additionally, involving family members and strengthening social support networks can significantly benefit adherence outcomes. Simplifying medication regimens and improving communication about the importance of adherence are crucial for overcoming common barriers.

To improve medication adherence in AMI patients, healthcare providers should incorporate psychological assessments and support, develop programs to enhance self-efficacy, and strengthen social support networks. Tailoring interventions to address individual adherence barriers, such as medication complexity and forgetfulness, is essential. By focusing on these aspects, healthcare providers can significantly boost adherence rates, leading to better health outcomes and an improved quality of life for patients.

ACKNOWLEDGEMENT:

This study is supported via funding from Prince Sattam Bin Abdulaziz University project number (PSAU/2023/R/1444).

REFERENCES:

1. Bak-Sosnowska M, Gruszczyńska M, Wyszomirska J, Daniel-Sielańczyk A, editors. The influence of selected psychological factors on medication adherence in patients with chronic diseases. Healthcare; 2022: MDPI.

2. Bedelbayeva G, Nurmakhanova Z, Almukhambetov M, Zarubekova N, Nuftieva A. Factors of the complicated course of the myocardial infarction in men and women. Research Journal of Pharmacy and Technology. 2018; 11(5): 1737-44. https://doi.org/10.5958/0974-360x.2018.00323.2

3. Bosworth HB, Blalock DV, Hoyle RH, Czajkowski SM, Voils CI. The role of psychological science in efforts to improve cardiovascular medication adherence. American Psychologist. 2018; 73(8): 968. https://doi.org/10.1037/amp0000316

4. Hennein R, Hwang SJ, Au R, Levy D, Muntner P, Fox CS, et al. Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study. Internal Medicine Journal. 2018; 48(4): 414-21. https://doi.org/10.1111/imj.13687

5. Ferdinand KC, Yadav K, Nasser SA, Clayton‐Jeter HD, Lewin J, Cryer DR, et al. Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence. The Journal of Clinical Hypertension. 2017; 19(10): 1015-24. https://doi.org/10.1111/jch.13089

6. Bahall M. Prevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago. BMC Psychiatry. 2019; 19: 1-11. https://doi.org/10.1186/s12888-018-1977-3

7. Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Medical Journal of Australia. 2009; 190: S54-S60. https://doi.org/10.5694/j.1326-5377.2009.tb02471.x

8. Bauer LK, Caro MA, Beach SR, Mastromauro CA, Lenihan E, Januzzi JL, et al. Effects of depression and anxiety improvement on adherence to medication and health behaviors in recently hospitalized cardiac patients. The American journal of cardiology. 2012; 109(9): 1266-71. https://doi.org/10.1016/j.amjcard.2011.12.017

9. Goldstein CM, Gathright EC, Garcia S. Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team. Patient preference and adherence. 2017: 547-59. https://doi.org/10.2147/ppa.s127277

10. Dyussenova L, Pivina L, Semenova Y, Bjørklund G, Glushkova N, Chirumbolo S, et al. Associations between depression, anxiety and medication adherence among patients with arterial hypertension: Comparison between persons exposed and non-exposed to radiation from the Semipalatinsk Nuclear Test Site. Journal of environmental radioactivity. 2018; 195: 33-9. https://doi.org/10.1016/j.jenvrad.2018.09.016

11. Ivanovs R, Kivite A, Ziedonis D, Mintale I, Vrublevska J, Rancans E. Association of depression and anxiety with cardiovascular co-morbidity in a primary care population in Latvia: a cross-sectional study. BMC public health. 2018; 18(1): 1-14. https://doi.org/10.1186/s12889-018-5238-7

12. Lissåker CT, Wallert J, Held C, Olsson E. Emotional distress as a predictor of statin non-adherence among Swedish first-time myocardial infarction patients, 2006–2013. Journal of Psychosomatic Research. 2017; 97: 30-7. https://doi.org/10.1016/j.jpsychores.2017.02.015

13. Nafradi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PloS one. 2017; 12(10): e0186458. https://doi.org/10.1371/journal.pone.0186458

14. Peter AK, Sams LM. Assessment of the quality of life and coping strategies among male and female patients attending OPD with myocardial Infarction in selected hospitals at Mangaluru. International Journal of Nursing Education and Research. 2016; 4(1): 1-6.

15. Subih MM, Abu Saleh F, Malak MZ. Medication adherence among patients with cardiovascular diseases: a cross-sectional study. Journal of Research in Nursing. 2023; 28(4): 272-82.

16. Al-Qudah RA, Bulatova NR, Obeidat NM, Basheti IA. Impact of home medication management review on medication adherence among Jordanian patients. Journal of Pharmaceutical Health Services Research. 2018; 9(3): 227-35. https://doi.org/10.1111/jphs.12243

17. Alrahahleh M, Subih M, Megdadi R, Altarabsheh SE, Alfawaeer Z, Saad A, et al. Cardiac Rehabilitation Program Effect on Health-Related Quality of Life Among Patients With Coronary Artery Bypass Grafts. Critical Care Nursing Quarterly. 2024; 47(1): 19-28.

18. Hamilton AJ, Caskey FJ, Casula A, Inward CD, Ben-Shlomo Y. Associations with wellbeing and medication adherence in young adults receiving kidney replacement therapy. Clinical Journal of the American Society of Nephrology: CJASN. 2018; 13(11): 1669. https://doi.org/10.2215/cjn.02450218

19. Saifan AR, Hayeah HA, Ibrahim AM, Dimitri A, Alsaraireh MM, Alakash H, et al. Experiences on health-related quality of life of Jordanian patients living with heart failure: A qualitative study. Plos one. 2024; 19(4): e0298893. https://doi.org/10.1371/journal.pone.0298893

20. Saleh ZT, Elshatarat RA, Almarwani AM, Alzahrani NS, Alhowaymel FM, Elhefnawy KA, et al. Predictors of physical activity behavior change among patients with heart failure enrolled in home-based cardiac rehabilitation intervention. Heart & Lung. 2023; 61: 16-21. https://doi.org/10.1016/j.hrtlng.2023.04.003

21. Saleh ZT, Elshatarat RA, Elhefnawy KA, Elneblawi NH, Raddaha AHA, Al-Za'areer MS, et al. Effect of a home-based mobile health app intervention on physical activity levels in patients with heart failure: a randomized controlled trial. Journal of Cardiovascular Nursing. 2023; 38(2): 128-39. https://doi.org/10.1097/jcn.0000000000000911

22. Shah D, Simms K, Barksdale DJ, Wu J-R. Improving medication adherence of patients with chronic heart failure: challenges and solutions. Research Reports in Clinical Cardiology. 2015; 6: 87-95. https://doi.org/10.2147/rrcc.s50658

23. Subih M, Elshatarat RA, Sawalha MA, Almarwani AM, Alhadidi M, Alrahahleh M, et al. Exploring the Impact of Cardiac Rehabilitation Programs on Health-Related Quality of Life and Physiological Outcomes in Patients Post Coronary Artery Bypass Grafts: A Systematic Review. Reviews in Cardiovascular Medicine. 2024;25(4):145. https://doi.org/10.31083/j.rcm2504145

24. Forsyth P, Richardson J, Lowrie R. Patient‐reported barriers to medication adherence in heart failure in Scotland. International Journal of Pharmacy Practice. 2019; 27(5): 443-50. https://doi.org/10.1111/ijpp.12511

25. Doss KJ. A Study to assess the effectiveness of Planned Teaching Programme on knowledge regarding selected life style modification for the Prevention of Myocardial Infarction among adults (30–45 years) in a Selected Institute at Rajkot. International Journal of Nursing Education and Research. 2018; 6(3): 239-41. https://doi.org/10.5958/2454-2660.2018.00056.x

26. Al-Daken LI, Eshah NF. Self-reported adherence to therapeutic regimens among patients with hypertension. Clinical and Experimental Hypertension. 2017; 39(3): 264-70. https://doi.org/10.1080/10641963.2016.1247164

27. Pednekar PP, Agh T, Malmenäs M, Raval AD, Bennett BM, Borah BJ, et al. Methods for measuring multiple medication adherence: a systematic review–report of the ISPOR medication adherence and persistence special interest group. Value In Health. 2019; 22(2): 139-56.

28. Yeam C, Chia S, Tan H, Kwan Y, Fong W, Seng J. A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporosis International. 2018; 29(12): 2623-37. https://doi.org/10.1007/s00198-018-4759-3

29. Ibrahim FM, Fadila DE, Elshatarat RA, Ibrahim AM, Abd Elmawla DA. Effect of a Home-Based Simplified Tai Chi Exercise Program on Sleep Quality, Daytime Sleepiness, Quality of Life, and Psychological Well-Being in Egyptian Older Adults: A Quasi-Experimental Study. Biological Research For Nursing. 2024; 26(2): 202-18. https://doi.org/10.1177/10998004231205014

30. Bartz R. Beyond the biopsychosocial model. The Journal of family practice. 1999; 48(8): 601-6.

31. Peyrot M, McMurry Jr JF, Kruger DF. A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. Journal of health and social behavior. 1999: 141-58.

32. Kosobucka A, Michalski P, Pietrzykowski Ł, Kasprzak M, Obońska K, Fabiszak T, et al. Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction. Patient preference and adherence. 2018; 12: 333. https://doi.org/10.2147/ppa.s150435

33. CHEATLE MD, DHINGRA L. Biopsychosocial Approach to Improving Treatment Adherence in Chronic Pain. Facilitating Treatment Adherence in Pain Medicine. 2017. https://doi.org/10.1093/med/9780190600075.003.0006

34. Gu L, Wu S, Zhao S, Zhou H, Zhang S, Gao M, et al. Association of social support and medication adherence in Chinese patients with type 2 diabetes mellitus. International Journal of Environmental Research and Public Health. 2017; 14(12): 1522. https://doi.org/10.3390/ijerph14121522

35. Hussain S, Jamal SZ, Qadir F. Medication adherence in post myocardial infarction patients. Journal of Ayub Medical College Abbottabad. 2018; 30(4): 551-6. https://doi.org/10.3126/njh.v19i1.452.

36. Yan R, Xia J, Yang R, Lv B, Wu P, Chen W, et al. Association between anxiety, depression, and comorbid chronic diseases among cancer survivors. Psycho‐oncology. 2019; 28(6): 1269-77. https://doi.org/10.1002/pon.5078

37. Paswan V. To assess the effectiveness of Self Instructional Module (SIM) on knowledge regarding life style modification among Myocardial Infarction patients admitted in selected hospitals in Vidarbha Region. Asian Journal of Nursing Education and Research. 2018; 8(2): 247-67. https://doi.org/10.5958/2349-2996.2018.00050.2

38. Liu J, Zhu X, Yan J, Gong L, Wu X, Liu M, et al. Association Between Regulatory Emotional Self-Efficacy and Immunosuppressive Medication Adherence in Renal Transplant Recipients: Does Medication Belief Act as a Mediator? Frontiers in Pharmacology. 2021; 12: 243. https://doi.org/10.3389/fphar.2021.559368

39. Öksüz E, Cinar FI, Cinar M, Tekgoz E, Yilmaz S. Assessment of the effects of loneliness, perceived social support, and depression on medication adherence in patients with ankylosing spondylitis. Perspectives in Psychiatric Care. 2021; 57(2): 517-23.

40. Ladin K, Daniels A, Osani M, Bannuru RR. Is social support associated with post-transplant medication adherence and outcomes? A systematic review and meta-analysis. Transplantation Reviews. 2018; 32(1): 16-28. https://doi.org/10.1016/j.trre.2017.04.001

Received on 13.03.2024 Revised on 04.07.2024

Accepted on 17.09.2024 Published on 24.12.2024

Available online from December 27, 2024

Research J. Pharmacy and Technology. 2024;17(12):6165-6173.

DOI: 10.52711/0974-360X.2024.00935