Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 3;19(5):e0302720.
doi: 10.1371/journal.pone.0302720. eCollection 2024.

Barriers and facilitators of adherence to low-dose aspirin during pregnancy: A co-produced systematic review and COM-B framework synthesis of qualitative evidence

Raya Vinogradov  1   2   3 , Eleanor Holden  4 , Mehali Patel  4   5 , Rowan Grigg  4   6 , Linda Errington  1 , Vera Araújo-Soares  7 , Judith Rankin  1   2
Affiliations

Barriers and facilitators of adherence to low-dose aspirin during pregnancy: A co-produced systematic review and COM-B framework synthesis of qualitative evidence

Raya Vinogradov et al. PLoS One. .

Abstract

Introduction: Women at increased risk of developing pre-eclampsia are advised to take a daily low-dose of aspirin from 12 weeks of pregnancy to reduce their risks. Despite the well-established prophylactic effect of aspirin, adherence to this therapy is low. This systematic review aimed to summarise evidence on the barriers and facilitators of adherence to low-dose aspirin to inform intervention development to support decision making and persistence with aspirin use for pre-eclampsia prevention.

Materials and methods: A systematic review and meta-synthesis of qualitative research was co-produced by representatives from charities, and public, clinical and academic members. Eight electronic databases (MEDLINE, PsycINFO, CINAHL, Web of Science, Scopus, EMBASE, Prospero, OpenGrey), archives of charities and professional organisations were searched (between October and November 2023 and re-run in August 2023) using predefined search terms. Studies containing qualitative components related to barriers and facilitators of adherence to low-dose aspirin during pregnancy were included. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. A combination of the COM-B framework with phases of adherence process as defined by international taxonomy was used as the coding framework. Co-production activities were facilitated by use of 'Zoom' and 'Linoit'.

Results: From a total of 3377 papers identified through our searches, five published studies and one dissertation met our inclusion criteria. Studies were published from 2019 to 2022 covering research conducted in the USA, Canada, UK, Netherlands and Australia. Barriers and facilitators to adherence were mapped to six categories of the COM-B for three phases of adherence: initiation, implementation, and discontinuation. The discontinuation phase of adherence was only mentioned by one author. Four key themes were identified relating to pregnancy: 'Insufficient knowledge', 'Necessity concerns balance', 'Access to medicine', 'Social influences', and 'Lack of Habit'.

Conclusions: The COM-B framework allowed for detailed mapping of key factors shaping different phases of adherence in behavioural change terms and now provides a solid foundation for the development of a behavioural intervention. Although potential intervention elements could be suggested based on the results of this synthesis, additional co-production work is needed to define elements and plan for the delivery of the future intervention.

Trial registration: PROSPERO CRD42022359718. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359718.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA diagram.
Fig 2
Fig 2. Barriers to initiation of aspirin.
Fig 3
Fig 3. Barriers to implementation of aspirin.
Fig 4
Fig 4. Barriers to timely discontinuation of aspirin in pregnancy.
See this image and copyright information in PMC

References

    1. Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2013;170(1):1–7. - PubMed
    1. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG: An International Journal of Obstetrics & Gynaecology. 2011;118(s1):1–203. - PubMed
    1. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PFA. WHO analysis of causes of maternal death: a systematic review. The Lancet. 2006;367(9516):1066–74. doi: 10.1016/S0140-6736(06)68397-9 - DOI - PubMed
    1. Chappell LC, Cluver CA, Kingdom J, Tong S. Pre-eclampsia. The Lancet. 2021. - PubMed
    1. Fox A, McHugh S, Browne J, Kenny LC, Fitzgerald A, Khashan AS, et al.. Estimating the Cost of Preeclampsia in the Healthcare System. Hypertension. 2017;70(6):1243–9. - PubMed

Publication types