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. 2025 Apr 14:19:1075-1087.
doi: 10.2147/PPA.S505297. eCollection 2025.

Contextual Factors Affecting Adherence Revealed by Old Patients with Heart Failure in Hospital and Primary Care Interactions: A Descriptive Study

Herman Bjørnstad  1   2 , Christine Frigaard  1   2 , Pål Gulbrandsen  1   2 , Jennifer Gerwing  2 , Henrik Schirmer  3 , Julia Menichetti  2
Affiliations

Contextual Factors Affecting Adherence Revealed by Old Patients with Heart Failure in Hospital and Primary Care Interactions: A Descriptive Study

Herman Bjørnstad et al. Patient Prefer Adherence. .

Abstract

Introduction: Old patients with heart failure are a vulnerable patient group facing various challenges, specifically during the transition from hospital to home. Non-biomedical factors, or "contextual factors", such as patient attitudes and social support, can influence treatment adherence. However, their role in clinical interactions is not well understood. This study aimed to identify and describe how and when these factors manifest during clinical interactions in the hospital-to-home transition.

Methods: We audio-recorded 42 old patients with heart failure admitted to hospital interacting with their physicians at: 1. the first ward visit, 2. discharge visit, 3. first primary care visit after discharge. Based on an umbrella review, we developed a list of 48 factors known to affect adherence among cardiovascular patients. Patient utterances from the recordings containing information on one of these factors (contextual indicators (CI)) were extracted and categorized according to the type of factor, mentioned impact, and being a facilitator or barrier to adherence.

Results: From the 105 audio recordings, 742 CI were identified, each interaction containing an average of 7 CI (SD = 4.2; median = 6). CI considered to have a potential impact on patient's life or adherence were overall evenly split between facilitators (n = 82, 42%) and barriers (n = 115, 58%), and both types of CI appeared in most patient trajectories. The most salient barrier CI was related to patients' concerns regarding medications side effects and regimen complexity, while CI facilitators were more commonly related to patients' knowledge, motivation and social support.

Discussion: The findings from this study provide insights for clinicians to the main types of non-biomedical factors revealed by old patients with heart failure in medical interactions, which affect their treatment adherence. Clinicians should particularly consider patient concerns regarding medications' side effects and the regimen complexity as important aspects to discuss, leveraging on motivational and social resources if present.

Keywords: audiotaped interactions; contextual factors; heart failure; old patients; patient adherence.

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Conflict of interest statement

HS has received lecture fees from Novartis, Novo-Nordisk and Boehringer Ingelheim; PG has received lecture fees from Norwegian Brain Tumor Society, Pfizer and Takeda; JM is a member of Advisory Committee and Board of Trustees for the International Association for Communication in Healthcare EACH (unpaid), and received lecture fees from Oslo Metropolitan University and EACH; no other relationships or activities that could appear to have influenced the submitted work. HS reports grants from Novartis, personal fees from Novartis, personal fees from Amgen, personal fees from Boehringer Ingelheim, personal fees from Astra Zeneca, personal fees from NovoNordisk, personal fees from Pfizer, outside the submitted work; In addition, Prof. Dr. Henrik Schirmer has a patent algorithm pending. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of Contextual barriers vs facilitators across visits (n = 742).
See this image and copyright information in PMC

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