{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:47:49Z","timestamp":1792133269170,"version":"4.4.0"},"reference-count":81,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T00:00:00Z","timestamp":1714694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health and Care Research Applied Research Collaboration North East and North Cumbria, UK","award":["APF2209"],"award-info":[{"award-number":["APF2209"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>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 \u2018Zoom\u2019 and \u2018Linoit\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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: \u2018Insufficient knowledge\u2019, \u2018Necessity concerns balance\u2019, \u2018Access to medicine\u2019, \u2018Social influences\u2019, and \u2018Lack of Habit\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      PROSPERO CRD42022359718.\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42022359718\" xlink:type=\"simple\">https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42022359718<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0302720","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T13:21:25Z","timestamp":1714742485000},"page":"e0302720","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Barriers and facilitators of adherence to low-dose aspirin during pregnancy: A co-produced systematic review and COM-B framework synthesis of qualitative evidence"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9375-7915","authenticated-orcid":true,"given":"Raya","family":"Vinogradov","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Holden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehali","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan","family":"Grigg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Errington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Ara\u00fajo-Soares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Rankin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"issue":"1","key":"pone.0302720.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejogrb.2013.05.005","article-title":"Global and regional estimates of preeclampsia and eclampsia: a systematic review","volume":"170","author":"E Abalos","year":"2013","journal-title":"European Journal of Obstetrics & Gynecology and Reproductive Biology"},{"issue":"s1","key":"pone.0302720.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1471-0528.2010.02847.x","article-title":"Saving Mothers\u2019 Lives: Reviewing maternal deaths to make motherhood safer: 2006\u20132008","volume":"118","year":"2011","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"issue":"9516","key":"pone.0302720.ref003","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/S0140-6736(06)68397-9","article-title":"WHO analysis of causes of maternal death: a systematic review","volume":"367","author":"KS Khan","year":"2006","journal-title":"The Lancet"},{"key":"pone.0302720.ref004","article-title":"Pre-eclampsia","author":"LC Chappell","year":"2021","journal-title":"The Lancet"},{"issue":"6","key":"pone.0302720.ref005","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1161\/HYPERTENSIONAHA.117.09499","article-title":"Estimating the Cost of Preeclampsia in the Healthcare System","volume":"70","author":"A Fox","year":"2017","journal-title":"Hypertension"},{"issue":"2","key":"pone.0302720.ref006","article-title":"Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis","volume":"10","author":"P Wu","year":"2017","journal-title":"Circulation Cardiovascular quality and outcomes"},{"issue":"4","key":"pone.0302720.ref007","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.5077","article-title":"Association of Preeclampsia With Incident Stroke in Later Life Among Women in the Framingham Heart Study","volume":"4","author":"A de Havenon","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0302720.ref008","unstructured":"Report WH. 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