{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T01:26:50Z","timestamp":1794274010723,"version":"4.9.0"},"reference-count":38,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Advanced Fellowship","award":["NIHR304435"],"award-info":[{"award-number":["NIHR304435"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Background\/Objectives: Stroke survivors require life-long secondary prevention to reduce recurrence, but they also often face long-term impairments that may limit medication adherence (MA) including cognitive, physical, and psychological effects. This updated qualitative meta-synthesis aims to descriptively explore and synthesise the experiences and perspectives of stroke\/TIA survivors, informal and formal carers of stroke survivors, and healthcare professionals involved in post-stroke\/TIA care, with a focus on factors influencing and hindering MA. Methods: A qualitative meta-synthesis was conducted in accordance with PRISMA guidance. Searches were undertaken across MEDLINE, CINAHL, Embase, PsycINFO, Scopus and Web of Science for studies published from 1 January 2018. Study quality was assessed using the Joanna Briggs Institute checklist and data synthesised using Thomas and Harden\u2019s method. Results: Of 5463 titles and abstracts screened, 212 underwent full-text review with 13 papers meeting inclusion criteria from eight countries with a total of 435 participants. Seven key themes were identified: knowledge and understanding, beliefs and attitudes, practical barriers, social support, healthcare system, psychological factors and medication characteristics. Survivors showed a varied understanding of their condition and prescribed medicines, with unclear communication often contributing to confusion. Beliefs and attitudes shaped adherence, ranging from confidence in treatment to scepticism. Practical barriers included financial costs, physical impairments, and limited access to services. Social support from family, friends, and healthcare professionals was also important. Psychological wellbeing, coping strategies, and medication side effects further influenced adherence, highlighting the challenges faced by this patient group. Conclusions: Medication adherence post-stroke\/TIA is shaped by multiple complex factors including knowledge, beliefs, attitudes, and lived experience. As a descriptive synthesis of qualitative evidence, these findings do not permit conclusions regarding causality or intervention effectiveness but provide insight into perceived barriers and facilitators that may inform future intervention development and clinical questioning.<\/jats:p>","DOI":"10.3390\/neurolint18020034","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:45:36Z","timestamp":1770831936000},"page":"34","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Medication Adherence Following Stroke and TIA: A Qualitative Synthesis of Patient, Caregiver and Clinician Perspectives"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3898-8538","authenticated-orcid":false,"given":"Erin","family":"O\u2019Kane","sequence":"first","affiliation":[{"name":"School of Medicine, University of Sunderland, Sunderland SR1 3SD, UK"},{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhiannon","family":"De Ivey","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Pearson","sequence":"additional","affiliation":[{"name":"Edinburgh Medical School, University of Edinburgh, Edinburgh EH16 4UX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1821-6144","authenticated-orcid":false,"given":"Christa","family":"Awad","sequence":"additional","affiliation":[{"name":"The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalifa","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Williamson","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0472-521X","authenticated-orcid":false,"given":"Richard Andrew","family":"Lumb","sequence":"additional","affiliation":[{"name":"Walton Library, Newcastle University, Newcastle upon Tyne NE2 4HH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ami","family":"Mehta","sequence":"additional","affiliation":[{"name":"School of Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1030-9311","authenticated-orcid":false,"given":"Eugene Yee Hing","family":"Tang","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World Stroke Organization: Global Stroke Fact Sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int. J. Stroke Off. J. Int. Stroke Soc."},{"key":"ref_2","first-page":"711","article-title":"The Frequency and Timing of Recurrent Stroke: An Analysis of Routine Health Insurance Data","volume":"116","author":"Stahmeyer","year":"2019","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.1007\/s00415-019-09660-y","article-title":"Post-stroke medication adherence and persistence rates: A meta-analysis of observational studies","volume":"268","author":"Zhang","year":"2021","journal-title":"J. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1161\/CIRCRESAHA.122.319951","article-title":"Post-Stroke Cognitive Impairment and Dementia","volume":"130","author":"Rost","year":"2022","journal-title":"Circ Res."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kusec, A., Milosevich, E., Williams, O.A., Chiu, E.G., Watson, P., Carrick, C., Drozdowska, B.A., Dillon, A., Jennings, T., and Anderson, B. (2023). Long-term psychological outcomes following stroke: The OX-CHRONIC study. BMC Neurol., 23.","DOI":"10.1186\/s12883-023-03463-5"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1177\/0193945917747856","article-title":"Measurement and Outcomes of the Perceived Risk of Stroke: A Review","volume":"41","author":"Aycock","year":"2019","journal-title":"West. J. Nurs. Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Maidment, I.D., Lawson, S., Wong, G., Booth, A., Watson, A., McKeown, J., Zaman, H., Mullan, J., and Bailey, S. (2020). Medication management in older people: The MEMORABLE realist synthesis. Health Services and Delivery Research, NIHR Journals Library.","DOI":"10.21203\/rs.2.15433\/v2"},{"key":"ref_8","first-page":"Cd009103","article-title":"Interventions for improving modifiable risk factor control in the secondary prevention of stroke","volume":"5","author":"Bridgwood","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","first-page":"4","article-title":"Medication-taking after stroke: A qualitative meta-synthesis of the perspectives of stroke survivors, informal carers and health professionals","volume":"37","author":"Gibson","year":"2020","journal-title":"Fam. Pract."},{"key":"ref_10","unstructured":"Department of Health and Social Care (2025, November 25). 10 Year Health Plan for England: Fit for the Future 2025, Available online: https:\/\/www.gov.uk\/government\/publications\/10-year-health-plan-for-england-fit-for-the-future."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Thomas, J., and Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med. Res. Methodol., 8.","DOI":"10.1186\/1471-2288-8-45"},{"key":"ref_13","unstructured":"The Joanna Briggs Institute (2025, August 15). Critical Appraisal Tools for Use in JBI Systematic Reviews Checklist for Qualitative Research. Available online: https:\/\/jbi.global\/sites\/default\/files\/2019-05\/JBI_Critical_Appraisal-Checklist_for_Qualitative_Research2017_0.pdf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1177\/1744987121993505","article-title":"Medication adherence early after stroke: Using the Perceptions and Practicalities Framework to explore stroke survivors\u2019, informal carers\u2019 and nurses\u2019 experiences of barriers and solutions","volume":"26","author":"Gibson","year":"2021","journal-title":"J. Res. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Hewitt, J., Azhari, H.F., O\u2019Neill, M., Smith, A., Quinn, T., and Dawson, J. (2024). Post-stroke diabetes management: A qualitative study. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1364217"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e020133","DOI":"10.1136\/bmjopen-2017-020133","article-title":"Online stroke forum as source of data for qualitative research: Insights from a comparison with patients\u2019 interviews","volume":"8","author":"Jamison","year":"2018","journal-title":"BMJ Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1016\/j.pec.2019.02.007","article-title":"Development of a tool to support person-centred medicine-focused consultations with stroke survivors","volume":"102","author":"DaCosta","year":"2019","journal-title":"Patient Educ. Couns."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bell, S., Kelly, H., Hennessy, E., Bermingham, M., O\u2019Flynn, J.R., and Sahm, L.J. (2023). Healthcare professional perspectives on medication challenges in the post-stroke patient. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1266277"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3192","DOI":"10.1080\/09638288.2018.1492029","article-title":"Opportunities and challenges in secondary stroke prevention: A mixed methods study","volume":"41","author":"White","year":"2019","journal-title":"Disabil. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.2147\/PPA.S257323","article-title":"A Qualitative Study of Barriers and Facilitators to Adherence to Secondary Prevention Medications Among French Patients Suffering from Stroke and Transient Ischemic Attack","volume":"14","author":"Viprey","year":"2020","journal-title":"Patient Prefer. Adher."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kindermann, D., Grosse-Holz, V.M., Andermann, M., Ringleb, P.A., Friederich, H.C., Rizos, T., and Nikendei, C. (2023). Coping Strategies and Posttraumatic Growth Following Transient Ischemic Attack: A Qualitative Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020575"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1111\/jan.15079","article-title":"Qualitative study of Stroke Survivors\u2019 Perceptions of Secondary Prevention","volume":"78","author":"Lin","year":"2022","journal-title":"J. Adv. Nurs."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Xu, J., Zhao, M., Vrosgou, A., Yu, N.C.W., Liu, C., Zhang, H., Ding, C., Roth, N.W., Pan, Y., and Liu, L. (2021). Barriers to medication adherence in a rural-urban dual economy: A multi-stakeholder qualitative study. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06789-3"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e15758","DOI":"10.2196\/15758","article-title":"Development and Local Contextualization of Mobile Health Messages for Enhancing Disease Management Among Community-Dwelling Stroke Patients in Rural China: Multimethod Study","volume":"7","author":"Gong","year":"2019","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e14399","DOI":"10.2196\/14399","article-title":"The Needs and Barriers of Medication-Taking Self-Efficacy Among Poststroke Patients: Qualitative Study","volume":"2","author":"Appalasamy","year":"2019","journal-title":"JMIR Nurs."},{"key":"ref_26","first-page":"100297","article-title":"Stroke survivors\u2019 perspectives on decision-making about rehabilitation and the prospect of taking recovery-promoting drugs: A qualitative study","volume":"11","author":"Firth","year":"2023","journal-title":"Explor. Res. Clin. Soc. Pharm."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.ypmed.2017.03.008","article-title":"Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis","volume":"99","author":"Conn","year":"2017","journal-title":"Prev. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e084680","DOI":"10.1136\/bmjopen-2024-084680","article-title":"Longitudinal changes in self-reported medication adherence and beliefs about post-stroke medicines in Sweden: A repeated cross-sectional study","volume":"14","author":"Gustafsson","year":"2024","journal-title":"BMJ Open"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1037\/hea0001316","article-title":"Changing medication-related beliefs: A systematic review and meta-analysis of randomized controlled trials","volume":"43","author":"Sheils","year":"2024","journal-title":"Health Psychol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Choi, Y.Y.C., Fineberg, M., and Kassavou, A. (2023). Effectiveness of Remote Interventions to Improve Medication Adherence in Patients after Stroke: A Systematic Literature Review and Meta-Analysis. Behav. Sci., 13.","DOI":"10.3390\/bs13030246"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gallacher, K.I., Batty, G.D., McLean, G., Mercer, S.W., Guthrie, B., May, C.R., Langhorne, P., and Mair, F.S. (2014). Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: Implications for treatment burden. BMC Med., 12.","DOI":"10.1186\/s12916-014-0151-0"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1007\/s11096-022-01416-5","article-title":"Polypharmacy and potentially inappropriate medications in stroke rehabilitation: Prevalence and association with outcomes","volume":"44","author":"Matsumoto","year":"2022","journal-title":"Int. J. Clin. Pharm."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1136\/ejhpharm-2020-002425","article-title":"Multiprofessional intervention to improve adherence to medication in stroke patients: A study protocol for a randomised controlled trial (ADMED AVC study)","volume":"29","author":"Khettar","year":"2022","journal-title":"Eur. J. Hosp. Pharm."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Gallacher, K., Morrison, D., Jani, B., Macdonald, S., May, C.R., Montori, V.M., Erwin, P.J., Batty, G.D., Eton, D.T., and Langhorne, P. (2013). Uncovering treatment burden as a key concept for stroke care: A systematic review of qualitative research. PLoS Med., 10.","DOI":"10.1371\/journal.pmed.1001473"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e036158","DOI":"10.1136\/bmjopen-2019-036158","article-title":"Medication-related experiences of patients with polypharmacy: A systematic review of qualitative studies","volume":"10","author":"Eriksen","year":"2020","journal-title":"BMJ Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1177\/17474930241283167","article-title":"The association between social networks and functional recovery after stroke","volume":"20","author":"Bishop","year":"2025","journal-title":"Int. J. Stroke Off. J. Int. Stroke Soc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1177\/1747493018772788","article-title":"Post-stroke social networks, depressive symptoms, and disability in Tanzania: A prospective study","volume":"13","author":"Saadi","year":"2018","journal-title":"Int. J. Stroke Off. J. Int. Stroke Soc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e600","DOI":"10.3399\/bjgp20X712289","article-title":"Primary medical care continuity and patient mortality: A systematic review","volume":"70","author":"Baker","year":"2020","journal-title":"Br. J. Gen. Pract."}],"container-title":["Neurology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/2\/34\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:11:35Z","timestamp":1770833495000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/2\/34"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["neurolint18020034"],"URL":"https:\/\/doi.org\/10.3390\/neurolint18020034","relation":{},"ISSN":["2035-8377"],"issn-type":[{"value":"2035-8377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]}}}