Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UK
Introduction Placental dysfunction is estimated to affect 10% of pregnancies and is associated with adverse perinatal outcomes. Low-dose aspirin (LDA) reduces placental dysfunction risk. However, adherence to LDA is suboptimal in pregnant women and may reduce its effectiveness.Objectives We aimed to...
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BMJ Publishing Group
2025-03-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/3/e093888.full |
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| author | Danya Bakhbakhi Christy Burden Abigail Fraser Anna Davies Sarah Chapman Charlotte Williams Francesca Neuberger Sadie Mullin |
| author_facet | Danya Bakhbakhi Christy Burden Abigail Fraser Anna Davies Sarah Chapman Charlotte Williams Francesca Neuberger Sadie Mullin |
| author_sort | Danya Bakhbakhi |
| collection | DOAJ |
| description | Introduction Placental dysfunction is estimated to affect 10% of pregnancies and is associated with adverse perinatal outcomes. Low-dose aspirin (LDA) reduces placental dysfunction risk. However, adherence to LDA is suboptimal in pregnant women and may reduce its effectiveness.Objectives We aimed to explore the barriers and facilitators to LDA adherence in pregnant women with placental dysfunction risk.Design Qualitative semi-structured individual interviews were undertaken, and data were inductively thematically analysed.Setting A single NHS Trust in South West England, UK.Participants Pregnant women aged>18, recommended daily LDA for pregnancy indications. We purposively recruited those with a range of adherence patterns (non-adherent, suboptimally adherent, adherent).Results 15 women participated (93% white British, 73% university educated). Five were adherent (6–7 doses per week), five suboptimally adherent (4–5 doses per week) and five non-adherent (<3 doses per week). Indications for LDA were pre-eclampsia risk, low PAPP-A and previous intrauterine growth restriction. Four themes and related subthemes were identified addressing motivational and implementation issues. Motivational barriers and facilitators included (1) risk perceptions: participants described limited understanding of their indications for LDA and the maternal and fetal impacts of placental dysfunction, feeling stigmatised by their body mass index being an indicator for LDA and perceiving it to be unlikely they would experience serious consequences of placental dysfunction. Facilitators were direct/indirect experiences of placental dysfunction. (2) Concerns about taking LDA, including bleeding risk. (3) Interactions with healthcare professionals: participants described receiving limited information from healthcare professionals, with limited attention given to LDA compared with other antenatal recommendations. Distrust and trust in healthcare professionals impacted non-adherence/adherence. Implementation barriers were (4) difficulties with establishing habits, tailing off and difficulties swallowing. Established habits and swallowing LDA whole supported taking it.Conclusions We identified motivational and implementation-related barriers and facilitators to LDA adherence in a clinical sample of women with placental dysfunction risk. Women require more information to enhance understanding and inform their decision, and require support to establish effective habits. Theory-informed behaviour change techniques could address these barriers. Adherence barriers and facilitators should be explored in minority ethnicity and economically deprived women, and healthcare staff providing LDA-related care to inform optimally effective interventions. |
| format | Article |
| id | doaj-art-e5c78334d43e40fabdc03b078c6a38bc |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e5c78334d43e40fabdc03b078c6a38bc2025-08-20T02:48:17ZengBMJ Publishing GroupBMJ Open2044-60552025-03-0115310.1136/bmjopen-2024-093888Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UKDanya Bakhbakhi0Christy Burden1Abigail Fraser2Anna Davies3Sarah Chapman4Charlotte Williams5Francesca Neuberger6Sadie Mullin7Centre for Academic Women’s Health, University of Bristol, Bristol, UKCentre for Academic Women’s Health, University of Bristol, Bristol, UKNIHR Biomedical Research Centre, University of Bristol, Bristol, UKAcademic Women’s Health Unit, Translational Health Sciences, University of Bristol, Bristol, UKDepartment of Cancer and Pharmaceutical Science, King’s College London Faculty of Life Sciences and Medicine, London, UKAcademic Women’s Health Unit, Translational Health Sciences, University of Bristol, Bristol, UKNorth Bristol NHS Trust, Bristol, UKAcademic Women’s Health Unit, Translational Health Sciences, University of Bristol, Bristol, UKIntroduction Placental dysfunction is estimated to affect 10% of pregnancies and is associated with adverse perinatal outcomes. Low-dose aspirin (LDA) reduces placental dysfunction risk. However, adherence to LDA is suboptimal in pregnant women and may reduce its effectiveness.Objectives We aimed to explore the barriers and facilitators to LDA adherence in pregnant women with placental dysfunction risk.Design Qualitative semi-structured individual interviews were undertaken, and data were inductively thematically analysed.Setting A single NHS Trust in South West England, UK.Participants Pregnant women aged>18, recommended daily LDA for pregnancy indications. We purposively recruited those with a range of adherence patterns (non-adherent, suboptimally adherent, adherent).Results 15 women participated (93% white British, 73% university educated). Five were adherent (6–7 doses per week), five suboptimally adherent (4–5 doses per week) and five non-adherent (<3 doses per week). Indications for LDA were pre-eclampsia risk, low PAPP-A and previous intrauterine growth restriction. Four themes and related subthemes were identified addressing motivational and implementation issues. Motivational barriers and facilitators included (1) risk perceptions: participants described limited understanding of their indications for LDA and the maternal and fetal impacts of placental dysfunction, feeling stigmatised by their body mass index being an indicator for LDA and perceiving it to be unlikely they would experience serious consequences of placental dysfunction. Facilitators were direct/indirect experiences of placental dysfunction. (2) Concerns about taking LDA, including bleeding risk. (3) Interactions with healthcare professionals: participants described receiving limited information from healthcare professionals, with limited attention given to LDA compared with other antenatal recommendations. Distrust and trust in healthcare professionals impacted non-adherence/adherence. Implementation barriers were (4) difficulties with establishing habits, tailing off and difficulties swallowing. Established habits and swallowing LDA whole supported taking it.Conclusions We identified motivational and implementation-related barriers and facilitators to LDA adherence in a clinical sample of women with placental dysfunction risk. Women require more information to enhance understanding and inform their decision, and require support to establish effective habits. Theory-informed behaviour change techniques could address these barriers. Adherence barriers and facilitators should be explored in minority ethnicity and economically deprived women, and healthcare staff providing LDA-related care to inform optimally effective interventions.https://bmjopen.bmj.com/content/15/3/e093888.full |
| spellingShingle | Danya Bakhbakhi Christy Burden Abigail Fraser Anna Davies Sarah Chapman Charlotte Williams Francesca Neuberger Sadie Mullin Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UK BMJ Open |
| title | Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UK |
| title_full | Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UK |
| title_fullStr | Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UK |
| title_full_unstemmed | Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UK |
| title_short | Qualitative study exploring the barriers and facilitators to low-dose aspirin adherence in pregnant women with placental dysfunction risk in the UK |
| title_sort | qualitative study exploring the barriers and facilitators to low dose aspirin adherence in pregnant women with placental dysfunction risk in the uk |
| url | https://bmjopen.bmj.com/content/15/3/e093888.full |
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