BMJ Open. 2025 Nov 13;15(11):e105613. doi: 10.1136/bmjopen-2025-105613.
ABSTRACT
OBJECTIVE: Studying issues related to stroke medication non-adherence is essential for secondary prevention of stroke. This study aimed to identify the prevalence of medication non-adherence and risk factors among stroke survivors. The reasons behind this are that some patients may not follow stroke medication plans, and potential ways to help patients adhere better to medication plans.
DESIGN: This study employed a cross-sectional patient survey.
SETTING: The study was conducted in 20 public and private healthcare facilities in a resource-constrained setting, in Punjab, the largest province of Pakistan.
PARTICIPANTS: We included 6538 stroke survivors aged 21-75 years with at least a 6 month history of stroke who were prescribed one or more anti-stroke medications and met the inclusion criteria.
PRIMARY OUTCOME MEASURES: The main outcome was medication non-adherence, measured by the Self-Efficacy for Appropriate Medication Scale (SEAMS) and self-reported pill count. Descriptive statistics were used to summarise study variables. chi-square (χ²)/Fisher’s exact test and independent t-test/ANOVA were employed. A generalised linear model (logit model using multivariable logistic regression shows that several factors are associated with medication non-adherence and adherence. Odds ratio (OR) plots were generated using Seaborn and Matplotlib.
RESULTS: Non-adherence based on pill counts was 49.7%, while the mean SEAMS score (31.3±7.7) showed moderate self-reported adherence. After adjusting for age, gender, marital status, education, income, health insurance, smoking status, comorbidities, stroke type, disease duration, blood pressure control, number of medications, dosing frequency, physiotherapy continuation, perceived side effects and doctor-patient satisfaction, we found that female gender (vs male: AOR 0.31, 95% CI 0.27 to 0.35), lower income (10k-25k PKR vs >100k PKR: AOR 0.31, 95% CI 0.23 to 0.41; 26k-50k PKR vs >100k PKR: AOR 0.57, 95% CI 0.47 to 0.68), primary/secondary education (vs postgraduate: AOR 0.74, 95% CI 0.64 to 0.87), controlled BP (vs uncontrolled: AOR 0.66, 95% CI 0.59 to 0.73), longer disease duration (≥5 years vs <5 years: AOR 0.43, 95% CI 0.37 to 0.49), one time per day dosing (vs three times per day: AOR 0.25, 95% CI 0.21 to 0.29) and fewer medications (<5 vs 10+: AOR 0.50, 95% CI 0.43 to 0.58; 5-9 vs 10+: AOR 0.71, 95% CI 0.61 to 0.83) significantly reduced non-adherence odds (all p<0.001). Married status (vs other: AOR 1.22, 95% CI 1.02 to 1.45, p=0.028) and diabetes (vs obesity: AOR 1.29, 95% CI 1.09 to 1.53, p=0.003) increased non-adherence risk.
CONCLUSION: This study addresses the significant issue of medication non-adherence in stroke patients in Pakistan, reflecting global patterns yet remaining under-explored locally. It emphasises the critical role of adherence in managing chronic conditions such as stroke, where consistent use of preventive therapies is vital for reducing recurrence and improving outcomes. While the non-adherence rates are consistent with global trends, there is a notable lack of observational studies and epidemiological data in the Pakistani context. Our findings support a comprehensive approach to enhance medication adherence, taking into account the complex connections among social, behavioural and clinical factors. It also highlights the importance of maintaining detailed records to monitor adherence trends, identify high-risk groups and inform targeted public health interventions.
PMID:41248386 | DOI:10.1136/bmjopen-2025-105613
