Patient Beliefs and Experiences of Adhering to Medical Therapies for Cardiovascular Comorbidities, Before Noncardiac Elective Surgery in South Africa: A Mixed-Methods Study
6 affiliations
- 1From the School of Medicine, University of Leeds, Leeds, United Kingdom
- 2The Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
- 3Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
- 4Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- 5Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
- 6Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
Abstract
BACKGROUND:: Cardiovascular comorbidities increase perioperative risk in patients undergoing noncardiac surgery. Optimizing medication adherence in this population is critical; yet adherence remains low in many low- and middle-income countries (LMICs), where health beliefs, systemic barriers, and healthcare communication bring significant challenges. This study aimed to explore the acceptability of validated patient-reported questionnaires and to investigate the beliefs and experiences influencing adherence to cardiovascular medication before surgery in a South African tertiary hospital.
METHODS:: A mixed-methods study was conducted using semistructured interviews with 21 patients taking cardiovascular medication before vascular surgery. Participants completed four validated self-report questionnaires: Brief Illness Perception Questionnaire (BIPQ), Beliefs about Medicines Questionnaire (BMQ), SHARED decision-making questionnaire, and SURE decisional conflict scale. Questionnaire responses were summarized with descriptive statistics. Thematic analysis of interview data was conducted using Braun and Clarke’s six-step framework.
RESULTS:: Most participants perceived their illness as chronic (15/20, 75%) and their treatment as effective (18/21, 86%), yet 15 of 21 (71%) reported high concern and 9 of 21 (43%) reported emotional distress. Belief in the need for medication was strong (21/21, 100%), but 14 of 21 (67%) worried about long-term side effects and 10 of 21 (47%) described their medication as a “mystery.” Shared decision-making appeared limited: only 7 of 21 (33%) recalled being asked for their views. Thematic analysis revealed seven major themes: understanding illness and treatment, health professional interactions, service access, social support, individual factors, routines, and habits.
CONCLUSIONS:: Patient-reported tools were acceptable and highlighted complex, interrelated factors associated with adherence. Integrating these tools into preoperative care may help identify at-risk patients and support person-centered perioperative planning in LMICs.
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BibTeX
@article{awoloto2026patient,
title = {{Patient Beliefs and Experiences of Adhering to Medical Therapies for Cardiovascular Comorbidities, Before Noncardiac Elective Surgery in South Africa: A Mixed-Methods Study}},
author = {Oluwanilo Awoloto and Hilary L. Bekker and Christella Alphonsus and Simphiwe Gumede and Khulile Singata and Elzanne Jansen van Rensburg and Simon J. Howell and Bruce Biccard},
journal = {Anesthesia and Analgesia},
year = {2026},
month = jul,
doi = {10.1213/ane.0000000000008110},
url = {https://doi.org/10.1213/ane.0000000000008110},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Patient Beliefs and Experiences of Adhering to Medical Therapies for Cardiovascular Comorbidities, Before Noncardiac Elective Surgery in South Africa: A Mixed-Methods Study
AU - Oluwanilo Awoloto
AU - Hilary L. Bekker
AU - Christella Alphonsus
AU - Simphiwe Gumede
AU - Khulile Singata
AU - Elzanne Jansen van Rensburg
AU - Simon J. Howell
AU - Bruce Biccard
PY - 2026
DA - 2026/07/03
JO - Anesthesia and Analgesia
DO - 10.1213/ane.0000000000008110
UR - https://doi.org/10.1213/ane.0000000000008110
AB - BACKGROUND:: Cardiovascular comorbidities increase perioperative risk in patients undergoing noncardiac surgery. Optimizing medication adherence in this population is critical; yet adherence remains low in many low- and middle-income countries (LMICs), where health beliefs, systemic barriers, and healthcare communication bring significant challenges. This study aimed to explore the acceptability of validated patient-reported questionnaires and to investigate the beliefs and experiences influencing adherence to cardiovascular medication before surgery in a South African tertiary hospital. METHODS:: A mixed-methods study was conducted using semistructured interviews with 21 patients taking cardiovascular medication before vascular surgery. Participants completed four validated self-report questionnaires: Brief Illness Perception Questionnaire (BIPQ), Beliefs about Medicines Questionnaire (BMQ), SHARED decision-making questionnaire, and SURE decisional conflict scale. Questionnaire responses were summarized with descriptive statistics. Thematic analysis of interview data was conducted using Braun and Clarke’s six-step framework. RESULTS:: Most participants perceived their illness as chronic (15/20, 75%) and their treatment as effective (18/21, 86%), yet 15 of 21 (71%) reported high concern and 9 of 21 (43%) reported emotional distress. Belief in the need for medication was strong (21/21, 100%), but 14 of 21 (67%) worried about long-term side effects and 10 of 21 (47%) described their medication as a “mystery.” Shared decision-making appeared limited: only 7 of 21 (33%) recalled being asked for their views. Thematic analysis revealed seven major themes: understanding illness and treatment, health professional interactions, service access, social support, individual factors, routines, and habits. CONCLUSIONS:: Patient-reported tools were acceptable and highlighted complex, interrelated factors associated with adherence. Integrating these tools into preoperative care may help identify at-risk patients and support person-centered perioperative planning in LMICs.
SN - 0003-2999
SN - 1526-7598
ER -