Search findings

The preliminary search yielded 14,002 titles. After resolving duplicates, 11,354 titles remained for title and abstract screening, resulting in 234 articles selected for full-text review (Fig. 1). Data were subsequently extracted from fifteen included articles.

Fig. 1

PRISMA flow chart diagram of the systematic review

Characteristics of included studies

Table 1 shows the characteristics of the included studies. The studies included 533 people who had experienced MI and 25 spouses of such people. Studies were performed in eight different countries, including four studies from the United Kingdom (UK) [29,30,31,32]; three from Sweden [33,34,35]; two from Canada [36, 37]; two from the United States of America (USA) [38, 39]; one from Indonesia [40]; Iran [41]; Norway [42] and Northern Israel [43]. Fourteen studies were solely qualitative in design, and one study employed a mixed-methodology approach, incorporating qualitative feedback from participants through a free-text questionnaire section [32]. One study used a focus group methodology, with interviews used in 13 studies and text was used in one-study. [29,30,31, 33,34,35,36,37,38,39,40,41,42,43].

Table 1 Characteristics of included studies

These studies assessed patients'/carers' perspectives on managing and adhering to medications post-MI. All fourteen domains of the TDF were reported as either a barrier, a facilitator, or both, as they pertained to medication adherence. The five most prominent domains are presented in Table 2 in addition to illustrative quotes.

Table 2 Summary of findings regarding barriers and facilitators for medication adherence and management post-MIDomain 1—Beliefs about consequences

This was the most mentioned domain across the 15 studies. Most patients considered medicines to be crucial for their health, with some expressing concerns about safety due to the high number of tablets required. Patients took their medications because they believed that MI was a serious condition that might lead to more complications. Family members reflected on their beliefs regarding the importance of medication adherence in preventing further complications and acknowledged the significant role that adherence plays in achieving positive health outcomes. Patients often struggled with adherence to medication after experiencing severe heart pain. This could have been due to various factors, including a lack of belief in medical advice and a lack of confidence in the drugs. Patients were sometimes also in denial about the disease, and incorrect beliefs could negatively affect medication adherence, with some patients expressing concern regarding medication side effects.

Domain 2—Environmental context and resource

Patients faced numerous contextual challenges relating to medication taking. This included insufficient communication channels with their treatment teams post-discharge, which hindered proper recovery and management. Patients often encountered improper behaviour and inadequate hospital facilities, impacting their overall care experience. Poor insurance coverage for necessary paraclinical actions and medications also exacerbated the financial burden, especially for disadvantaged populations.

Adherence to treatment regimens was also challenged by disruptions to daily lives, job-related barriers, and a lack of timely and adequate education on managing their condition. An often-cited obstacle was communication failure, resulting in inadequate treatment transitions, such as from inpatient to outpatient or specialist to primary care physician. Conversely, one patient characterised the hospital discharge process as being a cue for taking action, receiving adequate information regarding the medication and emphasising the importance of adherence.

Domain 3—Social influenceSubdomain—Family support

Many participants living with their families found it easier to adhere to their medications. Family members, particularly spouses, offered valuable reminders to adhere to treatment, as well as practical assistance. Perceiving real concern and support from others was considered crucial for adherence. Conversely, some participants felt that family support added pressure, and they felt uncomfortable or even offended by others’ attitudes regarding their adherence.

Subdomain—Healthcare professionals

Healthcare professionals were reported to significantly influence medication adherence, as their advice and guidance could greatly impact a patient's willingness to follow prescribed treatment plans. Some patients seemed to have a strong tendency to trust their doctors' prescribing decisions and directions. Having conversations with healthcare professionals could positively impact medication management and adherence, for example, if the patient experienced side effects. On the contrary, some patients felt that the information received from healthcare professionals was conflicting, which led to uncertainty and confusion among patients.

Domain 4—Emotion

Emotions reflected in the findings of the included studies encompassed the fear of being stigmatised due to heart disease and unwillingness to adhere to treatment. Individuals often preferred not to be perceived as cardiac patients. As a result, they sometimes concealed their condition and avoided taking medication in public settings. Sometimes, as a consequence of their participation in the study interview, patients realised the importance of their medicines, and this was reflected in planned behaviour. In contrast, others felt that the medication was limiting their daily activities. In addition, some showed concerns regarding the number of tablets taken by them or their partners. On the other hand, others felt that they had survived and that this was a second chance at life, so they chose to take advantage of it by leading a healthier life and adhering to their medication.

Domain 5—Knowledge

Patients frequently mentioned their lack of knowledge regarding medications. This served as a barrier for many patients, as they did not understand the rationale for taking all of these medications and the potential side effects. Other barriers included (i) being unaware of the cardiac rehabilitation programs, (ii) a lack of written information, and (iii) the use of medical jargon when being provided with information.

Interestingly, several individuals were able to state the name and the use of each medication, while others showed little knowledge. However, most patients were interested in receiving information from healthcare professionals and emphasised the importance of having written support documentation. They acknowledged that having appropriate knowledge could positively influence someone’s decision to take their medication.

Quality appraisal and CERQual grading

The fifteen included studies generally satisfied the JBI criteria for the quality of the included qualitative studies, for example, the congruity between the stated philosophical perspective and the chosen research methodology, as well as the consistency between the research methodology and the research question or objective [29, 31,32,33,34,35,36,37,38,39,40,41,42,43,44]. However, the criteria regarding locating the researcher culturally or theoretically were met in only four articles [35, 37, 41, 42]. Additionally, the researcher's influence on the research and vice-versa was reported in only two studies [38, 42]. Using the JBI checklist pertaining to methodology, a full description of the reporting assessment can be found in Table 3. The CERQual approach was used to assess confidence in our review findings based on methodological limitations, coherence, adequacy, and relevance [28]. All included studies showed high confidence, meeting the criteria across all components. In this review, the confidence level was not downgraded if any components were judged to have minor or very minor concerns.

Table 3 Quality appraisal according to JBI [23]