Document Type : Original Article


1 Department of Community Health and Gerontological Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

2 Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran


BACKGROUND: Nonadherence with the medication regimen in patients with heart disease can
lead to treatment failure. The purpose of this study was to identify the causes of nonadherence in
people with myocardial infarction.
MATERIALS AND METHODS: This study is a qualitative conventional content analysis. Data were
collected through semistructured interviews. Thirteen individual interviews and a focus group were
conducted with nurses, patients, and doctors. Data were analyzed using conventional content analysis.
RESULTS: Four main themes were identified, which are organizational‑managerial causes and
factors (drug‑related problems, educational system‑related problems, weak performance of hospitals,
and problems related to insurance companies); sociocultural causes and factors (factors related
to cultural problems and factors related to social problems); causes and factors related to care
providers (skill problems of care providers and functional problems of care providers); and causes
and factors associated with caregivers (factors related to social characteristics of the patient, factors
related to patient characteristics, and factors related to the patient’s belief).
CONCLUSIONS: Many individual and organizational factors affect nonadherence, which can be
reduced by fundamental changes.


1. Cunningham RM, Walton MA, Carter PM. The major causes of
death in children and adolescents in the United States. N Engl J
Med 2018;379:2468‑75.
2. Members WG, Thom T, Haase N, Rosamond W, Howard VJ,
Rumsfeld J, et al. Heart disease and stroke statistics – 2006
update: A report from the American Heart Association Statistics
Committee and Stroke Statistics Subcommittee. Circulation
3. Saadat S, Yousefifard M, Asady H, Moghadas Jafari A, Fayaz M,
Hosseini M. The most important causes of death in Iranian
population; a retrospective cohort study. Emerg (Tehran)
4. DeFilippis AP, Chapman AR, Mills NL, de Lemos JA,
Arbab‑Zadeh A, Newby LK, et al. Assessment and treatment of
patients with type 2 myocardial infarction and acute nonischemic
myocardial injury. Circulation 2019;140:1661‑78.
5. Maleki M, Alizadehas A, Haghjoo M. Chapter 19 – ST‑segment
elevation myocardial infarction. In: Practical Cardiology.
Philadelphia, PA: Elsevier; 2017. p. 311‑28.
6. Butler J, Arbogast PG, BeLue R, Daugherty J, Jain MK, Ray WA,
et al. Outpatient adherence to beta‑blocker therapy after acute
myocardial infarction. J Am Coll Cardiol 2002;40:1589‑95.
7. Masror Roudsari D, Dabiri Golchin M, Haghani H. Relationship
between adherence to therapeutic regimen and health related
quality of life in hypertensive patients. Iran Journal of Nursing.
8. Ranjbaran S, Shojaeizadeh D, Dehdari T, YaseriM, ShakibazadehE.
1. J Edu Health Promot 2020;9:170 [doi: 10.4103/jehp.jehp_175_20].
9. Goudarzi H, Barati M, Bashirian S, Moeini BJ. Determinants
of medication adherence among hypertensive patients using
the Pender’s health promotion model. J Edu Health Promot
10. Happell B, Manias E, Pinikahana J. The role of the inpatient
mental health nurse in facilitating patient adherence to medication
regimes. Int J Ment Health Nurs 2002;11:251‑9.
11. Celio J, Ninane F, Bugnon O, Schneider MP. Pharmacist‑nurse
collaborations in medication adherence‑enhancing interventions:
A review. Patient Educ Couns 2018;101:1175‑92.
12. Bissonnette JM. Adherence: A concept analysis. J Adv Nurs
13. Najimi A, Mostafavi F, Sharifirad G, Golshiri P. Barriers to
medication adherence in patients with hypertension: A qualitative
study. J Edu Health Promot 2018;7:24.
14. Meena LP, Pandey SK, Rai M, Bharti A, Chakravarty J, Sundar S.
Study the drug adherence and possible factor influencing drug
adherence in HIV/AIDS patients in north eastern part of India.
J Educ Health Promot 2014;3:31.
15. Ameri M, Movahed E, Farokhzadian J. Effect of information,
motivation, and behavioral skills model on adherence to
medication, diet, and physical activity in HIV/ADIS patients:
A health promotion strategy. J Educ Health Promot 2020;9:317.
16. Masoudi R, Lotfizade M, Gheysarieha MR, Rabiei L. Evaluating
the effect of Pender’s health promotion model on self‑efficacy
and treatment adherence behaviors among patients undergoing
hemodialysis. J Edu Health Promot 2020;9:197 [doi: 10.4103/jehp.
17. Basu S. A comment on medication adherence in geriatric patients:
A reply to Abarazi et al. (2017). J Educ Health Promot 2018;7:108.
18. Hsieh HF, Shannon SE. Three approaches to qualitative content
analysis. Qual Health Res 2005;15:1277‑88.
19. Kondracki NL, Wellman NS, Amundson DR. Content analysis:
Review of methods and their applications in nutrition education.
J Nutr Educ Behav 2002;34:224‑30.
20. Speziale HS, Streubert HJ, Carpenter DR. Qualitative Research
in Nursing: Advancing the Humanistic Imperative. Philadelphia
Lippincott Williams & Wilkins; 2011.
21. Mousavizadeh S, Ashktorab T, Ahmadi F, Zandi M. Evaluation
of barriers to adherence to therapy in patients with diabetes. J
diabetes Nurs 2016;4:94‑108.
22. McQuaid EL, Landier W. Cultural issues in medication adherence:
Disparities and directions. J Gen Intern Med 2018;33:200‑6.
23. Taher M, Abredari H, Karimy M, Abedi A, Shamsizadeh M. The
relation between social support and adherence to the treatment
of hypertension. J Educ Community Health 2014;1:63‑9.
24. Sadeghian E, Nezafatdoost M, Tapak L, Shamsaei F. Effect
of medication education on drug adherence with mental
disorders: A clinical trial study. Iranian Journal of Psychiatric
Nursing (IJPN) 2019;649‑56
25. Reach G. Two character traits associated with adherence to long
term therapies. Diabetes Res Clin Pract 2012;98:19‑25.
26. Asayeshi F, Mostafavi F, Hassanzadeh A. The relation between
medication‑related beliefs and treatment adherence in patients
with hypertension in urban health care centers in Isfahan, Iran.
J Health Syst Res 13.1 201732‑37.