"The medicine doesn't interest me at all." Beliefs, health behaviors, and medication adherence in peripheral arterial disease.

Background: Non-adherence to guideline-directed best medical therapies is prevalent in people with lower extremity peripheral arterial disease (PAD), constituting a significant challenge to effective treatment. Underlying drivers for non-adherence remain poorly understood. This study explored patients' health-related beliefs and behaviours regarding antithrombotic and lipid-lowering therapy to identify opportunities for improvement. Patients and methods: Using a qualitative design, we conducted semi-structured interviews with patients with symptomatic PAD based on a purposeful sampling strategy. Patients were recruited from four vascular surgery departments in Denmark between December 2022 and January 2024, excluding those with cognitive impairment or terminal illness. Data were analysed using framework analysis based on the six domains of the Health Belief Model (HBM): perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. Results: Sixteen patients participated (median age: 69 years, 38% women); 68.8% had intermittent claudication, 18.8% had chronic limb-threatening ischemia, and 12.5% had undergone major amputation. Seven patients were adherent, and nine were non-adherent to secondary preventive therapy. Patients expressed low perceived awareness of PAD severity and its cardiovascular implications. Their perception of PAD centred around leg pain and its impact on everyday life, limiting their understanding of the benefits of secondary preventive therapies. Patients lacked knowledge about treatment goals and did not link secondary preventive therapy with PAD. Adherence barriers included inadequate understanding of PAD's chronic progressive nature, concerns about side-effects, prescription confusion, and financial constraints. Internal adherence triggers included fear of recurring pain, complications, and early death. External cues to action included a trusting patient-provider relationship and receiving comprehensive, understandable information. Conclusions: This study highlights the multifaceted challenges hindering adherence to antithrombotic and lipid-lowering therapies. Addressing the limited disease awareness and the expressed need for patient-centred communication delivered in a trusting patient-provider relationship could serve as starting point for future strategies to improve adherence.