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Understanding Barriers and Facilitators to Lifestyle and Medication Adherence Among Cardiovascular Patients in Ghana: A Mixed Methods Study
Abstract   Peer reviewed

Understanding Barriers and Facilitators to Lifestyle and Medication Adherence Among Cardiovascular Patients in Ghana: A Mixed Methods Study

Esther Gordon, Leonard Baatiema and Justine S Sefcik
Nursing research (New York), v 75(3), pp E67-E67
May 2026
DOI: https://doi.org/10.1097/NNR.0000000000000903#page=E67

Abstract

Background: Introduction: Cardiovascular diseases (CVDs) are a leading cause of mortality in Ghana, driven by sedentary lifestyles, poor diets, obesity, stress, and limited preventive care. Although lifestyle modification is proven to improve outcomes, we lack a comprehensive understanding of patients’ unique adherence determinants to lifestyle modification plans and medication among patients with CVDs in Ghana. Purpose: This study aimed to identify individual-level barriers and facilitators influencing adherence to medications and lifestyle modification among patients with cardiovascular diseases in Ghana to inform targeted, culturally appropriate interventions. Methods: A concurrent mixed-methods study was conducted at Cape Coast Teaching Hospital, Ghana. Quantitative data were collected using a structured 7-Items questionnaire developed from reviewing key adherence barriers and domains. A qualitative descriptive design was employed, using 15 in-depth interviews and a focus group discussion with 13 participants to explore patients’ experiences. Analysis was done in Stata 18.0 using descriptive statistics, while conventional content analysis was used for qualitative data. Integration was achieved through a joint display aligning quantitative and qualitative findings. Results: Results: Among the 419 patients (mean age = 60 ± 12.3 years), financial constraints were the leading barrier (66.4%), followed by lack of knowledge (46.3%) and motivation (42.5%). Additional challenges included medication side effects (19%), inadequate social support (11.7%), and minimal participation in support groups (7.6%). Qualitative data reinforced financial challenges, knowledge gaps, and lack of social support. Cultural reliance on traditional high-carbohydrate diets, herbal medicines and or spiritual “cures” further hindered adherence. Educational and provider support facilitated adherence. These factors compound and reinforce one another, creating a complex challenge that healthcare providers must navigate when supporting patient behavior change. Conclusions and Implications: Conclusion: Lifestyle modification adherence among cardiovascular patients in Ghana is limited by financial hardship, inadequate knowledge, cultural norms, and weak social support. Improving adherence requires affordable, patient-centered interventions, culturally tailored education, and stronger community and family support.

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