Patient Beliefs and Experiences of Adhering to Medical Therapies for Cardiovascular Comorbidities, Before Noncardiac Elective Surgery in South Africa: A Mixed-Methods Study

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.