OP91 Adherence to aspirin in pregnancy: a co-produced systematic review and meta-ethnography

Background Women are advised to take low-dose aspirin (LDA) if at increased risk of a serious pregnancy complication: pre-eclampsia. Adherence to LDA amongst pregnant women is low. This systematic review aimed to synthesise qualitative evidence related to barriers and facilitators of adherence to LDA in pregnancy. Methods A systematic review and meta-ethnography of qualitative research was co-produced by representatives from charities, public, clinical and academic members. Electronic databases (Medline, Web of Science, CINAHL, PsycINFO, Embase, Scopus, Open Grey, Google Scholar), archives of charities and professional organisations were searched using predefined search terms. Citation searching was also undertaken. Studies containing qualitative components related to barriers and facilitators of adherence to LDA during pregnancy were included. Quality assessment was performed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. The meta-ethnography approach was utilised, using reciprocal translation and line-of-argument synthesis. Co-production activities were facilitated by the nominal group technique followed by structured group discussions. PROSPERO registration number CRD42022359718. Results Out of 3094 items identified though systematic searches, six studies were included in the review. No studies were excluded based on quality assessment. Four 3rd level constructs with a total of 10 sub-themes were identified: informational gap, verbal and non-verbal signals from the health care system, personal assets, and control. In an explanatory model we demonstrate that women are advised to take prophylactic LDA in a context of lack of information and misconceptions (informational gap) with patchy and inconsistent messages from the health care system (verbal and non-verbal signals from the health care system). Women ultimately control (own) their decision about use of LDA, however arrival to a decision depends on utilisation of personal resources/assets (unique personal characteristics inherited or acquired such as beliefs and values, desire to enjoy pregnancy, perception of risk, experiences, trust, practical and cognitive skills, habits, ability to navigate/utilise social environment, as well as physical and cognitive conditions). Conclusion There is an opportunity to support women and their support networks through improving the quality of information and its provision. This has the potential for reducing an intense need in utilisation of personal resources/assets and making use of this important preventative medicine more equitable. Priority and relevance Use of the co-production approach is expected to streamline the intervention development process as key stakeholders were actively engaged in evidence synthesis. It will allow this group of stakeholders to translate evidence into intervention and support its implementation.