BEYOND PRESCRIPTIONS: APPLYING THE HEALTH BELIEF MODEL TO UNDERSTAND CARDIOVASCULAR MEDICATION-TAKING BEHAVIOR: A NARRATIVE REVIEW

Abstract

Cardiovascular diseases (CVDs) are still among the major public health issues all over the world and significantly contribute to morbidity and mortality. Even though drugs are an integral element of the treatment process, there are many cases where patients do not adhere to the prescribed treatment. In order to improve patients' adherence to the treatment and understand the reasons why this adherence takes place, one should look into factors that impact it. This study will be based on the Health Belief Model (HBM), which is helpful in this regard.

The purpose of this narrative review is to consolidate the evidence related to the link between HBM constructs and adherence to medication among adults diagnosed with cardiovascular diseases (CVD). It will further highlight important determinants, as well as implications for cardiovascular nursing.Literature supporting the review were obtained by conducting systematic searches in PubMed/MEDLINE, Web of Science, Scopus, Science Direct, Research Gate, and Google Scholar. All articles published in the English language between January 2021 and July 2026 were considered. Several research approaches like quantitative, qualitative, mixed-methods, and intervention research studies were considered to provide a complete perspective on the available evidence. Methodological quality and reporting of the narrative review were assessed using the Scale for the Assessment of Narrative Review Articles (SANRA), whereas interpretation of the results was based on the constructs of the Health Belief Model (HBM).Across the 25 studies, self-efficacy and perceived barriers were the strongest and most modifiable HBM predictors of adherence, while susceptibility, severity, benefits, and cues to action contributed more variably. HBM-based educational and mobile health interventions improved HBM scores, adherence, and, in several studies, blood pressure control, though HBM constructs alone explained only modest-to-moderate variance in adherence. Non-HBM factors such as medication cost, regimen complexity, healthcare access, social support, and the patient–provider relationship independently predicted adherence and, in some studies, outweighed classic HBM beliefs altogether. The HBM offers a useful but inadequate framework for understanding modifiable beliefs around cardiovascular medication adherence; its constructs consistently identify self-efficacy and barrier reduction as intervention targets, but explain only part of adherence behavior. Effective strategies should combine HBM-informed education with barrier reduction, self-efficacy building, social support, and digital health tools, adapted to local cultural and health-system context. Longitudinal and intervention research particularly from Pakistan is needed to test integrated, culturally adapted models of sustained adherence.