Crespo-Leiro, María GenerosaPérez-Castro, Teresa-RosalíaAlmenar-Bonet, LuisSegura-Saint-Gerons, CarmenBrossa-Loidi, VicensSegovia Cubero, JavierNaya-Leira, CarmenLópez-Vilella, RaquelLópez-Granados, AmadorGil-Alonso, DoloresBriceño-Hinojo, AnaMuñiz, JavierGrille-Cancela, ZulaikaDenhaerynck, KrisDe Geest, Sabina2026-05-052026-05-052026-03-28Crespo-Leiro MG, Pérez-Castro TR, Almenar-Bonet L, Segura-Saint-Gerons C, Brossa-Loidi V, Segovia-Cubero J, Naya-Leira C, López-Vilella R, López-Granados A, Gil-Alonso D, Briceño-Hinojo A, Muñiz J, Grille-Cancela Z, Denhaerynck K, De Geest S. Person-level correlates of nonadherence to co-medication in spanish heart transplant recipients. West J Nurs Res. 2026 May;48(5):468-478.1552-8456https://hdl.handle.net/2183/48162Multicenter study[Abstract] Background: Nonadherence to heart transplantation-related medications involves both immunosuppressant drugs and co-medications; yet the correlates of heart transplantation patients' overall medication nonadherence remain unclear. Objectives: We aimed to (1) describe nonadherence to both immunosuppressive and co-medication among Spanish heart transplantation patients, (2) to identify individual-level predictors of co-medication nonadherence, and (3) to describe nonadherence to non-pharmacological advice (eg, sun protection, physical activity, alcohol use) and clinical practice patterns of transplant centers. Methods: For this multicenter cross-sectional study, we surveyed 224 adult patients attending 5 Spanish centers 1 to 5 years post-transplantation. We assessed nonadherence to immunosuppressants and co-medications using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS©). Correlates of nonadherence to co-medications were derived from the Integrative Model of Behavioral Prediction using self-report instruments, as were non-pharmacological treatment adherence and treatment centers' practice patterns. Supported by causal mapping, multiple logistic regression analysis allowed adjustment for relevant confounders. Results: Nonadherence prevalence was 16.5% for co-medications (range across centers: 7.4%-25.0%), versus 9.4% (range: 2.6%-22.2%) for immunosuppressants. Adherence support varied across centers. Barriers to immunosuppressant nonadherence predicted co-medication nonadherence (odds ratio = 11.80; 95% CI, 2.59-53.69). Nonadherence to non-pharmacological treatments, particularly sunscreen use (59.3%) and physical activity (31.8%), were also common. Conclusions: Post-heart transplantation co-medication nonadherence surpasses immunosuppressant nonadherence. Barriers to immunosuppressant adherence strongly predict co-medication nonadherence. While no direct causal relationship is clear, immunosuppressant nonadherence may prove useful for identifying patients prone to co-medication nonadherence.engBehavior and behavior mechanismsHeart transplantationMedication adherenceMulticenter studyMultifactorial causalityjournal articleopen access10.1177/01939459261422817