Investigating Lack Of Adherence To Medications Used For Primary Or Secondary Stroke Prevention In Rural Ecuador: Rationale And Protocol Of A Population-Based Study

Background: Stroke is an emerging public health crisis in Latin America, particularly in rural areas of low-and middle-income countries (LMIC), where limited healthcare access exacerbates disease burden. Medication adherence plays a fundamental role in stroke prevention, yet information on this topic remains insufficiently known due to issues related to socioeconomic, educational, and infrastructural barriers. Aims: This study introduces a protocol designed to assess adherence to primary and secondary stroke prevention medications in rural Ecuador. By identifying behavioral patterns and underlying barriers, this research aims to provide evidence-based recommen-dations for improving adherence and informing public health interventions. Methods: The study will be conducted in Atahualpa, Ecuador, using a population-based design with an initial cross-sectional assessment followed by a 10-year longitudinal follow-up. Medication adherence will be evaluated through validated questionnaires, clinical examinations, and annual updates on vascular risk factors and social determinants of health. Statistical analyses will assess the relationship between adherence levels, demographic variables, and cerebrovascular outcomes. Comment: This research provides essential insights into adherence behaviors in underserved populations, offering a foundation for targeted interventions. Findings will support healthcare accessibility, strengthen patient education, and improve adherence strategies to reduce stroke incidence and improve health outcomes in rural LMIC settings.