Identification of psychosocial factors which influence patient adherence with antihypertensive medication

Psychosocial Determinants of the Intention to Take Oral Antihypertensive Drugs: A Cross-sectional Study

Objective: To identify the psychosocial predictors that influence the behavioral intention to take oral antihypertensive drugs. Materials and methods: A cross-sectional study, based on the theory of planned behavior. A questionnaire constructed and validated was applied to 220 individuals with systemic arterial hypertension in outpatient follow-up at a public hospital. The chi-square and Fisher’s exact tests, Spearman’s correlation and multiple logistic regression were used for data analysis. Results: The participants presented a high intention of taking antihypertensive drugs. The behavioral beliefs (ß = 0.0432; p = 0.0364), subjective norm (ß = -1.5708; p < 0.01) and perceived behavioral control (ß = 2.2809; p = 0.0028) explained the behavioral intention in 33 %. Conclusions: The behavioral beliefs, the subjective norm, and the perceived behavioral control are significant psychosocial predictors of taking antihypertensive drugs and must be valued, individually and jointly, in the health actions targeted at this population.

Can the BASNEF Model Help to Develop Self-Administered Healthy Behavior in Iranian Youth?

Background:

The stage of youth is critical for human development in several ways. On the one hand, it can lead people towards the adoption of a healthy lifestyle during adulthood based on these earlier practices. On the other hand, it can comprise the development of healthy living practices later on in live, an outcome which is often caused by the youth adopting a risky lifestyle early on.

Objectives:

The primary objective of this study was to determine the effectiveness of implementing an educational intervention program based on the BASNEF Model (a simplified approach to understanding behavior), designed to cultivate self-administered lifestyle control skills in youths.

Materials and Methods:

This was a quasi-experimental intervention study, implemented during 2010 - 2011. A total of 288 randomly selected high-school students between the ages of 15 and 17 participated in this study. These students were later divided into experimental and control groups. Subjects completed a BASNEF questionnaire at the baseline (pre-test), one month later (post-test) and three months after the educational intervention (follow-up). Four educational sessions were held, each of a 120 - 150 minute duration. After the data had been collected, the ANOVA test was used to compare trends in changes. The Pearson correlation coefficient was then used to analyze the correlation between components of the BASNEF model. Finally, regression analysis was used to determine the predictive power of the study.

Results:

Results from the intervention study reveal that the beliefs and attitudes about nutrition of the intervention group, calculated in terms of scores, improved significantly for both male and female subjects (P < 0.001) as compared to the control group. The mean BASNEF scores for improvements in beliefs among girls and boys were 79.2% and 70.1%, respectively and for attitudes, 61.2% and 59.4%. The increase was significantly higher in the intervention group (P < 0.001). Furthermore, participation in physical activity was more frequent among members of the intervention group than among those in the control group (P < 0.001).

Conclusions:

The BASNEF model could be effective in encouraging the adoption of nutritious eating habits and more active lifestyles at an early age in order to foster long-term health and well-being.

Drug attitude and adherence: a qualitative insight of patients with hypertension

The study is aimed to explore the perceptions and experiences of hypertensive patients toward medication use and adherence. The study was qualitative in nature conducted at Sandamen Provisional Hospital of Quetta city, Pakistan; a public hospital catering to the health needs of about 40% of the population. A qualitative approach was used to gain an in-depth knowledge of the issues. Sixteen patients were interviewed, and the saturation point was achieved after the 14(th) interview. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Thematic content analysis yielded five major themes. (1) Perceived benefits and risks of medications, (2) physician's interaction with patients, (3) perception toward traditional remedies, (4) layman concept toward medications, and (5) beliefs toward hypertension and its control. The majority of the patients carried specific unrealistic beliefs regarding the long-term use of medication; yet these beliefs were heavily accepted and practiced by the society. The study indicated a number of key themes that can be used in changing the beliefs and experiences of hypertensive patients. Physician's attitude, patient's past experiences, and knowledge related to hypertension were noted as major contributing factors thus resulting in nonadherence to therapy prescribed.

Relationship of blood pressure self-monitoring, medication adherence, self-efficacy, stage of change, and blood pressure control among municipal workers with hypertension

Uncontrolled blood pressure remains a major public health issue. Medication adherence is a key factor in blood pressure management; however, adherence behavior is not clearly understood and the most significant factors contributing to poor medication adherence and blood pressure control are unknown. The purpose of this study was to determine the relationship of self-monitoring of blood pressure, medication adherence, self-efficacy, stage of change, and blood pressure control among municipal workers with access to health insurance. Stage of change was a significant independent predictor of self-monitoring of blood pressure, but not blood pressure control. A strong relationship was found between medication adherence and medication adherence self-efficacy (r = .549, p < .05).

Relationship of blood pressure self-monitoring, medication adherence, self-efficacy, stage of change, and blood pressure control among municipal workers with hypertension

Uncontrolled blood pressure remains a major public health issue. Medication adherence is a key factor in blood pressure management; however, adherence behavior is not clearly understood and the most significant factors contributing to poor medication adherence and blood pressure control are unknown. The purpose of this study was to determine the relationship of self-monitoring of blood pressure, medication adherence, self-efficacy, stage of change, and blood pressure control among municipal workers with access to health insurance. Stage of change was a significant independent predictor of self-monitoring of blood pressure, but not blood pressure control. A strong relationship was found between medication adherence and medication adherence self-efficacy (r = .549, p < .05).

Adherence to antihypertensive treatment and associated factors among patients on follow up at University of Gondar Hospital, Northwest Ethiopia

Background

Hypertension is an overwhelming global challenge with high morbidity and mortality rates. The prevalence of HTN is estimated to be 6% in Ethiopia and 30% in Addis Ababa. Poor adherence is associated with bad outcome of the disease and wastage of healthcare resources. In Ethiopia, particularly in the study area little is known about treatment adherence and associated factors. Therefore this study aimed to assess adherence to antihypertensive therapy and associated factors among HTN patients on follow up at University of Gondar Referral Hospital.

Method

Institution based cross sectional study was conducted. Systematic sampling technique was used to select 384 participants. A structured standard questionnaire was used after some modifications. Morisky Medication Adherence Scale was used for labeling patients as adherent or non-adherent. Data were entered and analyzed using SPSS version 16.

Results

More than half (64.6 %) of the study participants were found to be adherent to their treatment. Sex (AOR = 0.48, 95%CI = 0.28, 0.82), knowledge about HTN and its treatment (AOR = 6.21, 95%CI = 3.22, 11.97), distance from the hospital (AOR = 2.02, 95% CI =1.19-3.43) and co morbidity (AOR = 2.5, 95%CI = 1.01, 6.21) variables were found significantly associated with treatment adherence.

Conclusion

Only 64.6% of the study subjects were found to be adherent to their treatment. Factors such as sex, distance from the hospital, number of co morbidities, Knowledge about HTN and its treatment were associated with adherence behavior of patients. Early diagnosis and management of co morbidities, adherence counseling and patient education about the disease and its treatment are important to improve adherence status of patients.

Frequency, types and severity of medication use-related problems among medical outpatients in Nigeria

OBJECTIVES

To determine the frequency, types and severity of medications use-related problems among medical outpatients in a tertiary care setting in southwestern Nigeria.

SETTING

Medical outpatient clinics of a 900-bed Teaching Hospital located in Ibadan, Southwestern Nigeria.

METHODS

A prospective cross-sectional medication use review was conducted by ten pharmacists for 400 randomly selected medical outpatients over a 4 week period at a 900-bed premier teaching hospital located in Ibadan, Nigeria. Severity assessment of medication use-related problems was done by 3 independent assessors with a modified severity index.

MAIN OUTCOME MEASURE

Frequency, types and severity of medication use-related problems identified through pharmacist-initiated medication use review.

RESULTS

Of the 400 randomly selected patients, 324 (81.0%) consented and were interviewed. One hundred and sixty-three (50.3%) of the cohort were males and 161 (49.7%) were females; with mean ages 51.5 ± 17.6 and 52.1 ± 17.4 years respectively. Median no. of drugs prescribed per patient per day was 4 (Minimum-Maximum, 1-7). About 27.5% were self medicating with orthodox (prescription-only and over-the-counter) and/or herbal medicines; and only 14.6% claimed disclosure to their physicians. The proportion of patients self medicating with orthodox medicines was significantly higher (P < 0.0001). Two hundred and twenty-six medication use-related problems were identified from 58.6% of patients, but the highest number (5) was identified among 2.6% of patients. The frequency of medication use-related problems appear strongly related to the number of medicines prescribed (r = 0.71, P = 0.006). The majority of medication use-related problems were ranked as potentially harmful [Inter-rater reliability coefficient: Gwet AC1: 0.7214 (P ≤ 0.001)]. Non-adherence (43.8%), problems associated with self medication (39.3%) and adverse drug reactions (15.6%) were the most frequent. Unauthorized drug holidays (46.5%) and stoppage of prescribed prescription-only medications for local herbs (29.3%) were the major consequences of non-adherence. Potentially harmful drug-disease interactions were the most frequent medication use-related problems arising from self medication (40.4%).

CONCLUSION

Potentially harmful medication use-related problems are frequently encountered among medical outpatients in Nigeria. The institutionalization of medication use review and the devolution of this task to pharmacists may prove beneficial in optimizing outcomes of medication use in Nigeria.

Assessing patient adherence to anti-hypertensive drug therapy: can a structured pharmacist-conducted interview separate the wheat from the chaff?

Objective

To identify determinants of adherence and assess the impact of structured pharmacist-conducted interviews in determining patients' adherence to prescribed anti-hypertensive medications in a secondary care setting in Nigeria.

Method

The study was conducted in a secondary care facility located in Ibadan, Southwestern Nigeria. Two methodological approaches were employed. The first phase was pharmacist-conducted, pre-physician consultation, cross-sectional interviews of 400 hypertensive patients who presented at the study site within the 2-month study period. The second phase was a follow-up review of case notes of these patients after they had left the physician's office.

Key findings

The outcome of the pharmacist-conducted pre-physician consultation interview shows that financial difficulty was the most frequently identified factor responsible for patients' non-adherence to anti-hypertensive drug therapy (64%). A drug holiday, varying from 5–14 days per month, was the coping strategy adopted by patients to circumvent this difficulty. Only 48% (192) of patients were aware of the negative consequences of non-adherence with anti-hypertensive drug therapy, and of these, 75% were adherent. The level of awareness was significantly higher in adherent patients (P &lt; 0.001). Sixty-seven per cent (268) of patients use a daily medication reminder (DMR) to assist them in taking their anti-hypertensive drugs, and of these 65.7% were adherent. The use of DMRs was significantly higher among adherent patients (P &lt; 0.01). A meal time was the most frequently used DMR (88%). Forty-one per cent (164) of patients had additional measurement of their blood pressure at pharmacies (65.9%) and neighbourhood private hospital (34.1%), and of these 75.6% were judged to be adherent with their prescribed drug therapy. Additional measurement of blood pressure was significantly higher in adherent patients (P &lt; 0.001). Fifty-one per cent of the cohort were judged by pharmacists as non-adherent during pre-consultation interviews (phase 1), while physicians judged 25% of the same cohort as non-adherent during consultation (phase 2). The structured pharmacist-conducted pre-physician consultation interviews were significantly better at identifying patients who were non-adherent with prescribed anti-hypertensive drugs (P &lt; 0.01).

Conclusion

A brief structured pharmacist-conducted interview can be a valuable tool in assessing and/or identifying determinants of adherence with anti-hypertensive drug therapy.

Factors associated with adherence to anti-hypertensive treatment in Pakistan

Objectives

Poor adherence is one of the biggest obstacles in therapeutic control of high blood pressure. The objectives of this study were (i) to measure adherence to antihypertensive therapy in a representative sample of the hypertensive Pakistani population and (ii) to investigate the factors associated with adherence in the studied population.

Methods and Results

A cross-sectional study was conducted on a simple random sample of 460 patients at the Aga Khan University Hospital (AKUH) and National Institute of Cardiovascular Diseases, Karachi, from September 2005–May 2006. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS), with scores ranging from 0 (non-adherent) to 4 (adherent). In addition to MMAS, patient self-reports about the number of pills taken over a prescribed period were used to estimate adherence as a percentage. AKU Anxiety and Depression Scale (AKU-ADS) was incorporated to find any association between depression and adherence. At a cut-off value of 80%, 77% of the cases were adherent. Upon univariate analyses, increasing age, better awareness and increasing number of pills prescribed significantly improved adherence, while depression showed no association. Significant associations, upon multivariate analyses, included number of drugs that a patient was taking (P<0.02) and whether he/she was taking medication regularly or only for symptomatic relief (P<0.00001).

Conclusions

Similar to what has been reported worldwide, younger age, poor awareness, and symptomatic treatment adversely affected adherence to antihypertensive medication in our population. In contrast, monotherapy reduced adherence, whereas psychosocial factors such as depression showed no association. These findings may be used to identify the subset of population at risk of low adherence who should be targeted for interventions to achieve better blood pressure control and hence prevent complications.

Identification of psychosocial factors of noncompliance in hypertensive patients

This cross-sectional study was aimed to identify the predictors of medication noncompliance in hypertensive patients. The study was conducted at the Family Medicine Clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, which is a university-based teaching hospital. All hypertensive patients aged 40 or over-registered from January to June 2004, who had been on treatment for at least 3 months, were screened. Previously validated self-administered questionnaires were used to assess the compliance and psychosocial factors. A total of 240 hypertensive patients were recruited in the study. Of these, 55.8% were noncompliant to medication. Logistic regression showed that age (adjusted odds ratio (OR): 0.96; 95% confidence interval (CI): 0.92-0.997; P: 0.035), patient satisfaction (adjusted OR: 0.97; 95% CI: 0.93-0.998; P: 0.036) and medication barrier (adjusted OR: 0.95; 95% CI: 0.91-0.987; P: 0.009) were significant predictors of medication noncompliance. Therefore, younger age, poor patient satisfaction and medication barrier were identified as independent psychosocial predictors of medication noncompliant in hypertensive patients.