Predictors of Noncompliance to Antihypertensive Therapy among Hypertensive Patients Ghana: Application of Health Belief Model

Estimating the Lifetime Cost of Managing Hypertension in Ghana: A Modelling Study

Introduction

Over the last decade, hypertension (HPT) is among the leading causes of death and morbidity in Ghana. In recent past, most health policy research in Ghana and Africa focussed on communicable diseases. In recent times, Ghana and other developing nations have shifted their attention to non-communicable diseases because most of these countries are going through an epidemiologic transition where there is a surge in the prevalence of HPT. This paper was therefore set out to estimate the cost of treating HPT in Ghana from the patients' and health system's perspectives.

Method

We used a cost of illness framework to simulate the cost of HPT management in Ghana taking into account 4 of the common target organ complications with the most mortality implication. A decision analytic model (DAM) was developed in Microsoft® Excel to simulate the progression of HPT patients and the Markov model was employed in simulating the lifetime cost of illness.

Results

The results show that by 10 years from diagnosis, the probability of death from any of the 4 complications (ie, stroke, myocardial infarction, heart failure, and chronic kidney disease) is roughly 41.03%. By 20 years (or 243 months) from diagnosis, the probability of death is estimated to be 69.61%. However, by the 30th anniversary, the probability of death among the cohort is 82.3%. Also, the lifetime discounted cost of treating HPT is about GHS 869 106 which could range between GHS 570 239 and GHS 1.202 million if wide uncertainty is taken into account. This is equivalent to USD 119 056 (range: USD 78 115-164 723).

Conclusion

By highlighting the lifetime cost of treating HPT in Ghana, policies can be formulated regarding the cost of treating HPT by the non-communicable disease unit and National Health Insurance Authority (NHIA) of the Ministry of Health.

Factors Influencing Medication Adherence in Elderly Patients with Hypertension: A Single Center Study in Western China

Purpose

To develop and empirically test a conceptual model that explains the factors influencing antihypertensive medication adherence behavior in elderly patients in a city in western China.

Patients and Methods

The conceptual model was based on the Theory of Planned Behavior and the Health Belief Model and was empirically tested using cross-sectional survey data from Nanchong City, a city in western China, collected between October and December 2020. Data were analyzed using structural equation modeling.

Results

Behavioral intentions were the main predictor of medication adherence behavior (path coefficient of 0.353). Perceived benefits and perceived barriers directly (path coefficient = 0.201 and -0.150, respectively), and indirectly (path coefficient = 0.118 and -0.060) through behavioral intentions, influenced medication adherence behavior. Perceived susceptibility (path coefficient = 0.390) and perceived severity (path coefficient = 0.408) influenced behavioral attitudes, which influenced behavioral intentions (path coefficient = 0.298).

Conclusion

The conceptual model demonstrates a robust ability to predict and explain medication adherence behavior among elderly patients with hypertension, facilitating the adoption and maintenance of changes in adherence behavior and the potential for preventing disease progression and improving quality of life.

Predictors of Nonadherence to Medications among Hypertensive Patients in Ghana: An Application of the Health Belief Model

Introduction. Hypertension (HPT) is recognized as a significant public health problem worldwide from a health and economic perspective. This study determined predictors of nonadherence to HPT medications in Ghana using the health belief model. Methods. A cross-sectional descriptive survey employing a quantitative approach was conducted among HPT patients who routinely attend clinics at selected hospitals in the Brong Ahafo region of Ghana. Respondents (n = 399) were recruited using a multistage sampling technique. Results. The prevalence of nonadherence was 63.7% (n = 254). Nonadherence to hypertension medication was associated with lower education status ( $p=0.009$ ). In logistic regression analysis, patients with high “perceived susceptibility” and “perceived severity” were more likely to forfeit their HPT medication schedules, while patients with high “perceived barriers” and “cues to action” were less likely to skip their medication. Conclusion. The present study suggests a plausible path to improving medication adherence in this population. Given the high prevalence of nonadherence, policymakers need to urgently design tailor-made health promotion interventions to ensure optimal health outcomes.

Predictors of medication nonadherence among hypertensive clients in a Ghanaian population: Application of the Hill‐Bone and Perceived Barriers to Treatment Compliance Scale

Background and Aim

Nonadherence to antihypertensive medication impairs optimal blood pressure and is influenced by multiple interrelating factors. Knowing the complexity of medication nonadherence and its associated factors is essential for intervention strategies. This study evaluated the predictors of medication nonadherence among hypertensive clients in a Ghanaian population.

Methods

This was a hospital‐based cross‐sectional study conducted at the Hypertensive Clinic of the Kwame Nkrumah University of Science and Technology (KNUST) Hospital, Kumasi, Ghana. A self‐designed questionnaire, the Hill‐Bone Compliance to High Blood Pressure Therapy and Perceived Barriers to Treatment Compliance Scales, were used for data collection from 246 hypertensives. Data were analyzed using Statistical Package for Social Sciences, version 25.

Results

Medication nonadherence was observed among 8.5% of the study participants. In a multivariate regression model perceived noneffectiveness of medication (odds ratio [OR] = 1.76, 95% confidence interval [CI]: 1.34–2.31, p < 0.001) and barriers to alcohol and smoking cessation (OR = 2.83, 95% CI: 1.31–6.13, p = 0.008) were associated increased odds of antihypertensive medication nonadherence. Also, patients who do not know their total prescription (OR = 8.81, 95% CI: 2.28–34.0, p = 0.002) were more likely to be nonadherent to their antihypertensive medications. Moreover, clients who associate signs/symptoms of palpitations (OR = 5.82, 95% CI: 1.31–25.80, p = 0.021), poor sleep (OR = 3.92, 95% CI: 1.09–14.12, p = 0.036) and decreased sexual drive (OR = 4.74, 95% CI: 0.96–23.28, p = 0.055), were more likely to be nonadherent to antihypertensive medication.

Conclusion

In conclusion, we observed a lower nonadherence rate among hypertensive clients in a Ghanaian population with correlates being medication‐related factors. Most importantly, perceived noneffectiveness of medication, barriers to smoking and alcohol cessation, palpitations, poor sleep, and decreased sexual drive significantly predicted lower adherence and could serve as indicators for high risk of nonadherence to antihypertensive medications.

Parental Compliance towards Oral Health Education among Preschoolers with Special Healthcare Needs

Background: Young children with special needs greatly rely on their parents to support their daily living activities; parental compliance may have great impact on the implementation of health promotion activities among those children. This study aimed to investigate the parental compliance towards oral health education (OHE) among children with special healthcare needs (SHCN). Method: The participants were 306 parents whose children had participated in a 24-month OHE program for preschool children with SHCN. The primary outcome of this cross-sectional study was parental compliance towards the OHE program. Parents’ oral health literacy (OHL) was assessed by a validated tool. Parents’ socioeconomic status, attitudes towards OHE topics, perceptions of children’s oral hygiene status, and usefulness of OHE materials were collected via questionnaires. Results: A higher dropout rate was observed among parents who perceived that their children had unfavorable oral hygiene status (p = 0.038), or parents who had poor OHL skills (p = 0.015). Parental noncompliance was more likely to be observed among parents who perceived that the OHE materials were not useful for their children (OR = 3.63, 95% CI 1.56 to 8.47, p = 0.003), or parents whose children had been diagnosed with developmental delays (OR = 5.45, 95% CI 1.59 to18.74, p = 0.007). Conclusion: Non-compliance existed among parents whose children had received OHE intervention. Parental compliance towards OHE intervention might be associated with parents’ OHL skills, usefulness of OHE materials, and children’s developmental conditions. OHE programs should be individually tailored to support children whose parents are at a higher risk of noncompliant behaviors.

Using the Health Belief Model to Explain the Patient's Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

BACKGROUND

Hypertension remains a public-health challenge globally. Its prevention, early detection, proper and adequate treatment and control should be given high consideration to prevent occurrence of cardiovascular disease and stroke. This study is guided by the Health Belief Model (HBM) to investigate the influence of treatment compliance using HBM constructs among elderly hypertensive patients in 3 regional hospitals in Dar es Salaam, Tanzania.

METHODS

An analytical cross-sectional study was conducted in 3 region hospitals in Dar es Salaam from April to May 2012. The study included patients who were on antihypertensive medications. Simple Random Sampling was used to enrol the study participants. Data was collected using structured questionnaire. Data was analysed using SPSS version 20. Linear Multiple Regression analysis was performed to identify variables which are strongest predictor of treatment compliance among variables of the Health belief Model.

RESULTS

A total of 135 participants were enrolled of whom 56% were compliant to hypertensive treatment. Multivariate analysis indicated significant model fit for the data (F=11.19 and P value <.001). The amount of variance in treatment compliance that was explained by the predictors was 30.3% (R2=0.303) with perceived barrier being the strongest predictor of treatment compliance (β=-0.477; p< .001). Other predictor variables were not statistically associated with treatment compliance.

CONCLUSION

The study showed that 56% of study participants had hypertensive treatment compliance and perceived barrier to treatment was the strongest predictor. Innovative strategy on improving patients' perception of barrier to treatment is recommended in order to improve treatment compliance.

Improving Medication Adherence Through Adaptive Digital Interventions (iMedA) in Patients With Hypertension: Protocol for an Interrupted Time Series Study

BACKGROUND

There is a strong need to improve medication adherence (MA) for individuals with hypertension in order to reduce long-term hospitalization costs. We believe this can be achieved through an artificial intelligence agent that helps the patient in understanding key individual adherence risk factors and designing an appropriate intervention plan. The incidence of hypertension in Sweden is estimated at approximately 27%. Although blood pressure control has increased in Sweden, barely half of the treated patients achieved adequate blood pressure levels. It is a major risk factor for coronary heart disease and stroke as well as heart failure. MA is a key factor for good clinical outcomes in persons with hypertension.

OBJECTIVE

The overall aim of this study is to design, develop, test, and evaluate an adaptive digital intervention called iMedA, delivered via a mobile app to improve MA, self-care management, and blood pressure control for persons with hypertension.

METHODS

The study design is an interrupted time series. We will collect data on a daily basis, 14 days before, during 6 months of delivering digital interventions through the mobile app, and 14 days after. The effect will be analyzed using segmented regression analysis. The participants will be recruited in Region Halland, Sweden. The design of the digital interventions follows the just-in-time adaptive intervention framework. The primary (distal) outcome is MA, and the secondary outcome is blood pressure. The design of the digital intervention is developed based on a needs assessment process including a systematic review, focus group interviews, and a pilot study, before conducting the longitudinal interrupted time series study.

RESULTS

The focus groups of persons with hypertension have been conducted to perform the needs assessment in a Swedish context. The design and development of digital interventions are in progress, and the interventions are planned to be ready in November 2020. Then, the 2-week pilot study for usability evaluation will start, and the interrupted time series study, which we plan to start in February 2021, will follow it.

CONCLUSIONS

We hypothesize that iMedA will improve medication adherence and self-care management. This study could illustrate how self-care management tools can be an additional (digital) treatment support to a clinical one without increasing burden on health care staff.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04413500; https://clinicaltrials.gov/ct2/show/NCT04413500.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24494.

Exploring Culture, Religiosity and Spirituality Influence on Antihypertensive Medication Adherence Among Specialised Population: A Qualitative Ethnographic Approach

BACKGROUND

Hypertension is one of the major risk factors of stroke and leading risk factors for global death. Inadequate control of blood pressure due to medication non-adherence remains a challenge and identifying the underlying causes will provide useful information to formulate suitable interventions.

PURPOSE

This study aimed to explore the roles of culture, religiosity, and spirituality on adherence to anti-hypertensive medications.

METHODOLOGY

A semi-structured qualitative interview was used to explore promoters and barriers to medication adherence among hypertensive individuals residing in urban and rural areas of Perak State, West Malaysia. Study participants were individuals who are able to comprehend either in Malay or English, above 18 years old and on antihypertensive medications. Interview transcriptions from 23 participants were coded inductively and analyzed thematically. Codes generated were verified by three co-investigators who were not involved in transcribing process. The codes were matched with quotations and categorized using three levels of themes named as organizing, classifying and general themes.

RESULTS

Cultural aspects categorized as societal and communication norms were related to non-adherence. The societal norms related to ignorance, belief in testimony and anything "natural is safe" affected medication adherence negatively. Communication norms manifested as superficiality, indirectness and non-confrontational were also linked to medication non-adherence. Internal and organizational religiosity was linked to increased motivation to take medication. In contrast, religious misconception about healing and treatment contributed towards medication non-adherence. The role of spirituality remains unclear and seemed to be understood as related to religiosity.

CONCLUSION

Culture and religiosity (C/R) are highly regarded in many societies and shaped people's health belief and behaviour. Identifying the elements and mechanism through which C/R impacted adherence would be useful to provide essential information for linking adherence assessment to the interventions that specifically address causes of medication non-adherence.

The Role of Lifestyle Factors in Controlling Blood Pressure among Hypertensive Patients in Two Health Facilities in Urban Ghana: A Cross-Sectional Study

Introduction

Despite efforts to combat hypertension by pharmacotherapy, hypertension control rates remain low. Lifestyle modifications of individuals diagnosed with hypertension have prospects for the prevention and control of hypertension. This study assessed the effect of modifiable lifestyle factors on blood pressure control among adults in urban Accra.

Methods

In this cross-sectional study, 360 diagnosed hypertensive patients who were ≥18 years old, selected from two secondary-level referral hospitals in the Greater Accra Region, were interviewed. Demographic information, diet components, and exercise assessments as well as blood pressure measurements were taken. Chi-squared tests and binomial logistic regression were used to determine the association between demographic and lifestyle factors with blood pressure control. Area under the receiver-operator curves (AUROC) was used to identify lifestyle factors predicting optimal blood pressure control among patients diagnosed with hypertension.

Results

Approximately 54.2% of participants had no knowledge of either causes or complications of hypertension. Similarly, 52.5% of patients that had not achieved blood pressure control lacked knowledge of causes or complications of hypertension. Longer time since diagnosis of 2–5 years (AOR = 0.08 (95% CI: 0.01–0.47)) and 6–10 years (AOR = 0.08 (95% CI: 0.01–0.50)) and diets, mainly composed of meat (AOR = 0.13 (95% CI: 0.02–0.70)) and starch (AOR = 0.14 (95% CI: 0.03–0.79)), predicted poor blood pressure control compared to patients diagnosed within a year and diets without meat and starch as main components, respectively. Additionally, engaging in some physical activity of 30 minutes to one hour (AOR = 5.64 (95% CI: 2.08–15.32)) and more than an hour (AOR = 11.38, 95% CI: 2.01–64.47)) predicted blood pressure control.

Conclusion

The study concludes that increased physical activity, abstaining from alcohol and smoking, increased intake of fruits and vegetables, and reduced intake of carbohydrates, meat, and fat have a positive influence on blood pressure control. Lifestyle modifying factors have a key role in complementing pharmacotherapy in hypertension control.

Blood Pressure Control among Hypertensive Diabetic Patients on Follow-Up at Chronic Clinic of Nekemte Referral Hospital in West Ethiopia

Background

Hypertension is a prevalent comorbid condition in diabetes, affecting ∼20–60% of patients with diabetes, depending on obesity, ethnicity, and age. Adults with diabetes historically have two or three times higher rate of cardiovascular disease (CVD) than adults without diabetes.

Objective

The aim of this study was to assess blood pressure (BP) control and its predictors among hypertensive diabetic patients on follow-up at the chronic clinic of Nekemte Referral Hospital (NRH) in West Ethiopia.

Methods

A cross-sectional study was conducted among hypertensive adult patients comorbid with diabetes taking antihypertensive drugs for at least one year in NRH. Both bivariable and multivariable analyses were done. The odds ratio, along with 95% confidence level, was estimated to identify factors associated with uncontrolled BP by using multivariable logistic regression analysis. The level of statistical significance was declared at p value <0.05 levels. The patient's written informed consent was obtained after explaining the purpose and procedures of the study.

Results

A total of 186 study participants were included in this study. The mean age of the participants was 51.2 ± 12.2 years. Blood pressure and blood glucose were controlled in 104 (55.9%) and 106 (57.0%) study participants, respectively. In the multivariable analysis, age ≥60 years (AOR = 4.537, 95% CI = 1.142–18.024, p=0.032), duration with hypertension ≥5 years (AOR = 3.534, 95% CI = 1.062–11.760, p=0.040), cigarette smoking (AOR = 7.697, 95% CI = 2.356–25.146, p=0.001), nonadherence (AOR = 6.584, 95% CI = 2.337–18.553, p < 0.001), and uncontrolled glycaemia (AOR = 21.630, 95% CI = 8.057–58.070, p < 0.001) were independent predictors of uncontrolled blood pressure.

Conclusion

Compared to the previous studies, BP was better controlled among hypertensive diabetic patients in the present study. Older age, longer duration with hypertension, cigarette smoking, nonadherence, and uncontrolled glycaemia were predictors of uncontrolled BP. Thus, interventions on modifiable factors should be done to improve BP control of patients' comorbid with diabetes.

Determinants of medication adherence among hypertensive patients using the Pender's health promotion model

BACKGROUND

Poor adherence in treatment and medication is a global issue in curing the chronic diseases such as hypertension. The present study was conducted to identify the factors related with medication adherence among hypertensive patients referred to the health centers of Borujerd based on the Pender's Health Promotion Model (HPM).

MATERIALS AND METHODS

This cross-sectional study was conducted on 463 patients who were referred to the comprehensive health centers of Borujerd city by cluster sampling method in 2019. The data were collected using a questionnaire including demographic variables and Pender's HPM constructs. Data were analyzed by SPSS 18 software using Pearson correlation coefficient and linear regression.

RESULTS

The mean and standard deviation of the participants' age was 63.29 ± 11.2 years. The results showed that hypertensive patients had a relatively desirable level of medication adherence behavior. Perceived barriers (β = -0.169), perceived self-efficacy (β = 0.196), activity related affect (β = 0.232), and following medication regimen (β = 0.225) were the best predictors of performing the medication adherence behavior. In total, different structures of the HPM explained 42.2% of the variation of medication adherence behavior changes.

CONCLUSIONS

According to the findings, the design of educational programs using HPM is recommended to increase the medication adherence among hypertensive patients.

Promoting drug abuse preventive behaviors in adolescent students based on the health belief model

Background Nowadays, drug abuse is one of the most important health problems that can affect the quality of life of people in mental, psychological, physical, and social dimensions. Theory-based education can help the adolescents to promote their drug abuse preventive behaviors. Objectives The aim of this study was to determine the effectiveness of education based on the health belief model (HBM) on drug abuse preventive behaviors in adolescent students. Methods This study was an interventional quasi-experimental study with a pre-test/post-test design conducted in two high schools in the southeast of Iran. A two-step cluster sampling method was used and 120 students were randomly selected and categorized into the control (n = 60) and intervention (n = 60) groups. The intervention group participated in an education program based on the HBM in four 75-min sessions. Data were collected using demographic and drug abuse preventive behavior questionnaires based on the HBM. Results In the pre-test stage, the mean scores of drug abuse preventive behaviors and its dimensions were not significantly different between the intervention and control groups (t = -2.597 p = 0.641). In the post-test stage, the mean scores of the intervention and control groups were significantly different; the drug abuse preventive behaviors and its dimensions improved in the intervention group (t = 14.57, p < 0.001). Conclusion The findings showed that education based on the HBM had a significant effect on drug abuse preventive behaviors and its dimensions. Therefore, educational packages based on the HBM are recommended to improve these behaviors in adolescents.

Demographic and Lifestyle Predictors of Prehypertension: A Cross-Sectional Study among Apparently Healthy Adults in Kumasi, Ghana

Background

Prehypertension has been shown to increase future risk of hypertension. Some demographic and lifestyle characteristics have been implicated to increase the risk of development of prehypertension. Yet, there is paucity of data on the current prevalence of prehypertension and its associated risk factors in Ghana. This study evaluated the prevalence of prehypertension and examined the demographic and lifestyle characteristics associated with prehypertension among apparently healthy Ghanaian adults in Kumasi.

Methods

This was a cross-sectional study conducted from March to April, 2018, in Kumasi, Ghana. A total of 204 participants (80 males, 124 females, 25 years and above) who reported not diagnosed of hypertension and not on any antihypertensive medication were included in the study. Validated questionnaire was used to obtain sociodemographic and lifestyle characteristics of study participants. Height and weight of each respondent were measured and their corresponding Body Mass Index (BMI) was calculated. Blood pressure (BP) was measured with an automated blood pressure apparatus from the right arm. Prehypertension was defined as systolic BP of 120-139 mmHg and/or diastolic BP of 80-89 mmHg.

Results

Out of 204 participants, the prevalence of prehypertension was 49.0%. From multivariate logistic regression models, having lower level of education [aOR=2.74, 95% CI (1.15-6.55), p=0.02], not practicing at least 30 min daily walks [aOR=2.59, 95% CI (1.31-5.10), p=0.01], not exercising routinely [aOR=1.93, 95% CI (0.97-3.85), p=0.04], and alcohol consumption [aOR=3.58(1.52-8.46), p=0.004] were independently associated with higher odds of prehypertension.

Conclusion

The prevalence of prehypertension is high among apparently healthy Ghanaian adults (49.0%). Lower educational level, sedentary lifestyle, and alcohol consumption are the predominant risk factors for prehypertension in Kumasi.