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Identification of Psychosocial Factors of noncompliance in Hypertensive Patients
... Figure 4 presents the pooled prevalence of barriers to each HT management outcome organized by subthemes of the framework. Four studies reported barriers to hypertension awareness (figure 4.1) [55][56][57][58], 10 studies reported barriers to lifestyle change (figure 4.2) [44,45,[59][60][61][62][63][64][65][66], 15 studies reported barriers to treatment adherence (figure 4.3) [16,43,[58][59][60][67][68][69][70][71][72][73][74][75][76], and 9 studies reported barriers to following up with a health care provider (figure 4.4) [44,58,59,62,65,73,[77][78][79]. Of the 2 capability subthemes, only knowledge was assessed, and was mostly reported as a barrier to HT medication treatment adherence, reported as a barrier by 46% (95%CI:24–64%) of patients. ...
... Therefore, it is not possible to assess to what extent the provider reported barriers were actually associated with worse care. For patients, it was possible to assess the association of barriers with HT treatment adherence based on 5 studies that provided an adjusted effect measure [16,59,66, 67,69,74]. Figure 5shows that overall reporting of at least one barrier was associated with an increased risk of non-adherence (OR: 1.27, 95%CI: 1.00–1.58). ...
... In terms of acceptability, LMIC [25] reported barriers similar to those reported by ethnic minorities in HIC [30,41]. Among quantitative studies that provided enough data to pool the prevalence of patient barriers, only seven were from LMIC; 2 from South Africa [64,68], and one from each of Malaysia [67], Egypt [59], Singapore [81], Trinidad [60], and India [76]. Only one study assessed barriers to screening [69], two studies assessed barriers to medical adherence [64,81], and two assessed barriers to following up with a health care provider [59,81]. ...
Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers.
Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints.
Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers.
This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.
... However, adherence with medications was not measured in this study, and it is possible that patients who were willing to participate may not have acknowledged whether they had deliberately stopped taking their medication. In addition, as hypertension medication nonadherence rates among Asian patients may be as high as 56% [29], some findings from our study are only relevant to the half of the hypertensive population who are willing to take their medications. ...
Hypertension is one of the world's most common health conditions and is a leading risk factor for mortality. Although blood pressure can be modified, there is a large proportion of patients whose blood pressure remains uncontrolled. The aim of this study, termed Edvantage 360°, was to gain a deeper understanding of hypertension management in Asia from the perspective of patients and doctors, and to propose strategies to improve blood pressure control.
Conducted in Hong Kong, Indonesia, Malaysia, the Philippines, South Korea, Taiwan, and Thailand, Edvantage 360° was a mixed-methods observational study that used both qualitative and quantitative elements: qualitative interviews and focus groups with patients (N = 110), quantitative interviews with patients (N = 709), and qualitative interviews with doctors (N = 85).
This study found that, although there is good understanding of the causes and consequences of hypertension among Asian patients, there is a lack of urgency to control blood pressure. Doctors and patients have different expectations of each other and a divergent view on what constitutes successful hypertension management. We also identified a fundamental gap between the beliefs of doctors and patients as to who should be most responsible for the patients' hypertension management. In addition, because patients find it difficult to comply with lifestyle modifications (often because of a decreased understanding of the changes required), adherence to medication regimens may be less of a limiting factor than doctors believe.
Doctors may provide better care by aligning with their patients on a common understanding of successful hypertension management. Doctors may also find it helpful to provide a more personalized explanation of any needed lifestyle modifications. The willingness of the doctor to adjust their patient interaction style to form a 'doctor-patient team' is important. In addition, we recommend that doctors should not attribute ineffectiveness of the treatment plan to patient non-adherence to medications, but rather adjust the medication regimen as needed.
... With a growing worry on the increasing prevalence of hypertension among its population, health officers are thinking about the dreadful consequences of current and future Malaysians burdened with chronic ailments, which can otherwise be avoided. As for the seriousness of poor adherence to medical regimens in Malaysia was projecting in 2006, the publishing results of a study by Hassan et al. (2006) which showed that 55.8% of drugs prescribed by physicians were not taken as directed (4) . As far as hypertension is concerned, adhering to prescribed medication is critically important for controlling blood pressure and reducing the associated risk of ...
A number of factors have been identified that contribute to non-adherence to medications in hypertension, one of which is the drug regimen complexity. The purpose of this study was to identify patients with poor adherence to antihypertensive therapy and compare the levels of adherence with daily dose frequency of antihypertensive therapy [Single Daily Dose (SDD), Twice-Daily Dose (BID), and doses of more than twice daily (> BID)]. A cross sectional study was conducted on a convenience sampling of 518 patients with antihypertensive therapy at the Clinic of General Hospital of Penang, Malaysia. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS). The one-way Analysis of Variance (ANOVA) was used to compare the means of three categorical independent variable (SDD, BID and > BID), and one continuous dependent variable scores ranging from 1 (adherence) to 5 (poor adherence). Our results show that, the MORISKY scale items were summed that 195 patients had poor adherence to hypertensive medication. According to this result, 51.3% of our total sample was taking their medicines irregularly. Also we found a significant relationship between daily dose frequency groups and adherence at level p< 0.001. It shows that hypertension patients groups, who have more daily dose frequency, will show higher level of adherence towards antihypertensive medications.
... Adherence to CVD medications can involve a complex interplay of patient and treatment characteristics (Munger et al., 2007 ). Factors that have been suggested to influence non-adherence to CVD medication include being of a younger age (Hassan et al., 2005), suffering from depression (Aggarwal and Mosca, 2010), complexity of the prescription regimen (GrégoireGr´Grégoire et al., 2006), beliefs about necessity (Ruppar et al., 2012), beliefs about medication (Benson and Britten, 2002; Ogedegbe et al., 2004; Fergus, 2009) and beliefs about the severity of CVD (Stafford et al., 2008). Box 2. 5-item International Index of Erectile Function (IIEF-5) Adapted with permission from Rosen, et al. (1999) * How do you rate your confidence that you could get and keep an erection? ...
Due to their similar aetiologies, cardiovascular disease (CVD) and erectile dysfunction (ED) are closely linked, with the prevalence of ED being approximately 75% for individuals at high risk of CVD. ED can have a detrimental effect on quality of life not only for the individual but also his sexual partner which in turn impacts upon their intimate relationship. Some CVD medications have been found to have a negative effect on erectile function and therefore act as an influential factor for the cessation of important CVD medication. Low adherence to CVD medication has been linked to increased health costs, hospitalizations and importantly, a higher risk of mortality. Research has shown that men find it difficult to seek medical help in relation to ED which is also compounded by the notion that health care providers do not address sexual issues adequately. Patients' beliefs about CVD medication are modifiable and therefore an opportunity exists not only for health care providers to facilitate discussions in relation to ED and medication adherence but also encompass an opportunity to increase adherence to CVD medication through intervention.
... Many require two or more drugs, in addition to " health promoting life style modifications " . The compliance of patients with such recommendations is less than satisfactory, for a long line of complex reasons and further decreases with the addition of each new drug [3, 4]. The median time to discontinuing drugs is 90 days, persistence varies with individual drugs, and adverse side effects are the prime culprit [5]. ...
To evaluate the effect of adding tomato extract to the treatment regime of moderate hypertensives with uncontrolled blood pressure (BP) levels.
Fifty four subjects with moderate HT treated with one or two antihypertensive drugs were recruited and 50 entered two double blind cross-over treatment periods of 6 weeks each, with standardized tomato extract or identical placebo. Plasma concentrations of lycopene, nitrite and nitrate were measured and correlated with BP changes.
There was a significant reduction of systolic BP after 6 weeks of tomato extract supplementation, from 145.8 +/- 8.7 to 132.2 +/- 8.6 mmHg (p < 0.001) and 140.4 +/- 13.3 to 128.7 +/- 10.4 mmHg (p < 0.001) in the two groups accordingly. Similarly, there was a decline in diastolic BP from 82.1 +/- 7.2 to 77.9 +/- 6.8 mmHg (p = 0.001) and from 80.1 +/- 7.9 to 74.2 +/- 8.5 mmHg (p = 0.001). There was no significant change in systolic and diastolic BP during the placebo period. Serum lycopene level increased from 0.11 +/- 0.09 at baseline, to 0.30 +/- 01.3 micromol/L after tomato extract therapy (p < 0.001). There was a significant correlation between systolic BP and lycopene levels (r = -0.49, p < 0.001).
Tomato extract when added to patients treated with low doses of ACE inhibition, calcium channel blockers or their combination with low dose diuretics, had a clinically significant effect-reduction of BP by more than 10 mmHg systolic and more than 5 mmHg diastolic pressure. No side-effects to treatment were recorded and the compliance with treatment was high. The significant correlation between systolic blood pressure values and level of lycopene suggest the possibility of cause-effect relationships.
Nonadherence to antihypertensives is prevalent and is associated with poorer health outcomes. This study aimed to identify psychological factors associated with adherence in patients taking antihypertensives as these are potentially modifiable, and can, therefore, inform the development of effective interventions to increase adherence. PubMed, EMBASE and PsychINFO were searched to identify studies that tested for significant associations between psychological domains and adherence to antihypertensives. The domains reported were categorized according to the Theoretical Domains Framework. The quality of included studies was evaluated using the National Institute for Clinical Excellence critical appraisal of questionnaire checklist. Thirty-one studies were included. Concerns about medicines (a subdomain of 'beliefs about consequences') and 'beliefs about capabilities' consistently showed association with adherence in over five studies. Healthcare professionals should actively ask patients if they have any concerns about their antihypertensives and their belief in their ability to control their blood pressure through taking antihypertensives.
Objective:
To elaborate and validate an instrument of adherence to treatment for systemic arterial hypertension, based on Item Response Theory.
Methods:
The process of developing this instrument involved theoretical, empirical and analytical procedures. The theoretical procedures included defining the construct of adherence to systemic arterial hypertension treatment, identifying areas involved and preparing the instrument. The instrument underwent semantic and conceptual analysis by experts. The empirical procedure involved the application of the instrument to 1,000 users with systemic arterial hypertension treated at a referral center in Fortaleza, CE, Northeastern Brazil, in 2012.. The analytical phase validated the instrument through psychometric analysis and statistical procedures. The Item Response Theory model used in the analysis was the Samejima Gradual Response model.
Results:
Twelve of the 23 items of the original instrument were calibrated and remained in the final version. Cronbach's alpha coefficient (α) was 0.81. Items related to the use of medication when presenting symptoms and the use of fat showed good performance as they were more capable of discriminating individuals who adhered to treatment. To ever stop taking the medication and the consumption of white meat showed less power of discrimination. Items related to physical exercise and routinely following the non-pharmacological treatment had most difficulty to respond. The instrument was more suitable for measuring low adherence to hypertension treatment than high.
Conclusions:
The instrument proved to be an adequate tool to assess adherence to treatment for systemic arterial hypertension since it manages to differentiate individuals with high from those with low adherence. Its use could facilitate the identification and verification of compliance to prescribed therapy, besides allowing the establishment of goals to be achieved.
This study aimed to understand hypertensive patients' perceptions of and adherence to prescribed medication.
A qualitative research study based on 23 purposely selected participants from a community health clinic in Malaysia. The participants underwent in-depth semi-structured interviews, and the data were analyzed using qualitative content analysis method.
The participants were presented with six types of perceptions of medication. The majority of the participants had negative perceptions of Western medicine (WM), self-adjusted their prescribed medication with complementary and alternative medicine (CAM) and concealed their self-adjusting habits from their doctors. Participants who thought positively of WM took their prescribed medication regularly. Most of the participants perceived the nature of WM as not being curative because of its side effects. Patients have the right to choose their preferred medication when they understand their illness.
Local health care systems should provide patients with alternative health services that suit their requests.
J Clin Hypertens (Greenwich). 2012;14:877–886. ©2012 Wiley Periodicals, Inc.
Multiple barriers can influence adherence to antihypertensive medications. The aim of this systematic review was to determine what adherence barriers were included in each instrument and to describe the psychometric properties of the identified surveys. Barriers were characterized using the World Health Organization (WHO) Multidimensional Adherence Model with patient, condition, therapy, socioeconomic, and health care system/team-related barriers. Five databases (Medline, Embase, Health and Psychological Instruments, CINHAL, and International Pharmaceutical Abstracts [IPA]) were searched from 1980 to September 2011. Our search identified 1712 citations; 74 articles met inclusion criteria and 51 unique surveys were identified. The Morisky Medication Adherence Scale was the most commonly used survey. Only 20 surveys (39%) have established reliability and validity evidence. According to the WHO Adherence Model domains, patient-related barriers were most commonly addressed, while condition, therapy, and socioeconomic barriers were underrepresented. The complexity of adherence behavior requires robust self-report measurements and the inclusion of barriers relevant to each unique patient population and intervention.
Non-adherence to treatment for hypertension increases the risk of disease complications. The factors associated with non-adherence in a resource poor settings should be determined so as to lower the impact of the disease on the health systems, which are already overburdened, with infectious diseases. This study was therefore carried out among a sample of 804 hypertensive patients to determine factors that are associated with non-adherence to antihypertensive treatment. A cross sectional study was carried out from April to December 2009 in District McGann hospital, a tertiary care centre and teaching hospital in Shimoga, Karnataka. The participants were chosen from the outpatients of General Medicine department using systematic sampling. They were aged 35 years and above, had been taking antihypertensive treatment for at least one month and gave informed consent to participate. Non-adherence to antihypertensive therapy in the study population was 28.9%. Factors that were independently associated with non-adherence were: female sex, not understanding the drug regimen well, affordability to only some or none of prescribed drugs and longer time since last since last visit to a health care facility. Hence it is suggested that there is need to improve it through strategies helping patients understand their drug regimens, always availing drugs in the hospital so that they do not have to buy them and giving shorter time between visits to the nearest health care facility.
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