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Does Knowledge Matter?: Intentional Medication Nonadherence Among Middle-Aged Korean Americans With High Blood Pressure
Abstract
To examine predictors of intentional and unintentional nonadherence to antihypertensive medication regimens and their relationships to blood pressure outcomes.
Although poor adherence to medical regimens is a major concern in the care of patients with high blood pressure (HBP), our understanding of the complex behavior related to adherence is limited. Moreover, few studies have been devoted to understanding adherence issues in ethnic minority groups, such as the interplay between cultural beliefs and HBP medication-taking behaviors.
A cross-sectional analysis was performed to assess the factors affecting nonadherence to antihypertensive medication regimens.
The data used in this analysis came from an ongoing HBP intervention trial involving middle-aged (40-64 years) Korean Americans with HBP. A total of 445 Korean Americans with HBP was enrolled in the trial at baseline. Of these, 208 participants who were on antihypertensive medication were included in the analysis. Using multivariate logistic regression, we examined theoretically selected variables to assess their relationships to intentional and unintentional nonadherence in this sample.
Approximately 53.8% of the subjects endorsed 1 or more types of nonadherent behaviors. After controlling for demographic variables, multivariate analysis revealed that a greater number of side effects from the medication (adjusted odds ratio [OR], 1.19; 95% confidence interval [CI], 1.07 to 1.33) and a lower level of HBP knowledge (adjusted OR, 0.89; 95% CI, 0.79 to 0.99) were significantly associated with intentional nonadherence. Unintentional nonadherence was less strongly associated with the study variables examined in the analysis.
Our findings indicate that intentional nonadherence to antihypertensive medication that stems from incomplete knowledge of HBP treatment is prevalent among middle-aged Korean Americans with HBP. The results highlight the strong need for an intervention that focuses on increasing patient knowledge about HBP, including the benefits and side effects of antihypertensive medication. This type of focused intervention may help reduce intentional nonadherence to antihypertensive medications and ultimately result in achieving adequate BP control in this high-risk group.
... Several studies have demonstrated the reliability of the 9-item medication adherence subscale. 21,33,73,74 This systematic review revealed that the scales' utility has expanded from assessing adherence to hypertension and/or cardiovascular disease medication to include other conditions such as diabetes, Alzheimer's, and inflammatory bowel disease. This is important as medication non-adherence is equally vital in chronic conditions such as stroke, diabetes, and Alzheimer's disease. ...
... For instance, educational intervention can be provided to people who are intentionally not taking medications due to myths or insufficient knowledge. 74 For people who are missing medications due to unintentional reasons (eg, cognitive decline, busy schedule), habit forming (cognitive-behavioral) intervention was applied. 74 The HBCHBT scale has an adequate number of items that allow researchers and clinicians to identify the causes of their adherence barriers. ...
... 74 For people who are missing medications due to unintentional reasons (eg, cognitive decline, busy schedule), habit forming (cognitive-behavioral) intervention was applied. 74 The HBCHBT scale has an adequate number of items that allow researchers and clinicians to identify the causes of their adherence barriers. Given that the field is moving to precision health paradigm, the ability of the scale to phenotype adherence is critical and can be a basis for precision and personalized intervention, according to psychosocial phenotyping) to improve adherence to high blood pressure treatment regimen. ...
Background
Poor medication adherence hampers hypertension control and increases the risk of adverse health outcomes. Medication adherence can be measured with direct and indirect methods. The Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale, one of the most popular adherence measures, indirectly assesses adherence to hypertension therapy in three behavioral domains: appointment keeping, diet and medication adherence.
Aim
To synthesize evidence on the use of the HBCHBPT Scale, including psychometric properties, utility in diverse patient populations, and directions for future clinical use and research.
Methods
We searched electronic databases, specifically CINAHL, PubMed, PsychInfo, Embase, and Web of Science. We included original studies that used the HBCHBPT Scale or its subscales to measure a health outcome, or methodological studies involving translations and validations of the scale. We extracted and synthesized data following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.
Results
Fifty studies were included in this review, 44 on hypertension, two on diabetes, and others on other chronic conditions. The scale was successfully translated into numerous languages and used in descriptive and intervention studies. The scale demonstrated sound psychometric properties (Cronbach’s α coefficient 0.75) and sensitivity to capture intervention effects when used to evaluate the effectiveness of high blood pressure adherence interventions. The medication-taking subscale of HBCHBPT performs best and is widely used in diverse contexts to assess medication adherence for chronic conditions.
Conclusion
The HBCHBPT Scale has high versatility globally and has been used in various settings by various healthcare worker cadres and researchers. The scale has several strengths, including high adherence phenotyping capabilities, contributing to the paradigm shift toward personalized health care.
... Das führt dazu, dass die Betroffenen ein schlechteres Wissen bezüglich ihrer Krankheit und demzufolge auch der nötigen Therapie vorweisen. Die Folge davon ist eine reduzierte Selbstfürsorge der Patienten, die ebenso wie ein Mangel an Adhärenz zu einer mangelnden Umsetzung der Therapie führt und dadurch mit einer höheren Mortalität assoziiert ist [22][23][24][25]. ...
... Ein wesentlicher Einflussfaktor auf die Adhärenz der Patienten stellt deren Wissen bezüglich der Krankheit sowie ihrer Therapie dar [24] [39,40]. In anderen Studien zeigte sich, dass ca. ...
... Patienten haben [24,53] ...
... 21 reported a higher frequency of abnormal angiographic findings in women, which contradicts our results. Ungureanu et al. 22 reported higher rates of abnormal angiographic results in the elderly. Discrepancies between the results of the aforementioned studies may be in consequence of the recruitment of dissimilar study populations. ...
... Such effects have been well known in HF patients. 21,22 Dhinagra23 showed that there is a significant relation between QRS prolongation and higher risk of CHF and its association with LBBB, increasing the risk of CHF twofold. Nonetheless, after adjustment for LV mass, QRS duration was still a prognostic factor in that study. ...
... Although the antecedent or concurrent administration of antibiotics can potentially have an effect on the diagnostic accuracy of 99mTc-UBI scintigraphy, 22 no interruption in antibiotic therapy could be made owing to the critical condition of the patients who were suspected for deep SWI. Be that as it may, no reduction is noted in the scintigraphic sensitivity in our studyemphasizing the notion that 99mTc-UBI scintigraphy could be still an accurate diagnostic choice even in patients receiving antibiotic therapy. ...
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious and under diagnosed disorder with significant morbidity and mortality. For reasons that are still unclear, the lyses of blood clots does not occur in some survivors with acute pulmonary thromboemboli, which then evolve into the organization of the clot inside the pulmonary artery and CTEPH. Obstruction of the pulmonary artery results in increased vascular resistance and thereafter right heart strain and remodeling. Pulmonary artery endarterectomy is the treatment of choice with good outcome in these patients. Objectives: The aim of the present study was to evaluate right ventricular function and pulmonary artery pressure before and then after pulmonary thrombo-endarterectomy for a preoperative classification system and risk stratification to aid in patient selection. Methods: In this study, all clinical and paraclinical data such as echocardiographic data of patients with CTEPH were obtained before and after pulmonary thrombo-endarterectomy. Results: Pulmonary thrombo-endarterectomy was associated with significant improvement in right ventricular size (p value = 0.024), systolic pulmonary arterial pressure (p value = 0.012), and functional exercise capacity (p value = 0.007), but right ventricular systolic function did not show significant improvement after that. Conclusion: Pulmonary endarterectomy by well-experienced surgical and medical teams is the method of choice for the treatment of CTEPH with good long-term results and acceptable mortality and morbidity.
... Although Asian Americans are less physically active than whites and less likely to be overweight or obese, they are diagnosed with hypertension and heart disease (Centers for Disease Control and Prevention [CDC], 2013b), and 15.2 percent of 51,048 Asian American adults in California, ages 60 and older, reported heart disease (Kim et al., 2007). Sub-group prevalence ranged from 8.4 percent (Japanese American) to 15.9 percent (Chinese American). ...
... Past research indicates that older Asian Americans face additional challenges in managing chronic health conditions like hypertension. Among Korean Americans, non-adherence to medications for high blood pressure has been correlated with incomplete knowledge of high blood pressure treatment, including the benefits and side effects of hypertensive medication (Kim et al., 2007). Among Chinese Americans, nonadherence to anti-hypertensive medications was related to lower perceived susceptibility, higher perceived benefit of Chinese herbs, lower perceived benefit of Western medications, and longer length of stay in the United States (Li et al., 2006). ...
... Numerous studies have investigated relationships between patient knowledge and various clinical outcomes, for example, treatment compliance, illness control, quality of life, with results ranging from no association (e.g., Blalock et al., 2000;Chan & Molassiotis, 1999;Coates & Boore, 1996;Ho et al., 2003;Ivens & Sabin, 2006;Lee, Wing, & Wong, 1992;Sands & Holman, 1985;Scherer & Bruce, 2001) to significant positive associations (e.g., Abramowitz, Franklin, Zoellner, & DiBernardo, 2002;Barth, Campbell, Allen, Jupp, & Chisholm, 1991;Croquelois & Bogousslavsky, 2006;Kallich, McDermott, Xu, Fayers, & Cella, 2006;Kim et al., 2007;Kronmüller et al., 2006;Miller et al., 2003;Ngamvitroj & Kang, 2007;Ni et al., 1999;Soriano, Rabe, & Vermeire, 2004;Surawy, 1989;Weiss et al., 2003). However, patient knowledge is a broad term encompassing knowledge of diagnosis, symptoms, pathophysiology, further investigations, risks associated with procedures, prognosis and treatment instructions/advice. ...
... Since Ley's (1988) review, significant positive associations between knowledge and compliance have been reported by other researchers in diabetes (Barth et al., 1991;Kravitz et al., 1993), hypertension (Kim et al., 2007), heart failure (Ni et al., 1999), asthma (Kolbe, Vamos, Fergusson, Elkind, & Garrett, 1996;Ngamvitroj & Kang, 2007), HIV (Miller et al., 2003;Weiss et al., 2003) and ...
... Moreover, this brief questionnaire provides a simple method for clinicians in various settings to assess patients' self-reported adherence and to plan appropriate interventions. Consent to use the questionnaire was obtained through the original Hill-Bone website (Kim et al., 2000;2007;Lambert et al., 2006). ...
... Scale and subscale scores were calculated by summing up individual scores. Respondents who scored greater than 6 in the threeitem reducing sodium intake subscale were considered non-adherent to diet; those who scored greater than 4 in the two-item appointment keeping subscale were considered non-adherent to clinic visit; while those who scored greater than 18 in the nine-item medication taking subscale were considered non-adherent to medication intake [25]. The medication intake subscale was used to assess medication adherence in this study. ...
Introduction: Hypertension is one of the leading causes of morbidity and mortality globally. Blood pressure control is poor among patients with hypertension due to poor health-seeking behaviour, poor medication adherence, financial burden etc. This study aimed to determine the factors affecting medication adherence in patients with hypertension attending Irrua Specialist Teaching Hospital, Irrua, Nigeria. Its findings will improve blood pressure control among hypertensives and reduce the attendant overall morbidity and mortality. Methods: This was a descriptive cross-sectional, hospital-based study that was conducted in the Family Medicine clinic of Irrua Specialist Teaching Hospital, Irrua, Nigeria. A total of 192 adult patients with hypertension were consecutively recruited. Data was collected using the open data kit with a semi-structured, interviewer-based questionnaire. Analysis was done using the Statistical Package for Social Sciences version 21. Results: In this study, out of 192 respondents, 105 (54.7%) were males, 151 (78.7%) were married, 117 (60.9%) had secondary school education, 122 (63.5%) were non-NHIS (National Health Insurance Scheme) enrolees and 93 (48.4%) had uncontrolled blood pressure at presentation. The mean age of the respondents was 51±12 years. There was an association between medication adherence and female sex, being married, high monthly income, NHIS enrolees, and clinic appointment keeping. There was also association between blood pressure control and reduction in salt intake. Conclusion: Ensuring good financial status, with enrolment in health insurance scheme as well as advocating for regular clinic appointment will go a long way in achieving good blood pressure control and reducing related morbidity and mortality. ABSTRACT 53 INTRODUCTION Hypertension is the leading cause of cardiovascular morbidity and mortality globally [1-3]. A quarter of the world's population are estimated to have hypertension and this is estimated to increase to 29% of the world's population by 2025 [4]. It is estimated to cause 7.5 million deaths annually, about 12.8% of all deaths worldwide [5]. The burden of hypertension is particularly high in sub-Saharan African countries. The reported prevalence of hypertension in Ghana ranges from 19% to 32.8% in rural areas and 25.5% to 48% in urban areas [6]. Similarly, recent studies in Nigeria showed that the prevalence of hypertension in rural areas ranges from 21% to 25% [7,8], while in semi-urban and urban areas the prevalence ranged from 27% to 46% [9,10].
... Nearly 70% of the participants knew that high BP could lead to congestive heart failure. Almost all patients were aware of their blood pressure status with 91% reporting that a doctor or health care provider had told them that they had HTN [10]. These findings are consistent with NHANES III data suggesting that there has been an increase in BP awareness [11]. ...
Introduction: High blood pressure (HBP) is a leading major risk factor for chronic diseases such as CKD, CADx, and deaths. The prevalence of patients with hypertension (HT) has risen from 600 million in 1980 to one billion in 2008. Aims and Objectives: The basic aim of the study is to find the relationship of knowledge about hypertension with the control of blood pressure. Methodology of the Study: This cross sectional study was conducted in Mayo hospital Lahore from January 2021 to July 2021. The data was collected from 100 patients with high blood pressure who visited the OPD of our hospital. A questionnaire was prepared by the researchers in accordance with the literature to measure the level of knowledge about HT. Results: The data was collected from 100 patients of both genders. On comparison of questions related to knowledge, there was a statistically significant difference in; meaning of hypertension (p <0.001), target SBP (p0.001), target DBP (p 0.001), importance of SBP versus DBP, improvement of health with lowering of blood pressure (p 0.002), high blood pressure being asymptomatic (p <0.001), changing lifestyle improves blood pressure (p 0.003), hypertension being a lifelong disease (<0.001), lifelong treatment with anti-hypertensives (<0.001) and high blood pressure being part of aging (<0.001). Conclusion: It is concluded that patients who were aware that elevated BP levels lead to reductions in life expectancy had a higher compliance level with medication use and follow-up visits than patients without this awareness.
... 9 This scale satisfies the study's objectives and has been cross-culturally validated. [9][10][11] The Hill-Bone CHBPTS questionnaire consists of 14 items divided into three unique subscales. Subscales include a scale for reducing sodium intake, keeping appointments and medication use. ...
... to define an individual as non-adherent. A response of two or higher on adherence scale on at least two of the questions in medication adherence sub-scale was considered nonadherent [16]. ...
Background
Chronic diseases require long-term medication and adherence to medication is important for the control of disease as well as prevention of complications. Non-compliance may lead to worsening of the disease, which may affect patients' quality of life. This study aimed to assess the level of medication adherence and its association with quality of life (QOL) among hypertensive patients in Buraidah, Saudi Arabia.
Methods
A cross-sectional study was carried out in which 299 hypertensive patients were recruited from the randomly selected primary health care centers. Medication adherence was assessed by Hill-Bone Medication Adherence Scale, and quality of life was assessed by the World Health Organization’s Quality of Life (WHOQOL)-BREF. Multivariate linear regression was used to assess the association of medication adherence with quality of life. Data was analyzed using SPSS version 21.0 (IBM Inc., Armonk, USA).
Results
The prevalence of poor adherence was found to be 38.8%. We did not find a significant association of medication adherence with any of the four (physical, psychological, social relationship, and environmental) domains of WHOQOL-BREF. However, poor medication adherence was associated with poor perceived overall QOL adjusted β=-0.012 (95% confidence interval [CI]: -0.021 to -0.002; p=0.018) and health adjusted β=-0.013 (95% CI: -0.025 to -0.002; p<0.018).
Conclusion
We found a high prevalence of non-adherence among hypertensive patients. This calls for developing interventions to improve compliance with medications to prevent complications of hypertension. Our study could not find a significant association of medication adherence with any of the domains of QOL, while poor adherence was associated with lower overall perceived QOL and health. Nonetheless, worsening of disease due to non-adherence may affect the QOL of patients. We recommend large scale prospective studies to explore the relationship between medication adherence and QOL.
... Patient education enhances the knowledge about hypertension resulting in better adherence to medication. A number of studies support such an association in which a positive relationship was found between knowledge and adherence [20,[31][32][33]. ...
Background: Hypertension is a global health issue among the adult population with high morbidity and mortality rates. As the case
... In line with a former study in older subjects, a relevant proportion of our patients did not exactly know the names, reasons, and dosages of all their prescribed medications (35). Moreover, in other conditions and cohorts, lack of knowledge was found to be a critical determinant of nonadherence independent of education (36,37). ...
Background: Detailed knowledge about nonadherence to medication could improve medical care in elderly patients. We aimed to explore patterns and reasons for nonadherence in people with Parkinson's disease (PD) aged 60 years and older.
Methods: Detailed clinical data and adherence (German Stendal Adherence with Medication Score) were assessed in 230 patients with PD (without dementia). Descriptive statistics were used to study reasons for nonadherence in detail, and general linear models were used to study associations between clusters of nonadherence and clinical parameters.
Results: Overall, 14.2% (n = 32) of the patients were fully adherent, 66.8% (n = 151) were moderately nonadherent, and 19.0% (n = 43) showed clinically meaningful nonadherence. In the multivariable analysis, nonadherence was associated with a lower education level, higher motor impairment in activities of daily living, higher number of medications per day, and motor complications of PD. Three clusters of nonadherence were observed: 59 (30.4%) patients reported intentional nonadherence by medication modification; in 72 (37.1%) patients, nonadherence was associated with forgetting to take medication; and 63 (32.5%) patients had poor knowledge about the prescribed medication. A lower education level was mainly associated with modification of medication and poorer knowledge about prescribed medication, but not with forgetting to take medication. Patients with motor complications, which frequently occur in those with advanced disease stages, tend to be intentionally nonadherent by modifying their prescribed medication. Increased motor problems and a higher total number of drugs per day were associated with less knowledge about the names, reasons, and dosages of their prescribed medication.
Conclusions: Elderly patients with PD report many reasons for intentional and non-intentional nonadherence. Understanding the impact of clinical parameters on different patterns of nonadherence may facilitate tailoring of interventions and counseling to improve outcomes.
... There were only 35.4% (2016) respondents who recognized adequately that regular activity contributes to energy consumption and the stability of cardiovascular system [39]. Only 42.3% (2016) of respondents realized that people with hypertension should take drugs for life once they are diagnosed to influence blood pressure control [40]. Despite 62.1% (2016) of respondents recognizing the dangers of excessive salt intake, only 7.5% (2016) knew that adults should consume no more than 6 g of salt per day; this situation has not changed in three years. ...
The rapid urbanization in China has brought with it some health benefits, but it also brought about a negative influence on the lifestyle of residents. We conducted this study to assess the change in hypertension-related knowledge and behavior from 2013 to 2016 among recently urbanized residents and determine their association with socioeconomic status (SES). This research used data from two cross-sectional studies conducted in Hezuo community in Chengdu, Sichuan province of China. A total of 2268 and 2601 individuals, respectively, participated and completed standard questionnaires. According to the results, the median (IQR) scores of health knowledge was 1 (0,3) and 3 (1,5), respectively, (p < 0.001) and the median (IQR) scores of health behavior was 6 (5,6) and 5 (5,6), respectively, (p < 0.001) in 2013 and 2016. The rate of sufficient knowledge increased from 8.8% to 18.1% (p < 0.001), while the rate of correct behavior decreased from 54.5% to 45.5% (p < 0.001) in three years. Logistic regression analysis showed that higher education was associated with sufficient hypertension-related knowledge (p < 0.05), and those with higher education, unemployment, and retirement were more likely to have sufficient behavior (p < 0.05). The impact of SES on knowledge was stable between 2013 and 2016. The behavior difference between the middle school educated and the illiterate increased from 2013 to 2016 (p < 0.05), and the behavior difference between the unemployed and manual workers decreased from 2013 to 2016 (p < 0.05). Our results revealed that hypertension-related knowledge improved with no corresponding improvement in self-reported behavior among recently urbanized residents from 2013 to 2016. Organizational strategy should be implemented to improve health education on knowledge, and what is more, translate knowledge into behavior. All these measures should be given more attention to the lower educated and manual workers among recently urbanized residents to eliminate the SES disparity.
... Many studies have been conducted to determine factors that influence medication adherence among patients with chronic conditions. Patient-specific factors, such as forgetfulness and lack of disease-related knowledge, are included in one of the main categories of factors affecting medication adherence [12,13]. Thus, interventional studies have targeted these modifiable factors at the patient level to improve medication adherence among people with hypertension or other chronic conditions [14,15]. ...
Purpose of review:
This study aims to systematically review existing evidence on the effectiveness of mobile health technology (mHealth) interventions in addressing medication adherence among people with hypertension.
Recent findings:
Twenty-one studies of mHealth interventions were included in the final review after systematic searching and screening of publications from 2000 to 2017 in PubMed, Web of Science, and Embase. Key features of the mHealth interventions include high intervention intensity, multifactorial components, and patient-centered approaches with tailored content and interaction. All studies found tendencies to improvement in medication adherence, but only 12 studies reported that the improvements were statistically significant in the intervention groups compared with the control groups. Twelve studies also found that mHealth interventions were beneficial for blood pressure control. None of the studies was conducted in a low-income country. Our systematic review found evidence that mHealth interventions improved medication adherence and blood pressure control among people with hypertension. However, most studies were small in sample size and short in study duration, and not all results were statistically significant. Future research should focus on investigating the sustainability and generalizability of mHealth interventions.
... 20 Similarly, in a population of Korean Americans with hypertension, intentional nonadherence was more strongly associated with uncontrolled hypertension than unintentional nonadherence. 34 Distinguishing between intentional and nonintentional nonadherence may help in the clinical approach to nonadherence. 35,36 Intentional nonadherence is proposed to be influenced by the balance of an individual's reasons for and against taking medication. ...
Introduction
In the general population, medication nonadherence contributes to poorer outcomes. However, little is known about medication adherence among adults with chronic kidney disease (CKD). We evaluated the association of self-reported medication adherence with CKD progression and all-cause death in patients with CKD.
Methods
In this prospective observational study, 3305 adults with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Baseline self-reported medication adherence was assessed by responses to 3 questions and categorized as high, medium, and low. CKD progression (50% decline in eGFR or incident end-stage renal disease) and all-cause death were measured using multivariable Cox proportional hazards.
Results
Of the patients, 68% were categorized as high adherence, 17% medium adherence, and 15% low adherence. Over a median follow-up of 6 years, there were 969 CKD progression events and 675 deaths. Compared with the high-adherence group, the low-adherence group experienced increased risk for CKD progression (hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54) after adjustment for sociodemographic and clinical factors, cardiovascular medications, number of medication types, and depressive symptoms. A similar association existed between low adherence and all-cause death, but did not reach standard statistical significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47).
Conclusion
Baseline self-reported low medication adherence was associated with an increased risk for CKD progression. Future work is needed to better understand the mechanisms underlying this association and to develop interventions to improve adherence.
... [15][16][17] Specifically, knowledge about HTN (ie, knowing the appropriate BP parameters, disease duration, and lifestyle changes required for HTN control) has been associated with greater medication adherence and better BP control. 18,19 Adequate HTN knowledge can influence patients' HTN self-management by: (1) being more proactive in their care, (2) increasing self-monitoring and reporting inappropriate BP readings to their provider (>140/ 90 mm Hg), (3) eating less salty foods, (4) engaging in more physical activities, and (5) taking appropriate prescribed medication that could help to lower their BP. Social support is also an important factor that could facilitate medication adherence. ...
Novel ideas are needed to increase adherence to antihypertensive medication. The current study used data from the Counseling African Americans to Control Hypertension (CAATCH) study, a sample of 442 hypertensive African Americans, to investigate the mediating effects of expectation of hypertension care, social support, hypertension knowledge, and medication adherence, adjusting for age, sex, number of medications, diabetes, education, income, employment, insurance status, and intervention. Sixty-six percent of patients had an income of $20,000 or less and 56% had a high school education or less, with a mean age of 57 years. Greater expectation of care was associated with greater medication adherence (P=.007), and greater social support was also associated with greater medication adherence (P=.046). Analysis also showed that expectation of care mediated the relationship between hypertension knowledge and medication adherence (P<.05). Expectation of care and social support are important factors for developing interventions to increase medication adherence among blacks.
... These 2 types of medication nonadherence may have different bases and motivations. 25,[40][41][42] For instance, some studies have shown that intentional nonadherence may be motivated by faulty beliefs about the medication or their illness 37 or outsized concerns about the medication, its effects, or its necessity. 40 Patients may misunderstand their health-care providers' remarks about their condition relative to their medication taking; e.g., if a physician or dietitian comments that their phosphorus levels are good, patients may interpret that to mean that they no longer need to take their phosphorus binders. ...
Objective:
The purpose of this study was to determine the influence of patient-reported medication adherence and phosphorus-related knowledge on phosphorus control and pharmacy-reported adherence to phosphorus binding medication among patients on maintenance hemodialysis.
Design:
Retrospective, cross-sectional cohort study.
Subjects:
Seventy-nine hemodialysis patients (mean age 64.2 years, SD = 14 years; 46.8% female) in a stand-alone hemodialysis unit within an integrated learning healthcare system. Ten percent (10%) of subjects were Caucasian, 42% Latino, 19% African American, and 29% Asian. Forty-eight percent had diabetes; 72% had BMI ≥ 30. Inclusion criteria included the provision of survey data and having medication refill data available in the pharmacy system. 77.2% had mean phosphorus levels ≤ 5.5 mg/dL; 22.8% had mean phosphorus levels > 5.5 mg/dL.
Intervention:
Subjects were administered the 8-item Morisky Medication Adherence Scale (MMAS-8) and also reported on their phosphorus-related knowledge.
Main outcome measure:
Phosphorus levels within an adequate range.
Results:
The mean serum phosphorus level was 4.96 mg/dL (SD = 1.21). In the well-controlled group, mean phosphorus was 4.44 mg/dL (SD = 0.76). In the poorly controlled group, mean phosphorus was 6.69 mg/dL (SD = 0.74). A total of 61% of patients reported at least some unintentional medication nonadherence, and 48% reported intentional medication nonadherence. Phosphorus-specific knowledge was low, with just under half of patients reporting that they could not name two high-phosphorus foods or identify a phosphorus-related health risk. Phosphorus binder-related nonadherence was substantially higher in the uncontrolled than the controlled group. Adjusting for age, individuals with poorer self-reported binder adherence were less likely to have controlled phosphorus levels (odds ratio = 0.71, P = .06).
Conclusion:
Phosphorus-related non-adherence, but not low phosphorus-specific knowledge, was associated with poorer phosphorus control. Such findings provide important information for the development of evidence-based strategies for improving phosphorus control among patients on dialysis.
... Satisfaction with information about medication is linked to adherence, and so are treatment knowledge and confidence in taking a medicine as prescribed. In a study by Kim et al. (2007) lower hypertension treatment knowledge was significantly associated with higher intentional non-adherence. In the study by Burge et al. (2005) patient satisfaction, confidence and educational level were significantly related to better medication knowledge. ...
Background
Satisfaction with information on medication is linked to adherence, but patients are often dissatisfied with information about medication. Information about treatment with fingolimod is important for MS patients since an active role in managing treatment is required from them. To facilitate optimal treatment initiation, a nurse-led patient education program on fingolimod was implemented in a Swiss MS center.
Objective
To evaluate the impact of the evidence-based comprehensive patient education program on knowledge, self-efficacy and patient satisfaction.
Methods
Knowledge gain, subjective perception of being informed about the new treatment, self-efficacy in handling it and satisfaction with the program were evaluated in a pretest–posttest design. Patient reported outcomes were collected before and after an educational session on the first-dose day at the MS Center in a consecutive sample of 98 people with MS. Data was analyzed descriptively, score comparisons were done by Wilcoxon tests, and associations were estimated with Spearman's correlation coefficient.
Results
Knowledge increased significantly from pre- to posttest. Similarly, perception of being informed and self-efficacy increased significantly. Satisfaction with the program was high. Pretest-differences in knowledge concerning gender and marital status were balanced after the educational session. Results did not differ between patients with fingolimod as first treatment and those switching from other MS treatments. At posttest perception of being informed and self-efficacy were significantly related to satisfaction.
Conclusions
An evidence-based comprehensive treatment education program is suitable to satisfy MS patients' information needs at treatment initiation. It enhances short-term treatment knowledge and self-efficacy in handling a new treatment in daily life. MS Nurses can thus contribute to effective treatment education and potentially to medication safety and adherence.
... The knowledge about the disease presented by the patient of AH has been related to an improved control of the BP levels 6,10,11,15 . The increased level of knowledge about AH has been associated as well to an improved drug adherence to the treatment 8,15 . Despite this study not having assessed the adherence, the presence of controlled BP (≤140/90 mmHg), even in a higher percentage compared to other studies 2,4 , has not shown to be related to an increased level of knowledge about AH in subsequent analysis. ...
... [15][16][17] Specifically, knowledge about HTN (ie, knowing the appropriate BP parameters, disease duration, and lifestyle changes required for HTN control) has been associated with greater medication adherence and better BP control. 18,19 Adequate HTN knowledge can influence patients' HTN self-management by: (1) being more proactive in their care; (2) increasing self-monitoring and reporting inappropriate BP readings to their provider (>140/ 90 mm Hg); (3) eating less salty foods; (4) engaging in more physical activities; and (5) taking appropriate prescribed medication that could help to lower their BP. ...
... Medication nonadherence is associated with an individual's knowledge and motivation, skill, and ability to obtain medication (Compton, Haack, & Phillips, 2010). To be able to provide more effective care, it is important to distinguish whether the MSFWs' nonadherence is intentional (i.e., missing doses or altering doses) or unintentional (i.e., forgetting to take medication; Kim et al., 2007). Identifying why the MSFWs did not refill medication on time was beyond the scope of this study, but several factors have been documented in the literature (e.g., medication costs, lack of transportation, or conflicting working schedule; Rose et al., 2010) and need to be taken into consideration for future study. ...
Purpose:
This study explored Latino migrant/seasonal farmworkers' (MSFWs') adherence to hypertension treatment.
Design:
A cross-sectional correlational study was conducted.
Method:
Forty-five Latino MSFWs from two farmworker health clinics completed Spanish versions of the Morisky Medication Adherence Scale, the Blood Pressure Knowledge Scale and Blood Pressure Self-Care Scale, the Perceived Stress Scale, the Acculturation Rating Scale for Mexican Americans-II, the Short Assessment of Health Literacy for Spanish-Speaking Adults, health care access questions, and blood pressure measurements.
Results:
MSFWs had poor medication adherence (51%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and health care access accounted for 49% of the variance in blood pressure self-care. Higher acculturation level and health literacy were associated with better blood pressure control (p = .01).
Discussion:
MSFWs had poor medication adherence and blood pressure control. Blood pressure knowledge and acculturation played a role in blood pressure self-care.
Implications:
Culturally appropriate educational programs are needed to help MSFWs' adherence to hypertension treatment.
... [7][8][9][10][11] Inadequate adherence to prescribed medications is associated with multiple prescriptions with complex dosing regimens, inadequate knowledge and psychosocial issues. [12][13][14] Patients may adopt strategies to reduce costs, including not filling prescriptions and omitting doses. 15,16 A strategy based on using fixed-dose combination therapy ('polypills') with generic components may help reduce treatment gaps, by reducing costs, complexity of drug regimens and therapeutic inertia. ...
Most individuals at high cardiovascular disease (CVD) risk worldwide do not receive any or optimal preventive drugs. We aimed to determine whether fixed dose combinations of generic drugs ('polypills') would promote use of such medications.
We conducted a randomized, open-label trial involving 623 participants from Australian general practices. Participants had established CVD or an estimated five-year CVD risk of ≥15%, with indications for antiplatelet, statin and ≥2 blood pressure lowering drugs ('combination treatment'). Participants randomized to the 'polypill-based strategy' received a polypill containing aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide 12.5 mg. Participants randomized to 'usual care' continued with separate medications and doses as prescribed by their doctor. Primary outcomes were self-reported combination treatment use, systolic blood pressure and total cholesterol.
After a median of 18 months, the polypill-based strategy was associated with greater use of combination treatment (70% vs. 47%; relative risk 1.49, (95% confidence interval (CI) 1.30 to 1.72) p < 0.0001; number needed to treat = 4.4 (3.3 to 6.6)) without differences in systolic blood pressure (-1.5 mmHg (95% CI -4.0 to 1.0) p = 0.24) or total cholesterol (0.08 mmol/l (95% CI -0.06 to 0.22) p = 0.26). At study end, 17% and 67% of participants in polypill and usual care groups, respectively, were taking atorvastatin or rosuvastatin.
Provision of a polypill improved self-reported use of indicated preventive treatments. The lack of differences in blood pressure and cholesterol may reflect limited study power, although for cholesterol, improved statin use in the polypill group counter-balanced use of more potent statins with usual care.
... This scale was used with Korean Americans in our previous study. 18 The items are scored as correct or incorrect and then summed; higher scores indicate greater HBP knowledge. The Kuder-Richardson reliability coefficient for this study was 0.62. ...
Great strides have been made in improving heart health in the United States during the last 2 decades, yet these strides have not encompassed many ethnic minority populations. There are significant health disparity gaps stemming from both a paucity of valid research and a lack of culturally sensitive interventions. In particular, many Korean Americans with chronic illnesses encounter difficulty navigating the healthcare system because of limited health literacy.
The effect of a multimodal Self-Help Intervention Program on the Control of High Blood Pressure (HBP) was tested in a community-based clinical trial for Korean American seniors. Of 440 seniors enrolled, 369 completed the study (184 in the intervention group and 185 in the control group; mean age = 70.9±5.3 years). The intervention group received 6 weekly educational sessions on HBP management skill building, including health literacy training, followed by telephone counseling and home blood pressure (BP) monitoring for 12 months.
Findings support that the Self-Help Intervention Program on the Control of HBP was effective in controlling BP in this ethnic/linguistic minority population. The BP control rates for the intervention and control groups were 49.5% vs. 43.2% at baseline, 58.5% vs. 42.4% at 6 months, 67.9% vs. 52.5% at 12 months, and 54.3% vs. 53.0% at 18 months. Significant changes were observed over time in some psychobehavioral outcomes, including self-efficacy for BP control, medication adherence behavior, HBP knowledge, and depression.
The study findings suggest that the multimodal Self-Help Intervention Program on the Control of HBP is effective at promoting optimal HBP control for this ethnic/linguistic minority population.
NCT00406614.
... The Hill-Bone Adherence Scale-in particular the medication subscale-has demonstrated acceptable reliability and construct validity in several independent populations of African Americans, non-Hispanic whites, and Korean patients. 20,33 In addition, noncompliance assessed by the scale predicted higher BP in black patients in the United States and in South Africa, indicating predictive validity. 20,34 The alpha coefficient of the Hill-Bone Scale was 0.70 in the study sample. ...
Adequate self-care is crucial for blood pressure control. A number of hypertension (HBP) self-care instruments are available, but existing tools do not capture all the critical domains of HBP self-care and have limited evidence of reliability and validity.
The purpose of this study was to develop and validate a new tool-the HBP Self-Care Profile (HBP SCP)-in a sample of inner-city residents.
The HBP SCP encompasses comprehensive domains of HBP self-care behaviors. Guided by 2 validated theoretical approaches-Orem's self-care model and Motivational Interviewing-the HBP SCP includes 3 scales that can be used together or independently: Behavior, Motivation, and Self-efficacy. The sample included 213 English-speaking inner-city residents with HBP (mean age, 68.6 years; 76.1% women; 81.7% African American).
Item-total correlations ranged from 0.20 to 0.63 for Behavior, 0.46 to 0.70 for Motivation, and 0.40 to 0.74 for Self-efficacy, meeting the cutoff set a priori at 0.15. Internal consistency reliability coefficients ranged from 0.83 to 0.93. Concurrent and construct validities of the HBP SCP were achieved by significant correlations between HBP SCP scales and theoretically selected instruments (P < .05 for all correlation coefficients). The HBP SCP-Behavior scale also successfully discriminated between those with or without blood pressure control (P < .05).
The reliability and validity of the HBP SCP were supported in this sample of inner-city residents with HBP. The high reliability estimates and strong evidence of validity should allow researchers to use the HBP SCP to assess and identify gaps in HBP self-care behavior, motivation, and self-efficacy. Future research is warranted to evaluate the HBP SCP in diverse ethnic and age samples of hypertensive patient populations.
Background
Hypertension is the leading cause of death from cardiovascular disease. Non-adherence to treatment and lifestyle modification are the key drivers of suboptimal blood pressure control and cardiovascular events.
Objective
To assess the reliability and validity of the Amharic version of the Hill–Bone Adherence to High Blood Pressure Therapy Scale (HBTS) among Ethiopian hypertensive patients.
Methods
A cross-sectional study was conducted among 294 hypertensive patients at two health facilities from 1st October to 30th December 2021 using the culturally adapted HBTS. Psychometric properties were assessed in terms of acceptability, internal consistency, construct validity, and predictive validity. Statistical Package for Social Sciences version 26 was used to perform statistical tests at a significance level of p-value <0.05. The Statistical Package for Social Sciences AMOS version 26 was used for the confirmatory factor analysis.
Results
Cronbach of the 14-item HBTS was initially 0.801. After excluding one item from the appointment-keeping subscale, Cronbach of the modified 13-item HBTS was 0.806. The initial principal component analysis revealed four constructs for the 14-item and three for the 12-item with a total explained variance of 58.65% and 55.73%, respectively. The confirmatory factor analysis failed to fit the observed items with the latent subscales. The predictive validity test showed that the modified 12-item Amharic version was correlated (r= 0.118;p<0.043) with systolic blood pressure.
Conclusion
The modified 13-item Amharic version of the HBTS is a reliable and valid tool with adequate psychometric properties. It can be used to assess adherence to antihypertensive medications in Amharic-speaking patients in Ethiopia.
Adherence of patients to antihypertensive drugs refers to the extent to which their taking corresponds with agreed recommendations from a health care provider. The goal was to measure adherence and examine the association with socio-demographic and medication status variables. A cross-sectional pilot study was conducted with 120 respondents, aged ≥ 18 years, who are being treated for hypertension and who visited the ambulance of family physician at Primary Health Care Centre Cetinje in April and May 2022. A questionnaire with socio-demographic and medication status and the Hill-Bone scale was used. Adherence was categorized as good (≥ 80%) and worse (< 80%). The age of respondents was 64,6 ± 9,28. The majority were female, married, with a high school diploma, retired and treated for hypertension for ≥ 11 years. The total number of drugs in regular therapy was 6,1 ± 2,85 and antihypertensive 2,24 ± 0,85. 14,2% of respondents suspected the side effects of antihypertensive drugs and the majority participate in their costs. The number of points on the Hill-Bone scale was 10,04 ± 1,90 and 95% of respondents had good adherence. Of all the variables, a statistically significant association was found only for participation in the costs of antihypertensive drugs. The obtained results support the view that patients' personal beliefs about the necessity of taking therapy and the concerns of side effects are better predictors of adherence than other factors.
The prevalence of hypertension (HTN) among Black women in the United States has increased over the past 10 years with a decline in levels of HTN awareness, treatment, and control. Higher death rates occur in Black women from HTN-related diseases when compared with women of other racial/ethnic groups. Although interventions aimed at self-care/self-management are vital to adults becoming the cornerstone of their own health and well-being, there is a paucity of research in Black women. This randomized controlled pilot trial substudy examined the influence of a Chronic Disease Self-Management Program (CDSMP) with tailored coaching versus the CDSMP alone on blood pressure (BP), weight, and scores on self-care questionnaires and medication adherence for Black women with HTN over 9 months. Eighty-three women who had completed the CDSMP were randomly assigned to coaching or no coaching. Median age was 54 years and the time since the HTN diagnosis was 9 years. Significant differences were noted in self-care maintenance and management over time with better self-care in the treatment group. Though not significant, both groups denoted a trend toward better medication adherence. Almost 60% of the participants in both groups showed improvements in their systolic and/or diastolic BP. However, there was no significant difference between the study groups' BP and weight variables. The CDSMP was effective in decreasing BP and improving medication adherence. Further research is needed to evaluate effective coaching strategies that motivate Black women with HTN toward self-care management.
Introducción
La falta de adherencia a la terapia antihipertensiva contribuye directamente a que los pacientes coexistan con hipertensión, desencadenando mayor riesgo de morbilidad y mortalidad. Así, la falta de adherencia al tratamiento se convierte en una de las principales causas de hipertensión no controlada en la población. Evaluamos los factores asociados a la no-adherencia al tratamiento antihipertensivo en pacientes de cardiología de un hospital de EsSalud en San Juan de Lurigancho-Lima, durante el 2017.
Material y Métodos
Estudio analítico-transversal, se incluyeron pacientes que acudieron a consultorio externo de cardiología con historia previa de hipertensión esencial y se excluyeron hipertensión secundaria por otras causas biológicas. Se utilizó el Test de Morisky-Green Morisky Medication Adherence Scale (MMAS-4) para evaluar la no-adherencia al tratamiento antihipertensivo.
Resultados
De los 270 participantes de estudio, el 69% (n=185) eran adultos mayores de 65 años, 46% (n=124) varones y el 76% (n=118) tenían pareja estable. Entre los antecedentes clínicos, el 60% (n=122) reportó diagnóstico clínico de hipertensión arterial, el 30% (n=80) de diabetes mellitus tipo II y el 27% (n=73) no-adherencia al tratamiento. Los factores asociados a la no-adherencia de tratamiento fueron sexo masculino (ORa: 0,45, IC95% 0,20-1,04), trabajador independiente (ORa:3,88, IC95% 1,51-9,97), IMC mayor de 30 (ORa:0,23, IC95% 0,07-0,70).
Conclusiones
En los pacientes con diagnóstico de hipertensión esencial existen factores de riesgo modificables y no modificables asociados a la no-adherencia al tratamiento. Se deben considerar estos factores para implementar estrategias de tamizaje y focalizar las intervenciones para adherir a los pacientes renuentes a su tratamiento.
Depression is associated with increased risk of cardiovascular disease, but the mechanisms remain mostly unknown and may involve hostility or poor medical adherence. The objectives were: to examine whether hostile traits explain the prospective association between depressive symptoms and incident cardiac events; to examine whether depressive symptoms modify the prospective association between treatable cardiovascular risk factors (hypertension, diabetes and dyslipidemia) and incident cardiac events; and to study the prospective association between depressive symptoms and non-adherence to medications for treatable cardiovascular risk factors. We addressed these objectives using two large French population-based prospective cohorts (GAZEL and CONSTANCES cohorts) with Cox proportional hazard regression models and logistic regression models. Three findings were obtained. First, the association between depressive symptoms and cardiac events was independent of hostile traits. Second, the association between depressive symptoms and cardiac events was not explained by a heightened impact of these cardiovascular risk factors in the presence of depression. Third, depressive symptoms were not associated with non-adherence to medications for these cardiovascular risk factors. Hence, according to these findings, depression should be considered as a cardiovascular risk factor on its own. Further research is needed to identify the mechanisms underlying the association between depression and incident cardiovascular disease.
Résumé
Introduction
L’hypertension artérielle est un problème de santé majeur en prévalence croissante.
Objectif
Cette étude visait à déterminer les facteurs associés à l’adhésion thérapeutique (ATP) des sujets hypertendus.
Méthode
C’est une étude transversale, descriptive et corrélationnelle effectuée sur deux mois dans les cliniques privées à Beyrouth (Liban) en 2017. Elle a été réalisée à l’aide d’un questionnaire comprenant des questions sur l’ATP, le profil sociodémographique, le profil de santé des participants et les perceptions individuelles du Health Belief Model (HBM).
Principaux résultats
Deux cent dix sujets hypertendus ont participé à l’étude dont l’âge moyen était de 57,76 ans. Le taux de l’adhésion thérapeutique était de 54,3 % donc non optimale chez les participants. Les incitateurs à l’action, l’auto-efficacité, l’adoption d’une diète antihypertensive et la consommation de tabac sont les facteurs les plus associés à l’adhésion thérapeutique trouvés. Étant donné que de nombreux facteurs y sont associés, des stratégies d’intervention individualisées devraient être mises en œuvre notamment l’éducation thérapeutique.
© 2021
Medication non-adherence is a global problem and has existed for centuries. Patients have paid a very high price for their behaviour of non-adherence in the form of impaired cost, prolonged diseases, a burden to family, or even by their lives. In the era of science and technology where there is a solution for every odd problem, the issue of medication non-adherence can also find a remedy. This paper tries to highlight the factors of non-adherence and looks for solutions through various forms of technology. The review of different published literature highlights the findings of researchers and tries to assimilate a solution for addressing the prolonged problem of medication non-adherence.
Aims and Objectives
To examine the feasibility of a culturally tailored education programme for Haitian immigrants diagnosed with hypertension.
Background
Hypertension is a major public health problem, impacting more than 26% of the global population. The overall prevalence of hypertension is 45.4% in the United States with nearly 80,000 deaths due to hypertension in 2015. African Americans and other Black populations living in the U.S. are disproportionally affected by hypertension.
Design
Pre‐test and post‐test feasibility study.
Methods
A convenience sample of forty‐four participants who identified as Haitian immigrants was enrolled in this evidence‐based education programme. The intervention included culturally tailored education focused on improving knowledge, medication adherence and blood pressure. Outcomes were measured using the Hill‐Bone Medication Adherence Scale and Hypertension Knowledge Test. The SQUIRE 2.0 guidelines were used for reporting outcomes.
Results
Of the participants that completed the study (N=42), the mean age was 61.95 (± 9.75) years and 59% were female. Baseline systolic and diastolic blood pressures were 143 (±18.15) and 85 (±7.23), respectively. Six weeks after the intervention, there was a significant decrease in mean systolic, 126 (±12.07) and diastolic 78.50 (± 7.23) blood pressures. An increase in medication adherence and hypertension knowledge was also noted at the six‐week follow‐up period.
Conclusion
The feasibility of healthcare provider implementation of a culturally tailored intervention to manage hypertension has been demonstrated. However, future research is warranted to gain a more in‐depth understanding of how to approach hypertension management among Haitians and other Black immigrant communities.
Relevance to clinical practice
Advanced practice nurses are uniquely qualified to implement evidence‐based programmes that improve patient knowledge and adherence to hypertension management. Through tailoring and adopting an evidence‐based methods for educating patients about medication adherence and adequate blood pressure management, there is a potential to see improvements in patient outcomes.
Background: Cost-related medication non-adherence (CRN) can negatively impact health outcomes in older adults with asthma and chronic obstructive pulmonary disease (COPD) overlap (ACO) by reducing access and adherence to essential medications. The objective of this study is to examine the association of ACO to any CRN and specific forms of CRN among a nationally representative sample of older (age ≥65 years) adults.
Methods: We adopted a cross-sectional study design using data from pooled cross-sectional Medicare Current Beneficiary Surveys (2006-2013) and linked fee-for-service Medicare claims. Unadjusted and adjusted logistic regressions that accounted for the complex survey design examined the association of ACO to any CRN and specific forms of CRN.
Results: Among older adults with ACO, 16% reported any CRN. The most common form of CRN was “failing to get prescription”. As compared to older adults with no asthma and no COPD, those with ACO were more likely to report any CRN (AOR =1.50, 95%CI= [1.14, 1.96]) and all forms of CRN. However, when the number of unique medications were added to the model, there were no statistically significant differences in CRN between the two groups.
Conclusions: Older adults with ACO represent a vulnerable population with increased risk for CRN. Multiple factors can contribute to CRN including: a higher number of prescribed medications, multiple co-morbidities, and cost of therapies. Medication comprehensive review interventions have the potential of reducing the risk of CRN among the older Medicare beneficiaries with ACO.
Depression is a common comorbidity among patients with hypertension. Patients with hypertension and depression have worse health outcomes compared to those without depression. The combined effects of social support, physical comorbidity, and health literacy on depression among individuals with hypertension remain unclear. A survey was conducted between December 2017 and May 2018 to investigate the relationships among social support, physical comorbidity, health literacy, and depression in a population of patients with hypertension in rural areas of Sichuan province, China. Multiple linear regression was used to examine factors that influenced depression, and structural equation modeling (SEM) was used to examine the relationships among the four study variables. The mean scores of 549 patients with hypertension were 37.17 ± 6.84 for social support, 14.62 ± 6.26 for health literacy, and 3.56 ± 3.05 for depression; furthermore, 34.2% of participants had physical comorbidity. Gender and per capita annual family income were significantly associated with depression. Physical comorbidity was directly positively related to depression while health literacy was directly negatively related to depression. Social support had an indirect negative association with depression by the mediating effects of health literacy and physical comorbidity. Adequate social support and health literacy, and less physical comorbidity could potentially contribute to reducing depression. The study highlights the importance of social support in maintaining mental health among patients with hypertension. Strategies that target the enhancement of social support and health literacy should be prioritized to relieve depression among patients with hypertension. More attention should be paid to women, low-income individuals, and patients with physical comorbidities.
Objective
To study knowledge of risk factors and consequences of hypertension in a rural population in South India.
Methods
This is a community-based study conducted among adults of a rural population in the Rishi Valley, India. Residents of randomised rural villages were invited to participate in a study of hypertension. We obtained measures of blood pressure, height, weight, waist and hip circumferences and questionnaire-based information on knowledge about hypertension, sociodemographic characteristics and health behaviours. Multivariable logistic regression analyses were conducted to determine the factors associated with knowledge of risk factors for hypertension (knowledge of ≥2 risk factors).
Results
The study comprised 641 adults; 132 aware and 218 unaware of their hypertension, and 291 with normal blood pressure. Only 31% of participants knew that hypertension adversely affects an individual’s health and 7% knew the benefits of treating hypertension. Almost a third (30%) of those aware of their hypertensive status, and 48% overall, did not know any of the risk factors for hypertension. Being aware of one’s hypertensive status (OR 2.51, 95% CI 1.44 to 4.39), being treated for hypertension, male sex, younger age, having some schooling, abdominal obesity and physical inactivity were associated with better knowledge of risk factors for hypertension.
Conclusion
Knowledge of risk factors and consequences of hypertension in this disadvantaged population was poor. There was better knowledge of risk factors in some, but not all, people who were aware of having hypertension. Screening and targeted educational programmes are warranted in this population to improve health behaviours and reduce the consequences of hypertension.
The availability of distiller’s dried grain with solubles (DDGS), the main co-product of corn ethanol production, exceeds its demand as feedstuff. A physical separation process named elusieve can separate the hull fiber from DDGS or corn flour to obtain DDGS with enhanced protein and oil content, or corn flour with higher starch content. This study was performed to investigate the potential of using the hull fiber separated with elusieve process on DDGS or corn flour as fillers in high density polyethylene (HDPE) composites at the commercial scale. Additionally, the degradation effects of UV accelerated weathering on this material were investigated. Commercial scale composite samples were made with six combinations of oak fiber, corn hull fiber and DDGS fiber, with the fiber loading maintained at 50%, and then the samples were subjected to UV accelerated weathering for 2000 h. The unexposed DDGS samples showed better resistance to moisture absorption (less than 5%) than the corn filler samples (18%). The specific gravity for all the filler composites was more than one for both unexposed and UV weathered composites. The DDGS fiber also showed higher flexural properties in oak25/DDGS25 than other filler composites. For all samples, the accelerated weathering resulted in a lightening during the first 1000 h of exposure, followed by a darkening at 2000 h of UV exposure. Overall, UV weathering resulted in a chain scission of the HDPE polymer increasing the crystallinity of the polymer in the weathered filler composites.
Non-adherence to antihypertensive medication is the most important cause of uncontrolled blood pressure and is influenced by multiple interrelating factors. Understanding the complexity of medication non-adherence and its associated factors is important to determine intervention strategies. Therefore, a systematic review was performed aimed to identify factors associated with antihypertensive medication non-adherence. Different databases were searched for observational studies reporting on factors associated with non-adherence to antihypertensive medication. Titles, abstracts and full texts were reviewed by three researchers. Subsequently, the methodological quality of each study was assessed. Factors that were extracted from the included studies were categorised as factors with consistent or inconsistent evidence to put their potential importance into perspective. Forty-four studies were included. Higher co-payment, side effects and a poor patient-provider relationship were identified as factors with consistent evidence since consistent significant relationships were found for these factors whenever studied. The relationships between non-adherence and multiple other factors were inconsistent among the reviewed studies. However, some of these factors deserve some consideration. Since multiple potentially relevant factors were identified, patient-tailored interventions focussing on identifying and addressing patients' specific barriers to adherence are needed. Further research should clarify the influence of inconsistent factors on adherence and their potential to be addressed in interventions.Journal of Human Hypertension advance online publication, 29 June 2017; doi:10.1038/jhh.2017.48.
Objective:
To explore factors contributing to intentional and unintentional medication nonadherence in adults with chronic heart failure (HF).
Background:
Medication nonadherence is prevalent in HF but the factors contributing to it are not well understood.
Methods:
This secondary data analysis of qualitative data explored narrative accounts about medication adherence from four previous studies (N = 112). The Necessity-Concerns-Framework derived from the Common Sense Model (CSM) of Self-Regulation guided the interpretation of themes.
Results:
In this diverse sample (39% Black, 6% Hispanic, 63% male; mean age 59 ± 15 years), 90% reported at least intermittent nonadherence. For many (60%), missing medication was unintentional but 27% reported intentional nonadherence. Four interconnected patterns of behavior emerged: 1) rarely nonadherent, 2) frequently nonadherent, 3) intentionally nonadherent, and 4) reformed nonadherent. Misperceptions about HF, beliefs, concerns, and contextual factors contributed to both intentional and unintentional nonadherence.
Conclusion:
Medication nonadherence is prevalent in HF and influenced by modifiable factors.
Inadequate blood pressure (BP) control may be linked with poor adherence to guidelines by the treating physician. This study aimed at assessing the rates of controlled hypertension as per the 2009 Reappraisal of the 2007 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines in 2185 hypertensive adults across five countries (Algeria, Pakistan, Ukraine, Egypt and Venezuela). The rates of controlled hypertension according to physician perception, type of therapy and risk factors were evaluated. Overall, 40% of patients had controlled hypertension according to the guidelines. A marked divergence in the rates of controlled hypertension as assessed by physicians and guidelines was observed (72% vs 40%). The presence of high/very high risks was linked to poor BP control. High salt intake [29%; odds ratio (OR) 9.94, 95% confidence interval (CI) 6.72;14.69], treatment non-adherence (27%; OR 7.32, 95% CI 4.82;11.13), lack of understanding of the treatment’s importance (25%; OR 4.95, 95% CI 3.16;7.75), comorbidity (13%) and depression (9%; OR 10.50, 95% CI 5.37;20.54) were major reasons for not achieving hypertension control. Addition of another drug was the most frequent medication change prescribed. Poor rates of BP control warrant repeated promotion of guidelines while identifying potential contributing factors and implementing strategies that re-establish BP control.
Introduction: Hypertension is among the major causes of mortality and disability worldwide. Despite the development of various treatment protocols, a significant proportion of hypertensive patients cannot reach the target blood pressure. The present study followed the participants of the Isfahan Healthy Heart Program (IHHP) to evaluate the factors effective on blood pressure control. Methods: In a cross-sectional study, the names of hypertensive individuals in the IHHP were extracted. The subjects were then invited to fill out questionnaires - including demographics, socioeconomic status, knowledge, attitude, and performance toward hypertension, lifestylerelated information (diet, physical activity, smoking, and stress management), and history of diseases. Height, weight, and blood pressure measurements were then performed. Patients with blood pressure ≥ 140/90 mm Hg were considered to have uncontrolled blood pressure. Data of the two groups with controlled and uncontrolled blood pressure were compared using the independent t and chi-square tests in SPSS15. Results: Although 300 persons were invited, only 139 patients accepted to participate. Since 30 subjects did not fulfill hypertension criteria, a total number of 109 individuals were finally evaluated. Measurements revealed 30 (27.5%) patients to have blood pressure below 140/90 mm Hg. However, 79 (72.5%) subjects were identified to have uncontrolled blood pressure. Subjects with controlled and uncontrolled blood pressure were not significantly different in terms of mean age (61.07 ± 10.30 vs. 61.11 ± 9.82; p value = 0.982). The corresponding scores were 65.30 ± 14.24 and 70.48 ± 9.43 for knowledge (p value = 0.073) and 76.67 ± 23.61 and 82.91 ± 18.14 for attitude (p value = 0.144). The mean values of waist circumference and waist-to-hip ratio were significantly higher in patients with uncontrolled blood pressure. In addition, subjects with uncontrolled blood pressure had significantly better knowledge about the necessity of having physical activity, not smoking, and stress management. However, no other significant differences were observed between the two groups. Conclusion: According to our findings, patient education and follow-up, as well as designing supportive and reminder systems, must aim to control blood pressure through eliminating obesity. Evaluating the knowledge, attitude, and performance of Iranian physicians would further highlight factors affecting blood pressure control in the country.
Background: Patients' education, their knowledge of cardiovascular risk factors, their perception of the benefits and potential risks of treatment, and their active participation in treatment decisions have been found to affect their adherence with treatment recommendations. Nurses play an important role in helping patients modify unhealthy lifestyles and behaviors, but they do not always routinely advise their hypertensive patients to change their behavior. Aim of the study: The aim of this study is to evaluate the effect of counseling on patients' adherence regarding anti hypertensive therapeutic regimen. Design of this study was a quasiexperimental research design. Setting: This study was conducted at Cardiac Outpatient Clinic in Ain Shams University Hospital. Subjects: A purposive sample of 60 patients was included in the study with essential and secondary hypertension. Tools: Patient interview questionnaire sheet, Patient's adherence assessment sheets as Morisky Medication Adherence Scale (MMAS), Hypertension Self-Care Activity Level Effects (H-SCALE) and The Beliefs about Medicines Questionnaire (BMQ). Results: All of the studied patients had inadequate knowledge about hypertension and self care activities regarding it pre counseling program intervention, which improved at 1, 3 and 6 months after the program intervention with highly significant differences between preand post intervention. As well, the majority of the studied patients had adequate self-care practices post program intervention and during the follow up period. There was also a highly significant difference between the patents' adherence to the anti hypertension medication pre and post program Conclusion: The counseling program improved patents' knowledge, self care practices and adherence to the anti hypertensive medication Recommendation: The study should be replicated on a larger sample and different hospitals and community settings in order to generalize the results.
The prevalence of hypertension in South Africa has been estimated to be 20% of the adult population with over six million people being affected. Poor adherence to treatment plans lead to inadequate blood pressure control and high morbidity. Many studies have looked at factors contributing to poor blood pressure control in South Africa but few studies actually focus on district hospitals in Kwazulu-Natal in particular, despite the fact that the province has the most heterogeneous population in South Africa.
The study was a descriptive cross-sectional study conducted at the chronic out patient clinic of an urban district hospital involving 370 participants aged 18-90 years.
The study showed poorly controlled blood pressure in 58% of the participants. Only 35% knew their blood pressure results on the day of interview and 19.2% were aware of their target blood pressure. Good adherence was self-reported by 95% of the participants, whist 51.4% reported significant side-effects to medication.
The majority of patients had poor knowledge about blood pressure and little awareness of their blood pressure reading. These may be precursors to poor blood pressure control and this needs further investigation. A high level of self-reported adherence to medication did not translate into effective blood pressure control. A significant number reported medication side-effects which may have contributed to the poor blood pressure control. The high adherence rate may therefore have been over reported. An objective way tomeasure adherence will be necessary for future research.
Unlabelled:
Hypertension is an important risk factor for cardiovascular disease and occurs disproportionately among patients with depression. Few studies have rigorously examined outcomes specifically among hypertensive patients with newly diagnosed comorbid depression.
Aim:
We hypothesized that incident depression would exacerbate hypertensive disease and that this would be evident through greater utilization of medical services than would otherwise occur in the absence of depression.
Methods:
Claims data for hypertensive patients enrolled in Maryland Medicaid (2005-2010) were used to estimate the change in annualized utilization following incident depression, compared to a matched cohort of hypertensive patients never diagnosed with depression. Multivariate regression was used to adjust for changes in antihypertensive medications, adherence and comorbidity that followed depression onset.
Results:
While medical utilization increased after incident depression, additional encounters tended to be for nonacute medical care and there was no significant increase in encounters specifically for cardiovascular or hypertension-related conditions.
Discussion:
The results contribute to the discussion on the relationship between depression and cardiovascular disease and will inform future studies that aim to look at longer term outcomes in patients with hypertension.
In 2010, there were 1.7 million Korean Americans in the United States (U.S. Census, 2010). As a racial/ethnic group in the U.S, they face disparities in health care access and health status. Korean Americans continue to have the highest uninsured rates, limiting their access to care. This chapter will provide a brief overview of Korean immigration history to the U.S., then provide an overview of the latest research on current health issues and concerns facing the Korean American community today.
This cross-sectional study was designed to identify correlates of blood pressure control behaviors, including participation in physical activity, maintaining a healthy diet, limiting alcohol and tobacco use, discussing blood pressure with a doctor, and getting screened for blood pressure. The study sample included 116 Korean American men and women aged 42 to 77 years (M = 58.7) who resided in the greater Philadelphia area. Intention to exercise, comfort exercising in the neighborhood, and confidence in the ability to find time to exercise were positively correlated with participating in physical activity. Knowledge about the benefits of a healthy diet and confidence in the ability to maintain a healthy diet were positively correlated with maintaining a healthy diet. Intention to visit a doctor, having a regular doctor, satisfaction with the doctor, having confidence in the doctor, and confidence in the ability to ask doctors about health issues were positively correlated with medical adherence (including adhering to medication regimen and seeing a doctor regularly).
The central tenet of social cognitive theory, that individuals' construal processes and behaviors mutually reinforce each other, is tested for exercise behavior. Two longitudinal data sets (year 1 to year 2 and year 1 to year 6) from the Stanford Five-City Project, a field experiment to promote cardiovascular disease prevention in California, are analyzed through structural equation modeling techniques to evaluate the effects of demographics, exercise knowledge, and exercise self-efficacy on exercise behavior. The effects of exercise behavior on subsequent knowledge and self-efficacy are also examined. In both data sets (year 1 to year 2, N = 1254 and year 1 to year 6, N = 939), education, income, age, and sex were significant predictors of exercise behavior. Self-efficacy and knowledge also predicted behavior. Prior exercise behavior predicted subsequent knowledge and self-efficacy. Prior knowledge and self-efficacy, in turn, predicted subsequent exercise behavior. Recommendations are made for enhancing the effectiveness of public health efforts designed to promote healthy behaviors.
This study measured compliance and related demographic factors in a retrospective cohort of 4068 elderly outpatients newly starting antihypertensive therapy from 1982 through 1988.
Logistic regression modeling of data from the New Jersey Medicaid program was used.
These patients filled antihypertensive prescriptions covering an average of only 179 days in the 365-day follow-up period (49%) Good compliance (> or = 80%) was associated with advanced age (odds ratio [OR] = 2.12, for patients 85 or older) and White race (OR = 0.55 for Blacks). There was no relationship between compliance and gender.
Despite the efficacy of antihypertensive therapy in preventing cardiovascular morbidity, such high rates of noncompliance may contribute to suboptimal patient outcomes.
With the current wave of Asian immigration to the United States, awareness of their use of traditional medicine, often in combination with Western medicine, is an increasingly salient issue for health care professionals. This paper describes the use of traditional and Western medicine by Korean American elderly and factors that are associated with their health-seeking behaviors and health service utilization. Data were obtained from a convenience sample of 205 Korean elderly immigrants through interview. The findings revealed that health service utilization among Korean American elderly covered a broad spectrum of health resources, including the use of Western medicine, the traditional Korean medicine (hanbang), or both Western and traditional clinics. In addition, health insurance status and the source of health care were found to relate to the types of health service that Korean American elderly chose to utilize. Better understanding of patterns of health service utilization may improve the quality of health care by increasing health providers' cultural sensitivity and facilitating adequate communication between Asian immigrant clients and their care providers. Implications for research and practice are discussed.
This article discusses issues related to measuring depression in linguistic and cultural minority groups, using Korean Americans as an example. The article details the process of developing and evaluating a depression-screening tool for Korean Americans. A series of focus groups was conducted in the development stage of the study. In the evaluation phase, 154 first-generation Korean Americans participated in the assessment of the psychometric properties of the newly developed depression scale, the Kim Depression Scale for Korean Americans (KDSKA). The KDSKA showed adequate reliability, validity, and potentially high sensitivity as a depression-screening tool for Korean Americans.
Addressing the epidemic of poor compliance with antihypertensive medications will require identifying factors associated with poor adherence, including modifiable psychosocial and behavioral characteristics of patients.
Cross-sectional study, comparing measured utilization of antihypertensive prescriptions with patients' responses to a structured interview.
Four hundred ninety-six treated hypertensive patients drawn from a large HMO and a VA medical center.
We developed a survey instrument to assess patients' psychosocial and behavioral characteristics, including health beliefs, knowledge, and social support regarding blood pressure medications, satisfaction with health care, depression symptom severity, alcohol consumption, tobacco use, and internal versus external locus of control. Other information collected included demographic and clinical characteristics and features of antihypertensive medication regimens. All prescriptions filled for antihypertensive medications were used to calculate actual adherence to prescribed regimens in a 365-day study period. MAIN OUTCOME OF INTEREST: Adjusted odds ratios (ORs) of antihypertensive compliance, based on ordinal logistic regression models.
After adjusting for the potential confounding effects of demographic, clinical, and other psychosocial variables, we found that depression was significantly associated with noncompliance (adjusted OR per each point increase on a 14-point scale, 0.93; 95% confidence interval [95% CI], 0.87 to 0.99); in unadjusted analyses, the relationship did not reach statistical significance. There was also a trend toward improved compliance for patients perceiving that their health is controlled by external factors (adjusted OR per point increase, 1.14; 95% CI, 0.99 to 1.33). There was no association between compliance and knowledge of hypertension, health beliefs and behaviors, social supports, or satisfaction with care.
Depressive symptoms may be an underrecognized but modifiable risk factor for poor compliance with antihypertensive medications. Surprisingly, patient knowledge of hypertension, health beliefs, satisfaction with care, and other psychosocial variables did not appear to consistently affect adherence to prescribed regimens.
Although the Personal Resource Questionnaire (PRQ 85-Part 2) has been widely used to measure perceived level of social support, results of psychometric evaluation of the measure with a Korean population are not currently available in the literature.
To assess the psychometric properties of the Korean language version of the PRQ 85.
An empirical validation of the theoretical relationships among the construct, social support, as measured by the PRQ 85, and other related constructs was conducted. In addition, factor structure comparison with a cross-validation technique was utilized on a combined sample of 555 Korean adults from three independent studies.
Construct validity for the Korean PRQ 85 was evidenced by statistically significant correlations of perceived social support with the theoretically relevant variables such as depression and psychosocial adjustment. Using principal axis factoring with an oblique rotation, the two-factor solution was found to be most satisfactory in the first random sample and was cross-validated in the second sample, accounting for 52% and 54.1% of the total variance, respectively. Inspecting the distribution of variables within the factors, however, only the first factor appeared to be a construct-related factor; the second factor, which was exclusively represented by negatively keyed items, was method-related.
The findings suggest that a one-factor solution can be used to accurately describe a substantive (or construct-related) factor pattern of the Korean version of the PRQ 85. Although researchers generally agree that negatively worded questions are important in order to minimize the "response bias," this approach appeared to be problematic for Koreans who used the translated PRQ 85. Further research is warranted to explicate this important methodological issue in cross-cultural instrumentation.
Relationships between depression, alcohol and illicit drug use, adherence behaviors, and blood pressure (BP) were examined in 190 urban hypertensive Black men enrolled in an ongoing hypertension control clinical trial. More than one fourth (27.4%) of the sample scored greater than 16 on the Center for Epidemiological Studies-Depression Scale (CES-D), indicating a high risk of clinical depression. Depression was significantly associated with an increased likelihood of meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for alcohol abuse or dependence (odds ratio = 5.2; 95% confidence interval = 1.897-14.214). The level of depression was significantly correlated with poor medication (r =.301) and poor dietary compliance (r =.164). Both alcohol intake and illicit drug use were significantly correlated with poor dietary compliance (r =.195 and.185, respectively) and smoking (r =.190 and.269, respectively). Although no direct relationship between depression and the level of BP was substantiated by multivariate analysis, findings of descriptive analyses revealed statistically significant associations among depression, substance use, poor adherence, and poor BP outcomes. Given the harsh environment in which a large number of young urban Black men live, the high prevalence of substance abuse might be an attempt to fight off depression. Further in-depth investigation is needed to identify the role of depression and BP control in urban young Blacks in order to construct effective interventions that address their unique needs.
Adherence to therapy is important to ensure success. We wanted to explore this feature in patients with inflammatory bowel disease.
We explored adherence to treatment and its modifiers in 40 patients with inflammatory bowel disease using a battery of tests.
A 67% of patients (95% CI: 51-81%) acknowledged a certain degree of involuntary nonadherence, and 35% (95% CI: 20-51%) of voluntary nonadherence. Overall, 72% (95% CI: 56-85%) of patients had some form of nonadherence. An objective correlation of these self-reported data was assessed by the determination of urine salicylate levels in the subset of patients treated with mesalazine or its derivatives (15 cases). Two of them (13%) had no detectable urinary drug levels, indicating complete nonadherence. Voluntary nonadherence was higher in patients with lower scores in the intestinal (p = 0.02) and social areas (p = 0.015) of IBDQ-32, as well as in those with less active Crohn s disease (p < 0.005), patients with high depression scores and high patient-physician discordance (p = 0.01), patients with long-standing disease (p = 0.057), patients who considered themselves not to be well informed about the treatment they were getting (p = 0.04) or who trusted their attending physicians less (p = 0.03).
Intentional nonadherence to therapy is prevalent among patients with inflammatory bowel disease. A correction of factors associated to poor adherence could lead to higher therapeutic success.
The full benefit of many effective medications will be achieved only if patients adhere to prescribed treatment regimens. Unfortunately, applying terms such as “noncompliant” and “nonadherent” to patients who do not consume every pill at the desired time can stigmatize them in their future relationships with health care providers. This article on medication adherence (or compliance) reviews strategies to assess and enhance this important aspect of patient care.
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.
The aim of this study was to identify determinants of nonadherence to medication in outpatients with established inflammatory bowel disease (IBD).Methods
Ten gastroenterologists and 153 of their IBD patients participated in this prospective study. Demographic, clinical, and psychosocial characteristics, as well as patient-physician discordance, were assessed at an office visit. Nonadherence to medication was assessed 2 wk later. Separate generalized estimating equations were used to identify determinants of nonadherence.ResultsPhysicians averaged 47.9 yr in age (range 30.1–57.5 yr), and 90% were male. Patients averaged 37.0 yr (SD = 15.1), and 87 (56.9%) were female. In all, 63 patients (41.2%) were nonadherent to medication; of these, 51 (81.0%) indicated unintentional nonadherence, 23 (36.5%) intentional nonadherence, and 11 (17.5%) both. Overall nonadherence was predicted by disease activity (OR = 0.55, p = 0.0022), new patient status (OR = 2.14, p = 0.0394), disease duration (OR = 0.50, p = 0.0001), and scheduling a follow-up appointment (OR = 0.30, p = 0.0059), whereas higher discordance on well-being was predictive only in psychologically nondistressed patients (p = 0.0026 for interaction). Unintentional nonadherence was predicted by age (OR = 0.97, p = 0.0072), new patient status (OR = 2.80, p = 0239), and higher discordance on well-being in psychologically nondistressed patients (p = 0.0504). Intentional nonadherence was predicted by disease duration (OR = 0.55, p = 0032), scheduling a follow-up appointment (OR = 0.12, p = 0.0001), certainty that medication would be helpful (OR = 0.99, p = 0.0409), and total patient-physician discordance (OR = 1.59, p = .0120).Conclusions
These findings suggest that the therapeutic relationship, as well as individual clinical and psychosocial characteristics, influence adherence to medication.
Background
Although self-reported hypertension prevalence in the US is increasing, the current hypertension control rate is unknown.
Methods
This analysis of the National Health and Nutrition Examination Survey (NHANES) describes trends in the prevalence, awareness, treatment, and control of hypertension between 1988 and 2000 in US adults. Hypertension is defined as a measured blood pressure of 140/90 mm Hg or greater or reported use of antihypertensive medications. Hypertension awareness and treatment are defined on the basis of responses to standardized questions. Hypertension control is defined as being treated and a measured blood pressure less than 140/90 mm Hg (less than 130/85 mm Hg for those with diabetes mellitus).
Results
In 1999–2000, 28.7% of NHANES participants had hypertension, an increase of 3.6%, 95% CI [0 to 8.3] from 1988–1991. Hypertension prevalence was highest in Non Hispanic Blacks, increased with age, and tended to be higher in females. Females demonstrated a greater increase of hypertension prevalence (5.6%, 95% CI [0 to 11.4]) than males (2.2%, 95% CI [−4.5 to 8.9]). Overall, in 1999–2000, 68.9% were aware of their hypertension, 58.4% were treated, and 31.0% were controlled. Of all diabetic hypertensive participants, 25.4% were controlled. Control rate was lower in females (p=0.0057), Mexican Americans (p<0.0001) and in those 60 years or older (p<0.0001). Awareness rate remained unchanged from 1988 to 2000, although treatment and overall control rates increased by 6.0% (p<0.05) and 6.5% (p<0.05), respectively.
Conclusion
Hypertension prevalence is increasing in the US, possibly due to an increasing prevalence of obesity. Hypertension control rates, although improving, continue to be low. If the increase in hypertension control rates remain at the current pace, the 50% target by 2010 will not be achieved.
Background. Although the Personal Resource Questionnaire (PRQ 85-Part 2) has been widely used to measure perceived level of social support, results of psychometric evaluation of the measure with a Korean population are not currently available in the literature. Objective: To assess the psychometric properties of the Korean language version of the PRQ 85. Method: An empirical validation of the theoretical relationships among the construct, social support, as measured by the PRQ 85, and other related constructs was conducted. In addition, factor structure comparison with a cross-validation technique was utilized on a combined sample of 555 Korean adults from three independent studies. Results: Construct validity for the Korean PRQ 85 was evidenced by statistically significant correlations of perceived social support with the theoretically relevant variables such as depression and psychosocial adjustment. Using principal axis factoring with an oblique rotation, the two-factor solution was found to be most satisfactory in the first random sample and was cross-validated in the second sample, accounting for 52% and 54.1% of the total variance, respectively. Inspecting the distribution of variables within the factors, however, only the first factor appeared to be a construct-related factor; the second factor, which was exclusively rep-related. resented by negatively keyed items, was method Conclusion: The findings suggest that a one-factor solution can be used to accurately describe a substantive (or construct-related) factor pattern of the Korean version of the PRQ 85. Although researchers generally agree that negatively worded questions are important in order to minimize the "response bias," this approach appeared to be problematic for Koreans who used the translated PRQ 85. Further research is warranted to explicate this important methodological issue in cross-cultural instrumentation.
The evidence of construct validity that resulted from conjoint testing of two measures of social support, the Personal Resource Questionnaire (PRQ85) and the Cost and Reciprocity Index (CRI) is presented. Both instruments were used with two samples of adults, 333 who were part of a large health project and 99 who participated in a methodological study. The PRQ85 and CRI appear to tap the construct of support yet are not highly redundant. Both tools demonstrated similar curves of relationships to external criteria. Dissimilar patterns of relationships with negative mood states indicated an area of need for future study.
The Personal Resource Questionnaire (PRQ) was developed in 1981 to measure situational and perceived social support. This article presents the history of its development and the latest psychometric evaluation of the tool. Nurturance subscale items were rewritten to reflect a broader context of behaviors toward persons of any age. Content validity was further established by correlations between the PRQ and two mental health measures. Factor analysis indicated that a three-factor structure for the perceived social support scale may be more appropriate than the hypothesized five-subscale structure.
The Personal Resource Questionnaire (PRQ) is a two-part measure of the multidimensional characteristics of social support. Part one provides descriptive information about the person's resources, the satisfaction with these resources, and whether or not there is a confidant. Part two contains a 25-item Likert scale developed according to Weiss's relational dimensions and a five-item Self-Help Ideology scale. The PRQ was administered as the measure of one of the independent variables in a study of 149 male or female spouses of individuals with multiple sclerosis. Content and face validity procedures were completed previous to the study. An internal consistency reliability coefficient of alpha = .89 was obtained for the PRQ Part 2. Moderate intercorrelations for the dimensional subscales--intimacy, social integration, worth, and assistance--indicate that there is some overlap of these dimensions. Low intercorrelations between nurturance and the other four subscales suggest that nurturance is an independent scale. Modest predictive validity coefficients were obtained. At the present time the intended use of the PRQ is for research. Plans for tool development include obtaining further construct validity information and test-retest reliability.
To investigate racial differences in hypertensive patients' understanding of their disorder, we administered a questionnaire to 83 black and 260 white outpatients with the diagnosis of hypertension designated in their medical chart. No racial differences in systolic or diastolic blood pressure, age, or male/female ratio were observed. However, blacks were more likely than whites to identify renal failure as a consequence of hypertension, whereas whites were more likely to identify atherosclerosis. Blacks also were more likely than whites to accept higher diastolic blood pressures as normal (90 to 100 mm Hg versus 80 to 90 mm Hg). There was no correlation between knowledge and blood pressure. Our observations show that both racial groups are well educated about antihypertensive therapy as well as the consequences and complications of hypertension. Comprehensive treatment of hypertension should include educational strategies that are population-specific and that address ways to change disease-relevant behaviors, rather than merely identifying which behaviors to change.
The effects of consumer dissatisfaction with doctors and medical care services on intentions to seek care and subsequent behavior were estimated using data from four general population studies. Satisfaction was linked to reported intentions regarding care-seeking behavior (choices between self-care and seeking care from a regular doctor or emergency room) in response to both minor and serious medical problems. These results were replicated in two populations with diverse sociodemographic characteristics. Satisfaction scales also predicted subsequent changes in medical care providers and disenrollments from prepaid health plans independent field tests. These results suggest that the behavioral consequences of individual differences in satisfaction with doctors and health care services are noteworthy from both clinical and social perspectives.
To evaluate the validity of patient report, pharmacy dispensing records, and pill counts as measures of antihypertensive adherence using electronic monitoring as the validation standard.
The study was conducted among 286 members of Harvard Pilgrim Health Care, a managed care organization, who were at least 18 years of age, on monotherapy for hypertension, and had prescription drug coverage. Prescription refill adherence during the 12 months before enrollment was determined from their automated pharmacy dispensing records. Participants were interviewed about their medication adherence before and after a 3-month electronic monitoring period during which pill counts were also performed. Adherence to both recommended number and timing of doses was estimated from electronic monitoring data. Data analysis was based on statistical correlation and analysis of variance.
Electronic adherence monitoring revealed that the proportion of prescribed doses consumed was higher (0.92) than the proportion of doses taken on time (0.63). The correlation between adherence to quantity and timing of doses was 0.32. Concurrent pill counts and earlier refilling patterns were moderately correlated with electronic monitoring (pill count: r = .52 with quantity and r = .17 with timing; refill adherence r = .32 with quantity and r = .22 with timing). There was considerable misclassification of adherence reported by patients, although nonadherence was generally accurately reported.
Deviation from recommended timing of doses appears to be greater than from prescribed number of doses. Pharmacy dispensing records demonstrate predictive validity as measures of cumulative exposure and gaps in medication supply. Adherence levels determined from pill counts and pharmacy dispensing records correlate more closely with quantity than with timing of doses. Nonadherence reported by patients can serve as a qualitative indicator and predictor of reduced adherence.
The Hill-Bone Compliance to High Blood Pressure Therapy Scale assesses patient behaviors for three important behavioral domains of high blood pressure treatment: 1) reduced sodium intake; 2) appointment keeping; and 3) medication taking. This scale is comprised of 14 items in three subscales. Each item is a four point Likert type scale. The content validity of the scale was assessed by a relevant literature review and an expert panel, which focused on cultural sensitivity and appropriateness of the instrument for low literacy. Internal consistency reliability and predictive validity of the scale were evaluated using two community based samples of hypertensive adults enrolled in clinical trials of high blood pressure care and control. The standardized alpha for the total scale were 0.74 and 0.84, and the average interitem correlations of the 14 items were 0.18 and 0.28, respectively. The construct and predictive validity of the scale was assessed by factor analysis and by testing of theoretically derived hypotheses regarding whether the scale demonstrated consistent and expected relationships with related variables. In this study, high compliance scale scores predicted significantly lower levels of blood pressure and blood pressure control. Moreover, high compliance scale scores at the baseline were significantly associated with blood pressure control at both baseline and at follow up in the two independent samples. This brief instrument provides a simple method for clinicians in various settings to use to assess patients' self reported compliance levels and to plan appropriate interventions.
This study, conducted from October 1998 to February 1999, included a cross-sectional epidemiological survey administered to Korean Americans (KAs) living in Maryland (N = 761). One third (32%) of participants had high blood pressure (HPB: SBP > or = 140 mm Hg and/or DBP > or = 90 mm Hg or were on hypertension medication). HBP was more common among males (35%) than females (30%) and those who were aged 50 years or older (53%) compared to those who were less than 50 years old (12%). The prevalence of HBP in Maryland KAs was found to be much higher than in other Americans (24%) and in their counterparts in Korea (22% overall: 29% in males, 11% in females). Only 40% of the hypertensive KAs were taking HBP medication, and 74% of those did not have controlled HBPs. Further, multivariate logistic analyses were conducted to estimate the relative biobehavioral risk factors related to hypertension. Several significant risk factors were identified, including family history of HBP, gender, level of education, level of acculturation, regular exercise, and being overweight. Findings from this study indicate that culturally relevant approaches to prevention and treatment of HBP are urgently needed to address the HBP problem in Korean Americans.
An in-depth cardiovascular risk factor assessment was carried out in a sample of 205 Korean American elderly in Maryland, consisting of 75 males and 130 females aged 60 to 89 years (mean age = 69.9 +/- 6.5 years). Six risk factors were assessed in each participant: high blood pressure, current smoking, high blood cholesterol, overweight, sedentary lifestyle, and diabetes. The findings of this cross-sectional study suggested that high blood pressure was the leading cardiovascular disease risk factor among Korean American elderly (71%), followed by high blood cholesterol (53%), overweight (43%), sedentary life style (24%), diabetes (18%), and smoking (7%). Two thirds of the sample had multiple cardiovascular disease risk factors. The pattern of prevalence and risk factors that was observed was consistent with the distribution of multiple risk factors in that the combination of high blood pressure, high blood cholesterol, and overweight was most common in Korean American elderly (62%). These findings indicate that culturally relevant and salient strategies are needed to reduce multiple risk factors in this population.
This study focused on the extent of hypertension (HTN) and risk factors in 201 Vietnamese in a Gulf Coast community. Blood pressure and pulse were measured by a Welch-Allyn Vital Signs Monitor (Model AD-9000, Armstrong Medical, Lincolnshire, IL). The survey tool consisted of demographic information, health status, medications, dietary habits, smoking and alcohol use, education, family configuration, family health history, and 12 true or false items on HTN knowledge. Participants believed that HTN was inherited, presented symptoms, was caused by stress and lack of daily exercise, and had no cure. Of the factors correlated with high blood pressure, the most significant item was the total knowledge score. Nearly 44% of the participants in this sample were hypertensive. Other significant correlation findings included smoking r = .45, p < .05) and exercise r = .15, p < .05) were related to high blood pressure. Cultural sensitivity was found to be critical in the data collection process. This study demonstrates a profound need for health education related to cardiovascular disease, smoking, and alcohol use in Vietnamese Americans.
Adherence to medication is a critical factor in the continued health and well-being of patients with hypertension. Patients' acceptance of medical advice and information may be influenced by their subjective beliefs about their health condition; therefore, it is essential that their beliefs be taken into account when giving health advice or medical treatment.
To determine whether a relationship exists between illness attribution, perceived control, and adherence to antihypertensive medications.
A prospective, cross-sectional survey of hypertensive patients was conducted at the University of Michigan Medical Centers, Hypertension Clinic, Ann Arbor, MI. One hundred two patients with a goal to reduce their blood pressure were included in the study. Written and follow-up telephone survey questions assessing patients' illness attributions, perceived control, and medication adherence were administered. Associations between these variables were analyzed using correlation analyses.
The majority of patients (67.7%) were adherent with their hypertensive medications. Patients indicated that modifiable variables were the most common attribution believed to cause hypertension; however, there was no significant relationship to medication adherence. A significant inverse relationship was found between perceived control over hypertension and medication adherence (p < 0.01).
The findings suggest that patients' greater perception of control over trying to reduce blood pressure may result in decreased reliance on medications and subsequent nonadherence to drug therapy. Implications of these findings on pharmacy practice are discussed.
Nonadherence to medical regimens is a major problem in health care. Distinguishing between intentional nonadherence (missing/altering doses to suit one's needs) and unintentional nonadherence (forgetting to take medication) may help in understanding nonadherence. Participants with respiratory conditions completed an anonymous questionnaire about (i) nonadherence; (ii) reasons for and against taking medications; and (iii) perceived style of the consultation in which their medication was first prescribed, as well as demographic and clinical variables. Consistent with the hypotheses, intentional nonadherence is predicted by the balance of individuals' reasons for and against taking medication as suggested by the Utility Theory, where these reasons include only those which the individual considers relevant and on which he/she focuses. Unintentional nonadherence is less strongly associated with decision balance, and more so with demographics. The research highlights the importance of (a) treating intentional and unintentional nonadherence as separate entities and (b) assessing individuals' idiosyncratic beliefs when considering intentional nonadherence.
To estimate the frequency and possible predictors of patient-mediated intentional alterations in antiretroviral medication regimens in direct response to symptoms associated with antiretroviral therapy use.
Cross-sectional survey of a population-based dynamic cohort of antiretroviral recipients in a province-wide HIV drug treatment program, the only source of free-of-charge antiretroviral medications in the province of British Columbia.
Program participants voluntarily complete program surveys on an annual basis. Study subjects were those who responded to the annual treatment program survey between January 1 and November 1, 2001. Patients reported on the occurrence and severity of symptoms of 42 side effects of antiretroviral agents. Symptoms were classified into four subgroups based on whether they were considered subjective or objective and whether they would or would not prompt clinical action. For each of the four symptom categories, patients reported what their physician recommended in response to symptoms in that group and what the patient actually did in response to these same symptoms. Intentional nonadherence was defined as reporting either skipping or altering dosages of selective regimen components or temporary cessation of therapy that was not recommended by the physician in response to adverse drug effects in the past year.
Of 638 study subjects, 70 (11%) reported intentional nonadherence with between 4% and 7.4% reporting this activity over the preceding year depending on the symptom group. Multivariate analysis revealed that a plasma viral load of <400 copies/mL (adjusted odds ratio [AOR], 0.35; 95% CI, 0.21-0.61) and completion of high school (AOR, 0.43; 95% CI, 0.24-0.78) were both inversely associated with intentional nonadherence. Those subjects reporting at least one severe symptom were more than twice as likely to report intentional nonadherence (AOR, 2.24; 95% CI, 1.16-4.33). Similarly, each additional symptom considered to be objective and to require clinical action was associated with a 25% increase in the risk of intentional nonadherence (AOR, 1.25; 95% CI, 1.10-1.43).
Intentional nonadherence to antiretroviral therapy is common among persons experiencing therapy-related side effects. Although the type and severity of adverse effects impact intentional nonadherence, this activity occurs in relation to symptoms regardless of their strict clinical relevance.
The Medication Adherence Model (MAM) was developed to describe the process of medication adherence and guide health care providers in assessing medication-taking in individuals with hypertension. The MAM was structured with the idea that two types of nonadherence contribute to inconsistent
medication taking, the intentional decision to miss medications, and the unintentional interruptions that cause medications not to be taken. The three core concepts identified in the model are: (a) Purposeful Action, (b) Patterned Behavior, and (c) Feedback. Patients' initiating and sustaining
medication adherence are dependent on the deliberate decision to take medications based on perceived need, effectiveness, and safety (Purposeful Action). Then they establish medication-taking patterns through access, routines, and remembering (Patterned Behavior). Individuals use information,
prompts, or events (Feedback) during the appraisal process to evaluate health treatment that, in return, influences individuals' levels of Purposeful Action and Patterned Behavior (Johnson, 2002; Johnson, Williams, & Marshall, 1999). The MAM depicts the dynamic process of initiating and
maintaining medication adherence from the hypertensive patient's perspective. The model describes the key components of existing cognitive and self-regulatory models, and identifies an additional behavioral component. The succinct organization of the MAM may facilitate health care providers'
ability to evaluate and individualize interventions for promoting medication taking.
Prior analyses of National Health and Nutrition Examination Survey (NHANES) data through 1991 have suggested that hypertension prevalence is declining, but more recent self-reported rates of hypertension suggest that the rate is increasing.
To describe trends in the prevalence, awareness, treatment, and control of hypertension in the United States using NHANES data.
Survey using a stratified multistage probability sample of the civilian noninstitutionalized population. The most recent NHANES survey, conducted in 1999-2000 (n = 5448), was compared with the 2 phases of NHANES III conducted in 1988-1991 (n = 9901) and 1991-1994 (n = 9717). Individuals aged 18 years or older were included in this analysis.
Hypertension, defined as a measured blood pressure of 140/90 mm Hg or greater or reported use of antihypertensive medications. Hypertension awareness and treatment were assessed with standardized questions. Hypertension control was defined as treatment with antihypertensive medication and a measured blood pressure of less than 140/90 mm Hg.
In 1999-2000, 28.7% of NHANES participants had hypertension, an increase of 3.7% (95% confidence interval [CI], 0%-8.3%) from 1988-1991. Hypertension prevalence was highest in non-Hispanic blacks (33.5%), increased with age (65.4% among those aged > or =60 years), and tended to be higher in women (30.1%). In a multiple regression analysis, increasing age, increasing body mass index, and non-Hispanic black race/ethnicity were independently associated with increased rates of hypertension. Overall, in 1999-2000, 68.9% were aware of their hypertension (nonsignificant decline of -0.3%; 95% CI, -4.2% to 3.6%), 58.4% were treated (increase of 6.0%; 95% CI, 1.2%-10.8%), and hypertension was controlled in 31.0% (increase of 6.4%; 95% CI, 1.6%-11.2%). Women, Mexican Americans, and those aged 60 years or older had significantly lower rates of control compared with men, younger individuals, and non-Hispanic whites.
Contrary to earlier reports, hypertension prevalence is increasing in the United States. Hypertension control rates, although improving, continue to be low. Programs targeting hypertension prevention and treatment are of utmost importance.
Intentional nonadherence occurs when patients deliberately do not take their medications. This phenomenon has not been studied within HIV/AIDS care, a significant omission due to the difficulty of adherence to antiretroviral medications for HIV/AIDS patients and the severe risks associated with nonadherence. The purpose of this study was to explore, using HIV-positive women's own recollections collected in diary format, how and why women living with HIV/AIDS intentionally fail to adhere to their antiretroviral medications. We examined the journal entries of 20 HIV-positive women written during a 1-month period. Although three participants wrote about their intentional nonadherence, the journal entries of only one woman are presented in detail. This woman's story highlights the complex reasons for intentional nonadherence and the social/emotional ramifications of such nonadherence. Results suggest that intentional nonadherence is emotionally trying for patients and that patients' adherence decisions are continually renegotiated, underscoring the need for routine provider-patient adherence communication.
The aim of this study was to identify determinants of nonadherence to medication in outpatients with established inflammatory bowel disease (IBD).
Ten gastroenterologists and 153 of their IBD patients participated in this prospective study. Demographic, clinical, and psychosocial characteristics, as well as patient-physician discordance, were assessed at an office visit. Nonadherence to medication was assessed 2 wk later. Separate generalized estimating equations were used to identify determinants of nonadherence.
Physicians averaged 47.9 yr in age (range 30.1-57.5 yr), and 90% were male. Patients averaged 37.0 yr (SD = 15.1), and 87 (56.9%) were female. In all, 63 patients (41.2%) were nonadherent to medication; of these, 51 (81.0%) indicated unintentional nonadherence, 23 (36.5%) intentional nonadherence, and 11 (17.5%) both. Overall nonadherence was predicted by disease activity (OR = 0.55, p = 0.0022), new patient status (OR = 2.14, p = 0.0394), disease duration (OR = 0.50, p = 0.0001), and scheduling a follow-up appointment (OR = 0.30, p = 0.0059), whereas higher discordance on well-being was predictive only in psychologically nondistressed patients (p = 0.0026 for interaction). Unintentional nonadherence was predicted by age (OR = 0.97, p = 0.0072), new patient status (OR = 2.80, p = 0239), and higher discordance on well-being in psychologically nondistressed patients (p = 0.0504). Intentional nonadherence was predicted by disease duration (OR = 0.55, p = 0032), scheduling a follow-up appointment (OR = 0.12, p = 0.0001), certainty that medication would be helpful (OR = 0.99, p = 0.0409), and total patient-physician discordance (OR = 1.59, p =.0120).
These findings suggest that the therapeutic relationship, as well as individual clinical and psychosocial characteristics, influence adherence to medication.
Patients' adherence to antihypertensive drug regimens is a complex but important factor in achieving blood pressure control and reducing adverse cardiovascular outcomes. Approximately one half of patients with hypertension adhere to prescribed medications, and fewer than one in three patients have controlled blood pressure.
Several recent studies have highlighted the importance of patient medication adherence and have outlined factors that affect patient compliance with prescribed therapy.
On the basis of published studies, a conceptual framework of factors that affect patient adherence is presented. Recognizing patient nonadherence to medical therapy as a factor leading to poor blood pressure control and adverse outcomes remains a key challenge for clinicians caring for patients with hypertension.
Hypertension is poorly controlled in the US due to medication nonadherence. Recent evidence suggests that nonadherence can be classified as intentional or unintentional and different patient characteristics, such as the experience of adverse effects, may be associated with each.
To examine associations between patient characteristics, including reported adverse effects, and both intentional and unintentional nonadherence among 588 hypertensive patients.
Baseline data from a clinical trial, the Veterans' Study To Improve the Control of Hypertension, were examined. Intentional and unintentional nonadherence were assessed using a self-report measure. Participants were presented with a list of adverse effects commonly associated with antihypertensive medication and asked to indicate which symptoms they had experienced. Logistic regression analyses were used to examine adjusted associations between patient characteristics and type of nonadherence.
Approximately 31% of patients reported unintentional nonadherence and 9% reported intentional nonadherence. Non-white participants, individuals without diabetes mellitus, and individuals reporting > or = 5 adverse effects were more likely to report intentional nonadherence than their counterparts. Individuals with less than a 10th-grade education and non-white participants were more likely to report unintentional nonadherence than their counterparts. When symptoms of increased urination and wheezing/shortness of breath were reported, patients were more likely to report intentional and unintentional nonadherence compared with those who were adherent. Unintentional nonadherence was also associated with reports of dizziness and rapid pulse.
Both intentional and unintentional nonadherence are common and related to perceived adverse effects. Furthermore, different interventions may be necessary to improve adherence in unintentionally and intentionally nonadherent patients.
The purpose of this pilot study was to identify ethnic group differences in nonadherence and to determine predictors of nonadherence to antidepressant medications in older minority-group members.
Participants were 49 black and 52 Latino subjects over the age of 55 who had been prescribed antidepressant medications within the past 12 months.
We found a distinction between intentional nonadherence (e.g., alteration of medication regimen to fit one's needs) and unintentional nonadherence (e.g., forgetfulness/difficulties keeping track of medication regimen). Results suggested that older Latino subjects reported significantly more unintentional nonadherence than older black subjects. However, once other predictors were entered into the model, ethnicity did not remain a significant predictor. No ethnic group differences in intentional nonadherence were suggested. After controlling for ethnicity and medication type, intentional nonadherence was associated with concerns about the side effects of antidepressant medications, the stigma associated with antidepressant medications, and the attribution of lesser importance to antidepressant medications than other medications. Unintentional nonadherence was associated with greater cognitive impairment.
Results suggest that the two ethnic minority groups face similar barriers to adherence to antidepressant medications. Interventions to increase adherence should target the specific type of nonadherence presented by the elderly patients. Some may benefit from memory aids and the assistance of family and friends, others from specific educational interventions about the nature of depression and antidepressant medications.
To assess contexts of adherence with hypertension care among Hmong Americans, in-person interviews were conducted with a convenience sample of 323 adults using culturally adapted survey instruments. The mean age of participants was 58 years; 91% had no education, and 86% spoke no English. Although more than 90% had health insurance and were treated with medications, the rate of blood pressure control was low (27%). A majority (> 90%) suffered from psychological distress, and 46% lived with physical illness. Over 50% reported nonadherence with hypertension care. Respondents who were 50 years of age or older, had no physical illness, did not know that hypertension was preventable, or believed that American medicine was too strong, were more likely to report nonadherence with proper medication consumption. Findings suggest that adherence was not due to lack of health care coverage; instead, it may be due to gaps in health services.
This report examines the prevalence of hypertension, its management and control, and the use of antihypertensive medication, diet, and exercise in Chinese adults residing in the San Francisco community. Blood pressure (BP) was measured objectively using an automated oscillometric Dinamap recorder on 708 Chinese adults (295 men and 413 women; age range from 19 to 98 years, mean 59.7), and hypertension, defined as BP >140/90 mm Hg and/or the use of antihypertensive medications, was found in 489 (69%), most of them immigrants from China. Although 202 patients (41%) received antihypertensive medications, only 28 (14%) achieved BP control (<140/90 mm Hg), and in examining the self-management of hypertension, it was found that only 45% of patients used low-sodium diets, and 49% performed regular exercises for > or = 30 minutes > or = 3 times weekly.
Patient adherence with prescribed inhaled therapy is related to morbidity and mortality. The terms "compliance" and "adherence" are used in the literature to describe agreement between prescribed medication and patient practice, with "adherence" implying active patient participation. Patient adherence with inhaled medication can be perfect, good, adequate, poor, or nonexistent, although criteria for such levels are not standardized and may vary from one study to another. Generally, nonadherence can be classified into unintentional (not understood) or intentional (understood but not followed). Failing to understand correct use of an inhaler exemplifies unintentional nonadherence, while refusing to take medication for fear of adverse effects constitutes intentional nonadherence. There are various measures of adherence, including biochemical monitoring of subjects, electronic or mechanical device monitors, direct observation of patients, medical/pharmacy records, counting remaining doses, clinician judgment, and patient self-report or diaries. The methods cited are in order of more to less objective, although even electronic monitoring can be prone to patient deception. Adherence is notoriously higher when determined by patient self-report, compared to electronic monitors. A general lack of adherence with inhaled medications has been documented in studies, and adherence declines over time, even with return clinic visits. Lack of correct aerosol-device use is a particular type of nonadherence, and clinician knowledge of correct use has been shown to be imperfect. Other factors related to patient adherence include the complexity of the inhalation regimen (dosing frequency, number of drugs), route of administration (oral vs inhaled), type of inhaled agent (corticosteroid adherence is worse than with short-acting beta2 agonists), patient awareness of monitoring, as well as a variety of patient beliefs and sociocultural and psychological factors. Good communication skills among clinicians and patient education about inhaled medications are central to improving adherence.
To identify the predictors of medication adherence in patients with COPD and contrast the health beliefs, experiences, and behaviors of COPD patients self-reporting good adherence with those of patients reporting suboptimal adherence to their medications.
Cross-sectional self-administered questionnaire.
Ambulatory care.
Patients with chronic respiratory ailments identified through respiratory support groups and from a pulmonary rehabilitation database.
A 30-item questionnaire comprising items pertaining to health beliefs, experiences, and behaviors along with a valid self-reported measure of adherence-the medication adherence report scale (MARS)-was administered to 525 ambulatory patients with chronic lung conditions. A total of 276 usable responses were received (52.6%). The mean age of the respondents was 71 years, and there were slightly more male patients (54.4%). COPD was the underlying disease condition in 90.6% of the respondents; two thirds of the respondents had comorbid conditions. The respiratory condition was managed by both general practitioners and respiratory specialists in 61.2% of cases. One third of the respondents self-reported complementary and alternative medicine use. The mean score (+/- SD) on the MARS among the respondents was 23.37 +/- 2.09. One hundred two patients self-reported perfect adherence on the MARS. Differences in knowledge about the illness and treatment, faith in and satisfaction with the treatment and doctors, concerns about the treatment, and intentional and unintentional deviations from the recommended treatment were detected between the adherent and less adherent groups. In multivariate analysis, "I vary my recommended management based on how I am feeling" and "I get confused about my medications" were found to be significant independent predictors of nonadherence.
Patients' acceptance of the disease process and recommended treatment, knowledge about and faith in the treatment, effective patient-clinician interaction, and routinization of drug therapy are critical for optimal medication adherence in patients with COPD.
To determine characteristics associated with drug adherence and blood pressure control among patients with hypertension, and to assess agreement between self-reported and refill adherences.
Cross-sectional analysis of baseline data from an ongoing randomized controlled trial.
Primary care center at an urban, county health system in Indianapolis, Indiana.
Four hundred ninety-two participants with hypertension and taking at least one antihypertensive drug.
Social and demographic factors, comorbidity, self-reported drug adherence, prescription refill adherence, and systolic and diastolic blood pressures were recorded at baseline. Participants were aged 57 +/- 11 (mean +/- SD) years, were predominantly women (73%) and African-American (68%), and took 2.4 +/- 1.1 antihypertensive drugs. Agreement between self-reported and refill adherences was poor to fair (kappa = 0.21). On multiple logistic regression analysis, increased age (p< or =0.002) and being married (p=0.03) were independent predictors of improved self-reported and refill adherence, whereas depressed patients had low self-reported adherence (p=0.005), and African-Americans had low refill adherence (p<0.001). Compared with nonadherent patients, adherent patients had lower systolic (-5.4 mm Hg by self-report and -5.0 mm Hg by refill) and diastolic (-2.7 mm Hg by self-report and -3.0 mm Hg by refill) blood pressures (p< or =0.02). Increased age was the only other variable strongly associated with systolic and diastolic blood pressure control in both measures of drug adherence (p< or =0.001). The association of depression, race, and sex with blood pressure control was model dependent.
Age, sex, race and depression are associated with antihypertensive drug adherence and blood pressure control. Self-reported and refill adherences appear to provide complementary information and are associated with reductions in systolic and diastolic blood pressure of similar magnitude.
This report describes the management and control of high blood pressure (HBP) in a sample of middle-aged (40 to 64 years) Korean Americans (KAs) with HBP. Participants in the Self-Help Intervention Program for HBP care (SHIP-HBP), a culturally tailored clinical trial for HBP management in KAs through lifestyle approaches, underwent baseline assessments to determine HBP control status and knowledge, beliefs, and practices related to HPB control. Data were stratified by sex. In all, 445 Korean patients are described. About 55% of the sample were receiving antihypertensive therapy, and less than one-third had controlled BP (< 140/90 mm Hg). Sex differences were observed in terms of clinical characteristics and anti-hypertensive medication use: women were more likely than men to have controlled BP and lower diastolic BP and to have been on HBP medication. Lower rates of smoking, drinking, and overweight or obesity were also observed more frequently in women. Most participants agreed that taking anti-hypertensive medication lowered BP. When asked what the most important behavioral factor was for controlling BP, about a quarter reported cutting down on salt, followed by exercise and medication taking. While poor HBP control remains a common problem that contributes to significant cardiovascular morbidity and mortality, particularly among ethnic minorities, our findings underscore the need to test the beneficial effects of primary and secondary prevention programs, suitably modified to meet the language, cultural, and individual needs of this high-risk population of hypertensive patients.
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