No abstract

Objective The study aimed to identify the determinants of medication adherence in a population of hypertensive outpatients. The principle objective of the present study was to determine the utility of self‐efficacy and the Theory of Planned Behaviour (TPB) in predicting adherence with antihypertensive medication. Setting An outpatient hypertension clinic at the Belfast City Hospital, Northern Ireland. Method Outpatients who had attended the hypertension clinic on at least one previous occasion were invited to participate in the study. Participants completed a questionnaire incorporating measures of adherence with medication, medical and sociodemographic factors, together with measures of self‐efficacy and the TPB. There were no specific study exclusion criteria. Key findings A total of 139 participants took part in the study; 20.9% of the participants reported non‐adherence with their prescribed antihypertensive medication. A statistically significant difference in self‐efficacy scores between the adherent and non‐adherent groups was revealed by a Mann‐Whitney test, with adherent patients perceiving higher levels of self‐efficacy. Regression analysis with the TPB variables revealed that adherence was predicted by intentions and subjective norms, with 41% of the variance explained. Intention was predicted by attitudes and perceived behavioural control, with 61.9% of the variance explained. Conclusion The present study provides support for the use of self‐efficacy and the TPB in predicting medication adherence; however, further research is required on the application of the TBP in the prediction of health behaviour. These findings have implications for the design of adherence‐enhancing interventions.

Participants indicated a willingness to be involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual's medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

Despite the absence of overt rationing in the south of Ireland, as far as the judgement of therapeutic benefit from biologicals was concerned, the clinical judgement policies of practitioners were very similar to those in the north. The adoption of NICE/BSR guidelines in the north may have improved the uniformity of clinical practice in Northern Ireland.