Factors Associated with Non-Adherence to Three Hypertension Self-Management Behaviors: Preliminary Data for a New Instrument

Abstract

BACKGROUND: Clinicians have difficulty in identifying patients that are unlikely to adhere to hypertension self-management. Identifying non-adherence is essential to addressing suboptimal blood pressure control and high costs. OBJECTIVES: 1) To identify risk factors associated with non-adherence to three key self-management behaviors in patients with hypertension: proper medication use, diet, and exercise; 2) To evaluate the extent to which an instrument designed to identify the number of risk factors present for non-adherence to each of the three hypertension self-management behaviors would be associated with self-management non-adherence and blood pressure. DESIGN: Cross-sectional analysis of randomized trial data. PATIENTS: Six hundred and thirty-six primary care patients with hypertension. MEASUREMENTS: 1) Demographic, socioeconomic, psychosocial, and health belief-related factors; 2) measures of self-reported adherence to recommended medication use, diet recommendations, and exercise recommendations, all collected at baseline assessment; 3) systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS: We identified patient factors associated with measures of non-adherence to medications, diet, and exercise in hypertension. We then combined risk factors associated with ≥1 adherence measure into an instrument that generated three composite variables (medication, diet, and exercise composites), reflecting the number of risk factors present for non-adherence to the corresponding self-management behavior. These composite variables identified subgroups with higher likelihood of medication non-adherence, difficulty following diet recommendations, and difficulty following exercise recommendations. Composite variable levels representing the highest number of self-management non-adherence risk factors were associated with higher SBP and DBP. CONCLUSIONS:We identified factors associated with measures of non-adherence to recommended medication use, diet, and exercise in hypertension. We then developed an instrument that was associated with nonadherence to these self-management behaviors, as well as with blood pressure. With further study, this instrument has potential to improve identification of nonadherent patients with hypertension.

Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors

“…We also included single-item self-reported measures assessing social support and financial security, the latter of which we dichotomized using a previously reported approach. 15 Additionally, health literacy was assessed via the Rapid Estimate of Adult Literacy in Medicine (REALM) score, which we dichotomized as ≤60 (<9th grade reading level) or ≥61 (≥9th grade reading level). [15][16][17] We also evaluated knowledge of cardiovascular disease risk factors using a validated continuous measure.…”

“…15 Additionally, health literacy was assessed via the Rapid Estimate of Adult Literacy in Medicine (REALM) score, which we dichotomized as ≤60 (<9th grade reading level) or ≥61 (≥9th grade reading level). [15][16][17] We also evaluated knowledge of cardiovascular disease risk factors using a validated continuous measure. 18 Medical comorbidities included diabetes status, history of stroke, smoking status, and body mass index.…”

“…20 We also evaluated single-item self-reported measures assessing stress level and the degree to which the patient identified as nervous or tense, both of which we dichotomized based on a previously reported approach. 15 Finally, health belief-related factors included single-item selfreported continuous measures reflecting worry about having a myocardial infarction and about having a stroke ("How worried are you about having a heart attack/stroke?" with each rated on a scale from 1 [definitely not worried] to 10 [extremely worried]).…”

“…15,17 If patients did not respond to any one of the four items, the non-adherence variable was considered as missing.…”

“…15 There are many possible explanations for the observed link between younger age and medication non-adherence. For example, younger patients tend to experience higher employment and social engagement, and such activities may make them less likely to adhere to recommended medications.…”