Intentional and Unintentional Medication Non-Adherence in Hypertension: The Role of Health Literacy, Empowerment and Medication Beliefs

Abstract

BackgroundMedication non-adherence is a major public health issue, creating obstacles to effective treatment of hypertension. Examining the underlying factors of deliberate and non-deliberate non-adherence is crucial to address this problem. Thus, the goal of the present study is to assess the socio-demographic, clinical and psychological determinants of intentional and unintentional non-adherence.Design and methodsA cross-sectional survey was conducted between March, 2015 and April, 2016. The sample consisted of hypertension patients holding at least one medical prescription (N=109). Measurements assessed patients’ medication adherence, health literacy, empowerment, self-efficacy, medication beliefs, and patients’ acceptance of their doctor’s advice, socio-demographic and clinical characteristics.ResultsPatients who occasionally engaged in either intentional or unintentional non-adherence reported to have lower adherence selfefficacy, higher medication concern beliefs, lower meaningfulness scores and were less likely to accept the doctor’s treatment recommendations. Patients who occasionally engaged in unintentional nonadherence were younger and had experienced more side effects compared to completely adherent patients. Adherence self-efficacy was a mediator of the effect of health literacy on patients’ medication adherence and acceptance of the doctor’s advice was a covariate.ConclusionsRegarding the research implications, health literacy and adherence self-efficacy should be assessed simultaneously when investigating the factors of non-adherence. Regarding the practical implications, adherence could be increased if physicians i) doublecheck whether their patients accept the treatment advice given and ii) if they address patients’ concerns about medications. These steps could be especially important for patients characterized with lower self-efficacy, as they are more likely to engage in occasional nonadherence.Significance for public healthMedication non-adherence is a critical public health issue, leading to increased health care costs, morbidity and mortality across several chronic conditions. Medication non-adherence is also one of the main obstacles to effective hypertension care, as between 20-50% of the patients do not follow appropriately their prescribed medication regimen. Despite the large body of empirical evidence available, relatively little is known about the potential differences between the determinants underpinning intentional versus unintentional nonadherence. Shedding light on the factors of medication non-adherence is inevitable to develop interventions and health campaigns addressing the issue. Thus, the present study quantitatively examines the patient-related factors of medication non-adherence to antihypertensive drugs, distinguishing between the determinants of deliberate versus non-deliberate non-adherence. Moreover, based on the outcomes, we advocate potential new approaches to address medication non-adherence in hypertension.

Self-Care Management Among Elderly Patients With Hypertension and Poor Adherence to Treatment, Living in Rural Thailand: A Qualitative Study

“…Forgetfulness, lack of effectiveness, adverse side effects and patient's general dissatisfaction with the medicine have also shown to be contributors to adherence levels. These studies also align with our proposition that there are several barriers for good adherence among elderly that need to be addressed (9)(10)(11). In addition, improved methods to provide accurate education to patients and the community on the nature of hypertension and its treatment, may be helpful to improving adherence among this group of patients.…”

<p>Gender Differences in the Associations Between Health Literacy and Medication Adherence in Hypertension: A Population-Based Survey in Heris County, Iran</p>

“…However, this kind of dedicated uptake is rarely seen, 27 for most part, due to patients' own faults. 28 For instance, those affected "do not have the time to take prescribed AHMs", or, have "a lot of important tasks to do", or, AHMs prohibit their "life's pleasures" and interfere in "personal liberty". 29 In our population as well, only 7.0% subjects had maintained high adherence, despite being affected and despite having good fSES (ie, 94.0% subjects) and medical insurance cover (ie, 98.3% subjects) that reimburses their costs.…”

Role of Medication Beliefs on Medication Adherence in Hypertensive Middle Eastern Refugees and Migrants in Australia

“…The effective control of hypertension requires patients to adopt and maintain a healthy lifestyle and take medication regularly (Shahin, Kennedy, Cockshaw, & Stupans, 2020). However, medication non-adherence constitutes a significant obstacle to hypertension care worldwide with a prevalence between 20% and 50% (Nafradi, Galimberti, Nakamoto, & Schulz, 2016). In Australia, the mean non-adherence to antihypertensive therapy is about 15% (Carvalho & Santos, 2019).…”