Factors related to intentional and unintentional medication nonadherence in elderly patients with hypertension in rural community
Authors Bae SG, Kam S, Park KS, Kim KY, Hong NS, Kim KS, Lee YM, Lee WK, Choe MSP
Received 7 June 2016
Accepted for publication 29 July 2016
Published 29 September 2016 Volume 2016:10 Pages 1979—1989
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Dr Johnny Chen
Sang Geun Bae,1 Sin Kam,2 Ki Soo Park,3,4 Keon-Yeop Kim,2 Nam-Soo Hong,2 Ki-Su Kim,2 Yu-mi Lee,2 Won Kee Lee,2 Michael Sung Pil Choe5
1Department of Preventive Medicine, Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, 2Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, 3Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang National University School of Medicine, 4Department of Preventive Medicine, Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, 5Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
Purpose: We assessed medication nonadherence, categorized as intentional or unintentional, and related factors in elderly patients with hypertension, correlating the data with measurement of blood pressure as the final target of medication adherence and other possible influencing factors, such as lifestyle.
Patients and methods: Subjects were aged ≥65 years, resided in a rural area, and were taking antihypertensive drugs. The survey was conducted in July 2014. Participants were divided into the following three groups: “Adherence”, “Unintentional nonadherence”, and “Intentional nonadherence”. Individual cognitive components, such as necessity and concern as well as self-efficacy and other related factors, were compared according to adherence groups. The interrelationships between those factors and nonadherence were tested using structural equation modeling analysis.
Results: Of the 401 subjects, 182 (45.6%) were in the adherence group, 107 (26.7%) in the unintentional nonadherence group, and 112 (27.9%) in the intentional nonadherence group. Necessity and self-efficacy were found to have a significant direct influence on unintentional nonadherence behaviors (necessity β=–0.171, P=0.019; self-efficacy β=–0.433, P<0.001); concern was not statistically significant (β=–0.009, P=0.909). Necessity was found to have significant direct and indirect impact on intentional nonadherence (direct β=–0.275, P=0.002; indirect β=–0.113, P=0.036). Self-efficacy had no significant direct effect on intentional nonadherence though it had the only significant indirect effect on intentional nonadherence (direct β=–0.055, P=0.515; indirect β=–0.286, P<0.001). Concern had no significant influence on intentional or on unintentional nonadherence (direct β=0.132 0.132, P=0.151; indirect β=–0.006, P=0.909).
Conclusion: Unintentional nonadherence should be regularly monitored and managed because of its potential prognostic significance. Interventions addressing cognitive factors, such as beliefs about medicine or self-efficacy, are relatively difficult to implement, but are essential to improve medication adherence.
Keywords: medication adherence, hypertension, aged, self-control, self-efficacy
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