Impact of multimodal interventions on medication nonadherence among elderly hypertensives: a randomized controlled study
Received 21 November 2018
Accepted for publication 12 March 2019
Published 18 April 2019 Volume 2019:13 Pages 549—559
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Melita Sheilini,1 H Manjunatha Hande,2 Mukhyaprana M Prabhu,2 Mamatha Shivananda Pai,3 Anice George4
1Department of Medical Surgical Nursing, Manipal College of Nursing Manipal, MAHE, Manipal, Udupi District, Karnataka, India; 2Department of Medicine, Kasturba Hospital, MAHE, Manipal, Udupi District, Karnataka, India; 3Department of Child Health Nursing, Manipal College of Nursing Manipal, MAHE, Manipal, Udupi District, Karnataka, India; 4Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal MAHE, Manipal, Udupi District, Karnataka, India
Purpose: The study was conducted to investigate the effects of multimodal interventions on medication nonadherence, quality of life (QoL), hypertension (HTN), self-efficacy, and clinical outcome in terms of blood pressure (BP) among elderly people with HTN.
Methods: An experimental design using a randomized controlled trial was adopted (N=80+80). The experimental group received multimodal interventions and the control group received routine care. Both groups were followed up at baseline and at 3 and 6 months. The data collection tools of demographic and clinical proforma, structured knowledge questionnaire on HTN (r=0.84), Revised Medication Adherence Self-Efficacy Scale (r=0.94), Morisky Medication Adherence Scale (r=0.83), World Health Organization Quality of Life-BREF scale (r=0.87), and digital BP apparatus were used. Necessary administrative permission was obtained for the study.
Results: The study results proved that nurse-led multimodal interventions led to an improvement in medication adherence [F(1.75,214.30)=774.18, p<0.001], knowledge on HTN [F(2,244)=43.83, p<0.001], and self-efficacy [F(1,122)=3.99, p=0.04] of elderly people on antihypertensives over a period of 6 months. Overall QoL did not exhibit any statistically significant improvement, and no statistically significant reductions in the systolic BP (SBP) and diastolic BP (DBP) scores were obtained (p>0.05) in the experimental group over a period of 6 months. However, the clinical significance of multimodal interventions for improvements in medication adherence, QoL, knowledge on HTN, and self-efficacy was more favorable compared with the reduction in SBP and DBP scores.
Conclusion: Nurses play a crucial role in improving medication adherence among elderly people with HTN.
Trial details: Ethical clearance was obtained (IEC no. KH IEC 253/2012) from the Institutional Ethical Committee of Manipal University, Manipal, and the study was conducted in accordance with the Declaration of Helsinki. The study is registered under Clinical Trials Registry of India (CTRI/2017/04/008405). Informed consent was obtained from participants, and the confidentiality of information was assured.
Keywords: hypertension, elderly, medication adherence, knowledge, self-efficacy, quality of life
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