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Hypertension is a major risk factor for cardiovascular disease leading to global mortality among women. Poor adherence to hypertensive treatment is one of the most important problems in controlling blood pressure. However, limited research in this area has been undertaken in Thailand. Thus, this descriptive correlational study aimed to investigate predictability of selected factors on adherence to hypertensive treatment among women with hypertension. A sample of 326 women with hypertension were recruited from hypertension clinics in six public health centers in Bangkok Metropolitan using multi-stage sampling. A set of self-administered questionnaires was used to collect data: background characteristics, Hypertension Knowledge Scale, Thai-version of the Center for Epidemiologic Studies Depression Scale, Patient-Provider Communication Scale, Hypertension Social Support Scale, and Adher- ence to Hypertensive Treatment Scale. Data were analyzed using descriptive statistics and hierarchical regression analysis.
Results revealed that hypertension knowledge, patient-provider communication, and hypertension social support were significant predictors and could explain 18.3% of the variance in adherence to hypertensive treatment. Such adherence is a collective outcome which may be predicted by multiple factors, such as self-efficacy, perceived benefit, and perceived barriers, so these factors should be included in future study among women with more heterogeneous background characteristics. Our findings suggest that the nurses should develop strategies by using digital health strategies providing healthcare support via mobile technologies such as smartphones. This could provide more convenient patient-provider communication, hypertension knowledge and social support to enhance adherence to hypertensive treatment.
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World Health Organization. Global Health Observatory (GHO) data: raised blood pressure. Geneva, Switzerland, 2016. [cited 2016 May 31]. Available from https://www.who.int/gho/ncd/risk_ factors/blood_pressure_prevalence_text/en/
Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and
systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA. 2017;317(2):165-82. doi:10.
Wenger NK, Arnold A, Bairey Merz CN, Cooper-DeHoff RM, Ferdinand KC, Fleg JL, et al. Hypertension across a woman’s life cycle. J Am Coll Cardiol. 2018;71(16): 1797-813. doi: 10.1016/j.jacc.2018.02.033
Rödström K, Weman L, Sandin L, Hange D, Björkelund C. Is it possible to investigate menopausal age? A comparative cross-sectional study of five cohorts between 1968 and 2017 from the population study of women in Gothenburg, Sweden. Menopause (New York, NY). 2020;27(4):430-6. doi: 10.1097/GME.0000000000001476
Laohasiriwong W, Puttanapong N, Singsalasang A. Prevalence of hypertension in Thailand: Hotspot clustering detected by spatial analysis. Geospat Health [Internet]. 2018May7 [cited 2018Jul.29];13(1). Available from: https://www.geospatialhealth.net/index.php/gh/article/view/608. doi:10.4081/gh.2018.608
Writing Group M, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, et al. Heart disease and stroke
statistics-2016 update: A report from the American Heart Association. Circulation. 2016;133(4):e38-e360.
Garcia M, Mulvagh SL, Merz CNB, Buring JE, Manson JE. Cardiovascular disease in women: clinical perspectives. Circ Res. 2016;118(8):1273-93. doi:10.1161/CIRCRESAHA. 116.307547
Oparil S. SY 11-3 Hypertension in women: more dangerous than in men? J Hypertens. 2016;34:e366. doi: 10.1097/01.hjh.0000500943.95477.bd
Muiesan ML, Salvetti M, Rosei CA, Paini A. Gender differences in antihypertensive treatment: myths or legends? High Blood Press Cardiovasc Prev. 2016;23:105-13. doi 10.1007/s40292-016-0148-1
Mahmoodi H, Jalalizad Nahand F, Shaghaghi A, Shooshtari S, Jafarabadi MA, Allahverdipour H. Gender based cognitive determinants of medication adherence in older adults with chronic conditions. Patient Preference and Adherence. 2019;13:1733–44. doi: 10.2147/PPA.S219193
Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine. 2017;96(4):e5641-e. doi: 10.1097/MD.0000000000005641
Baker-Goering MM, Roy K, Howard DH. Relationship between adherence to antihypertensive medication regimen and out-of-pocket costs among people aged 35 to 64 with employer-sponsored health insurance. Prev Chronic Dis. 2019;16:E32. doi: 10.5888/pcd16.180381
Wang X, Robinson KM, Hardin HK. The impact of caregiving on caregivers’ medication adherence and appointment keeping. West J Nurs Res. 2015;37(12):1548-62. doi: 10.1177/0193945914533158
Abegaz T.M., Shehab A., Gebreyohannes E.A., Bhagavathula A.S., Elnour A. A. nonadherence to antihypertensive drugs a systematic review and meta-analysis. Medicine. 2017;96:e5641. doi: 10.1097/MD.0000000000005641. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
World Health Organization. Country Office for Thailand. Hypertension care in Thailand: best practices and challenges, 2019. [cited 2020 March 30]. Available from https://apps.who.int/iris/handle/10665/330488
Rivera SL, Martin J, Landry J. Acute and Chronic Hypertension: What clinicians need to know for diagnosis and management. Crit Care Nurs Clin North Am. 2019;31(1):97-108. doi: 10.1016/j.cnc.2018.11.008.
Woodham N, Taneepanichskul S, Somrongthong R, Auamkul N. Medication adherence and associated factors among elderly hypertension patients with uncontrolled blood pressure in rural area, Northeast Thailand. Journal of Health Research. 2018;32:449-58. doi 10.1108/JHR-11-2018-085
Taengsakha K, Maneesriwongul W, Putawatana P. Factors related to adherence to treatment in essential hypertensive patients with early renal insufficiency. Rama Nurs J [Internet]. 2019. [cited 2019 November11];25(1):87-101. Available from: https://med. mahidol.ac.th/ nursing/jns/DocumentLink/D_110813.pdf
Chiang L-C, Heitkemper MM, Chiang S-L, Tzeng W-C, Lee M-S, Hung Y-J, et al. Motivational counseling to
reduce sedentary behaviors and depressive symptoms and improve health-related quality of life among women with metabolic syndrome. J Cardiovasc Nurs. 2019;34(4):327-35. doi: 10.1097/JCN.0000000000000573
Green L, Kreuter M. Health Program Planning: An educational and ecological approach. 4th edition. New York: McGrawHill; 2005.
Jankowska-Polańska B, Uchmanowicz I, Dudek K, Mazur G. Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient preference and adherence. 2016;10:2437-47. doi:10.2147/PPA.S117269
Shi S, Shen Z, Duan Y, Ding S, Zhong Z. Association between medication literacy and medication adherence among patients with hypertension. Front. Pharmacol. 2019;10(822). doi:10.3389/fphar.2019.00822
Pan J, Wu L, Wang H, Lei T, Hu B, Xue X, et al. Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine (Baltimore). 2019;98(27):e16116. doi: 10.3389/fphar. 2019.00822
Uchmanowicz B, Chudiak A, Mazur G. The influence of quality of life on the level of adherence to therapeutic recommendations among elderly hypertensive patients. Patient preference and adherence. 2018;12:2593-2603. doi: 10.2147/PPA.S182172
Saadat Z, Nikdoust F, Aerab-Sheibani H, Bahremand M, Shobeiri E, Saadat H, et al. Adherence to antihypertensives in patients with comorbid condition. Nephrourol Mon. 2015 Jul; 7(4): e29863. doi: 10.5812/numonthly.29863
Zhang Y, Li X, Mao L, Zhang M, Li K, Zheng Y, Cui W, Yin H, He Y, Jing M. Factors affecting medication adherence in community-managed patients with hypertension based on the principal component analysis: evidence from Xinjiang, China. Patient preference and adherence. 2018;12:803-12. doi: 10.2147/PPA.S158662z
Berntson J, Stewart KR, Vrany E, Khambaty T, Stewart JC. Depressive symptoms and self-reported adherence to medical recommendations to prevent cardiovascular disease: NHANES 2005–2010. Soc Sci Med. 2015;138:74-81. https://doi.org/10.1016/j.socscimed.2015.05.041
Goldstein CM, Gathright EC, Garcia S. Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team. Patient Preference and Adherence. 2017;11:547-59. doi: 10.2147/PPA.S127277
Schoenthaler A, Knafl GJ, Fiscella K, Ogedegbe G. Addressing the social needs of hypertensive patients: The role of patientprovider communication as a predictor of medication adherence. Circ Cardiovasc Qual Outcomes. 2017;10(9):e003659. doi:10.1161/CIRCOUTCOMES.117.003659
Namwong A, Panuthai S, Suwanprapisa T, Khampolsiri T. A Casual Model of Adherence to Therapeutic Thai Older Adults with Hypertension. PRIJNR [Internet]. 2015May20 [cited 2020Jul.16];19(2):107-21. Available from:
Ofoli JN, Dankyau M, Ja S, Db L. Relationship between family and social support and adherence to treatment among outpatient hypertensives in an urban hospital. NJFP [Internet]. 2017March08[cited 2018 June.20]; 8(1):45-52. Available from: https://www.researchgate.net/publication/314385420
Pinprapapan E, Panuthai S, Vannarit T, Srisuphan W. Casual model of adherence to therapeutic regimens among Thais with hypertension. PRIJNR [Internet]. 2013Aug.28 [cited2020Jul.29];17(3):268-81. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/8781
Limchareon S, Masingboon K, Kunsonkeit W. Factors related to adherence to treatment among essential hypertensive patients. The J of Faculty of Nursing Burapha Uni. 2007. [cited 2019 November 10];15(1):63-79. Available from: https://digitalcollect.lib. buu. ac.th/ journal/Nursing/15_1/p63-79.pdf (in Thai)
Kuptniratsaikul V, Pekuman P. The study of the Center for Epidemiologic Studies-Depression Scale (CES-D) in Thai people. Siriraj Hosp Gaz. 1997;49.
Stewart AL, Nápoles-Springer AM, Gregorich SE, SantoyoOlsson J. Interpersonal processes of care survey: patientreported measures for diverse groups. Health Serv Res. 2007;42(3 Pt 1):1235-56. doi: 10.1111/j.1475-6773. 2006.00637.x
Maneesriwongul W, Dixon JK. Instrument translation process: a methods review. J Adv Nurs. 2004;48(2):175-86.
Akoko BM, Fon PN, Ngu RC, Ngu KB. Knowledge of hypertension and compliance with therapy among hypertensive patients in the Bamenda Health District of Cameroon: A Cross-sectional Study. Cardiol Ther. 2017;6(1):53-67. doi. 10.1007/s40119-016-0079-x