Perspectives Regarding Adherence to Preventive Behaviors : A Qualitative Study of Thais with Prehypertension

Main Article Content

Siriwan Chukumnird
Umaporn Boonyasopun
Piyanuch Jittanoon


             Poor adherence to preventive behaviors can lead to recurrence of diseases. Despite current interventions to assist patients’ adherence to preventive routines, there has been minimal improvement in their behaviors. However, in Thailand few research studies have been done to describe adherence to preventive behaviors and this study in particular sought to explore the characteristic adherence regarding preventive behaviors of Thais with prehypertension.

                   A descriptive, qualitative method using in-depth interviews with nine participants who self-identified as being successful in adherence to preventive behaviors was used. Participants were recruited from three selected primary health care units located in three provinces in southern Thailand. Data were analyzed using content analysis.

                  Three main themes of adherence to preventive behaviors were identified as being 1) commitment to active participation, with 3 sub-themes (intentional action, expected success, and self-discipline), 2) persistence in practicing preventive behaviors, with 2 sub-themes (repeated action and regular pattern), and 3) maintenance of desired preventive behaviors, with 2 sub-themes (long-term behavior changes and sensations of well-being). The results supported that adherence to preventive behaviors is a multidimensional behavior involving exercise, dietary control, and stress management. This finding may influence how nurses and other health care providers design intervention programs that are congruent with social and cultural contexts for enhancing adherence to preventive behaviors. 

Article Details

How to Cite
Chukumnird S, Boonyasopun U, Jittanoon P. Perspectives Regarding Adherence to Preventive Behaviors : A Qualitative Study of Thais with Prehypertension. PRIJNR [Internet]. 2016 Apr. 27 [cited 2022 May 25];20(2):106-18. Available from:
Original paper


1. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008 371:1513-8.

2. Habib GB, Virani SS, Jneid H. Is 2015 the primetime year for prehypertension? prehypertension: A cardiovascular risk factor or simply a risk marker? J. Am. Heart Assoc. 2015 4(2): e001792.

3. Huang Y, Cai X, Li Y, Su L, Mai W, Wang S, et al. Prehypertension and the risk of stroke: a meta-analysis. Neurology. 2014 82(13):1153-61.

4. Aekplakorn W, Sangthong R, Kessomboon P, Putwatana P, Inthawong R, Taneepanichskul S, et al. Changes in prevalence, awareness, treatment and control of hypertension in Thai population, 2004–2009: Thai National Health Examination Survey III–IV. J Hypertens. 2012 30:1734-42.

5. Trief PM, Ploutz-Snyder R, Britton KD, Weinstock RS. The relationship between marital quality and adherence to the diabetes care regimen. Ann Behav Med. 2004 27(3):148-54.

6. Dunton GF, Cousineau M, Reynolds KD. The intersection of public policy and health behavior theory in the physical activity arena. J phys Act Health. 2010 7(Suppl 1):S91-8.

7. Serour M, Alqhenaei H, Al-Saqabi S, Mustafa AR, Ben-Nakhi A. Cultural factors and patients’ adherence to lifestyle measures. Br J Gen Pract. 2007 57(537):291-5.

8. Scotto CJ. The lived experience of adherence for patients with heart failure. J Cardiopulm Rehabil Prev. 2005 25(3):158-63.

9. Brundisini F, Vanstone M, Hulan D, DeJean D, Giacomini M. Type 2 diabetes patients’ and providers’ differing perspectives on medication nonadherence: a qualitative meta-synthesis. BMC Health Serv Res. 2015 15:516.

10. Naemiratch B, Manderson L. Control and adherence: living with diabetes in Bangkok, Thailand. Soc Sci Med. 2006 63(5):1147-57.

11. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001 26(5):331-42.

12. Sarradon-Eck A. The meaning of adherence. Ethnography of medication practices in hypertensive patients. Sciences Sociales et Santé. 2007 25(2):5-36 [in French].

13. Panpakdee O, Sritanyarat W, Tanomsup S. Self-care process in thai people with Hypertension: An Emerging Model. Thai Nurs Res. 2003 7 (2):121-36.

14. Ingadottir B, Halldorsdottir S. To discipline a “dog”: the essential structure of mastering diabetes. Qual Health Res. 2008 18(5):606-19.

15. Mihalko SL, Brenes GA, Farmer DF, Katula JA, Balkrishnan R, Bowen DJ. Challenges and innovations in enhancing adherence. Contro Clin Trials. 2004 25:447-57.

16. Bissonnette JM. Adherence: a concept analysis. J Adv Nur. 2008 63(6):634-43.

17. Cohen SM. Concept analysis of adherence in the context of cardiovascular risk reduction. Nurs Forum. 2009 44(1):25-36.

18. Landier W. Adherence to oral chemotherapy in childhood acute yymphoblastic leukemia: An evolutionary concept analysis. Oncol Nurs Forum. 2011 38:343-52.

19. Shay LE. A concept analysis: adherence and weight loss. Nurs Forum. 2008 43:42-52.

20. Johnson MJ. The Medication Adherence Model: a guide for assessing medication taking. Res Theory Nurs Pract. 2002 16(3):179-92.

21. Hellman EA. Use of the stages of change in exercise adherence model among older adults with a cardiac diagnosis. J Cardiopulm Rehabil Prev. 1997 17(3):145-55.

22. Pinprapapan E, Panuthai S, Vannarit T, Srisuphan W. Casual Model of Adherence to Therapeutic Regimens among Thais with Hypertension. Thai Nurs Res. 2013 17(3) 268-281.

23. World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.

24. Springer J. Health behavior change as it relates to the adoption of and adherence to a program of physical activity [Ph.D.]. Ann Arbor: The University of Wisconsin - Milwaukee; 2004.

25. Lehane E, McCarthy G. Medication non-adherence—exploring the conceptual mire. Int J Nurs Pract. 2009 15:25-31.

26. Sandman L, Granger BB, Ekman I, Munthe C. Adherence, shared decision-making and patient autonomy. Med Healthc Philos. 2012 15(2):115-27.

27. Morse JM. Designing funded qualitative research. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research Thousand Oaks: California:Sage Publications; 1994.

28. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today.2004 24(2): 105-112.

29. Horne R. Compliance, adherence, and concordance*: Implications for asthma treatment. Chest. 2006 130(1_ suppl):65S-72S.

30. Ahmed R, Aslani P. What is patient adherence? A terminology overview. Int j clin Pharm. 2014 36(1):4-7.

31. Amrhein PC, Miller WR, Yahne CE, Palmer M, Fulcher L. Client commitment language during motivational interviewing predicts drug use outcomes. J Consult Clin Psychol. 2003 71(5):862-78.

32. Komin S. Psychology of the Thai people : Values and behavioral patterns. National Institute of Development Administration: Bangkok, Thailand; 1991.

33. McArthur D, Dumas A, Woodend K, Beach S, Stacey D. Factors influencing adherence to regular exercise in middle-aged women: a qualitative study to inform clinical practice. BMC women’s health. 2014 14:49.

34. Kirdphon W. Accepting and adjusting to chronicity of hypertension: A grounded theory study in Thai people [Ph.D.]. Ann Arbor: University of Washington; 2003.

35. Naewbood S, Sorajjakool S, Triamchaisri SK. The role of religion in relation to blood pressure control among a Southern California Thai population with hypertension. J Relig Health. 2012 51(1):187-97.

36. Phutthikhamin T. Spirituality of Thai Buddhists with chronic cardiovascular disease [Ph.D.]. Ann Arbor: The University of Texas School of Nursing at Houston; 2008.

37. Prochaska JO, Redding CA, Evers KE. The transtheoretical model and the stages of change. 2 nd ed. K. Glanz, Lewis FM, Rimer BK, editors. San Francisco: CA: Jossey-Bass;1997.

38. Rattanakun P. Buddihism, Health, Disease, and Thai Culture. In: Harold C, Rattanakun P, editors. A cross-cultural Dialogue on Health Care Ethics. Canada: Wilfrid Laurie University; 1999.