Factors Influencing Medication Adherence in Nepalese Patients with Essential Hypertension

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Prabha Shrestha
Doungrut Wattanakitkrileart
Kanaungnit Pongthavornkamol


         Purpose: To identify the level of medication adherence and to examine the predicting factors of medication adherence in Nepalese patients with essential hypertension.

         Design: Correlational predictive study.

         Methods: A cross-sectional study was conducted amongst 140 participants attending the tertiary level university hospital in Kavre, district of Nepal between December 2017 and January 2018. Research instruments included Hill Bone Medication Adherence Scale, Modified Medical Outcome Study Social Support Survey, Patient Doctor Relationship Questionnaire, and Hypertension Knowledge Level Scale. Descriptive statistics, and binary logistic regression analysis were applied for data analysis.

         Main findings: Mean age of the participants was 53.82 (SD = 12.12), in which 55% were male. Medication adherence rate in Napalese patients with essential hypertension was 62.1%. Logistic regression model explained 39% of the variance on medication adherence. The significant predictors of medication adherence were; Patient-doctor relationship (OR = 1.10, 95% CI[1.01-1.20]) and knowledge about hypertension (OR = 1.29, 95% CI: 1.14-1.45). Participants who had better relationships with their doctor were 1.10 times more likely to adhere with their medication regimen. Similarly, the participants with more knowledge about hypertension were 1.29 times more likely to have the better adherence medication regimen.

         Conclusion and recommendations: Medication adherence rate among Nepalese hypertensive patients were low which is significantly predicted by patient-doctor relationship and the patients' knowledge about hypertension. Health care facilities and nursing authorities of Nepal need to promote knowledge about hypertension and encourage positive relationship between patients and providers to improve medication adherence. 


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Shrestha, P., Wattanakitkrileart, D., & Pongthavornkamol, K. (2019). Factors Influencing Medication Adherence in Nepalese Patients with Essential Hypertension. Nursing Science Journal of Thailand, 37(3), 18–31. Retrieved from https://he02.tci-thaijo.org/index.php/ns/article/view/203358
Research Papers


1. Kirkland EB, Heincelman M, Bishu KG, Schumann SO, Schreiner A, Axon RN, et al. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003–2014. J Am Heart Assoc. 2018;7(11). pii: e008731. doi: 10.1161/JAHA.118.008731.

2. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization; 2003. 194 p.

3. Lee HJ, Jang SI, Park EC. Effect of adherence to antihypertensive medication on stroke incidence in patients with hypertension: a population-based retrospective cohort study. BMJ Open. 2017;7(6):e014486. doi: 10.1136/bmjopen-2016-014486.

4. Dhungana RR, Pandey AR, Bista B, Joshi S, Devkota S. Prevalence and associated factors of hypertension :a community-based cross-sectional study in municipalities of Kathmandu, Nepal. Int J Hypertens. 2016;2016:1656938. doi: 10.1155/2016/1656938.

5. Vaidya A, Pathak RP, Pandey MR. Prevalence of hypertension in Nepalese community triples in 25 years: a repeat cross sectional study in rural Kathmandu. Indian Heart J. 2012;64(2):128-31.

6. Bhandari B, Bhattarai M, Bhandari M, Ghimire A, Pokharel PK, Morisky DE. Adherence to antihypertensive medications: population based follow up in Eastern Nepal. J Nepal Health Res Counc. 2015;13(29):38-42.

7. Khan GM, Thapa RK, Khakurel A, Shrestha G, Katila N, Bhurtel S. medication adherence and blood pressure control among hypertensive patients of Pokhara Valley. Journal of Health and Allied Sciences. 2013;3(1):64-7.

8. Wang PS, Bohn RL, Knight E, Glynn RJ, Mogun H, Avorn J. Noncompliance with antihypertensive medications: the impact of depressive symptoms and psychosocial factors. J Gen Intern Med. 2002;17(7):504-11.

9. Tong X, Chu EK, Fang J, Wall HK, Ayala C. Nonadherence to antihypertensive medication among hypertensive adults in the United States – HealthStyles, 2010. J Clin Hypertens (Greenwich). 2016;18(9):892-900.

10. Rao CR, Kamath VG, Shetty A, Kamath A. Treatment compliance among patients with hypertension and type 2 diabetes mellitus in a coastal population of Southern India. Int J Prev Med. 2014;5(8):992-8.

11. Van der Laan DM, Elders PJM, Boons CCLM, Beckeringh JJ, Nijpels G, Hugtenburg JG. Factors associated with antihypertensive medication non-adherence: a systematic review. J Hum Hypertens. 2017;31(11):687-94.

12. Mahmoudian A, Zamani A, Tavakoli N, Farajzadegan Z, Fathollahi-Dehkordi F. Medication adherence in patients with hypertension: does satisfaction with doctor-patient relationship work? J Res Med Sci. 2017;22:48. doi: 10.4103/jrms.JRMS_205_16.

13. Malik A, Yoshida Y, Erkin T, Salim D, Hamajima N. Hypertension-related knowledge, practice and drug adherence among inpatients of a hospital in Samarkand, Uzbekistan. Nagoya J Med Sci. 2014;76(3-4):255-63.

14. Jankowska-Polańska B, Uchmanowicz I, Dudek K, Mazur G. Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient Prefer Adherence. 2016;10:2437-47.

15. Dhital SM, Karki A. Dealing with the burden of hypertension in Nepal: current status, challenges and health system issues. Regional Health Forum. 2013;17(1):44-52.

16. Brodaty H, Pond D, Kemp NM, Luscombe G, Harding L, Berman K, et al. The GPCOG: a new screening test for dementia designed for general practice. J Am Geriatr Soc. 2002;50(3):530-4.

17. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60.

18. Song Y, Han HR, Song HJ, Nam S, Nguyen T, Kim MT. Psychometric evaluation of hill-bone medication adherence subscale. Asian Nurs Res. 2011;5(3):183-8.

19. Bosworth HB. Enhancing medication adherence: the public health dilemma. London, UK: Springer Healthcare; 2012. 60 p.

20. Manandhar S, Shrestha DS, Taechaboonsermsk P, Siri S, Suparp J. Quality of life among breast cancer
patients undergoing treatment in national cancer centers in Nepal. Asian Pac J Cancer Prev. 2014;15(22):9753-7.21.
21. Moser A, Stuck AE, Silliman RA, Ganz PA, Clough-Gorr KM. The eight-item modified medical outcomes study social support survey: psychometric evaluation showed excellent performance. J Clin Epidemiol. 2012;65(10):1107-16.

22. Van der Feltz-Cornelis CM, Van Oppen P, Van Marwijk HW, De Beurs E, Van Dyck R. A patient-doctor relationship questionnaire (PDRQ-9) in primary care: development and psychometric evaluation. Gen Hosp Psychiatry. 2004;26(2):115-20.

23. Erkoc SB, Isikli B, Metintas S, Kalyoncu C. Hypertension Knowledge-Level Scale (HK-LS): a study on development, validity and reliability. Int J Environ Res Public Health. 2012;9(3):1018-29.

24. Pirasath S, Kumanan T, Guruparan M. A study on knowledge, awareness, and medication adherence in patients with hypertension from a tertiary care centre from Northern Sri Lanka. Int J Hypertens. 2017;2017:9656450. doi: 10.1155/2017/9656450.

25. American Psychological Association. Memory changes in older adults. "Senior moments" less inevitable than once thought [Internet]. Washington, DC: American Psychological Association; 2006 [cited 2017 Dec 15]. Available from: https://www.apa.org/research/action/memory-changes.aspx.

26. Abel WM, Efird JT. The association between trust in health care providers and medication adherence among black women with hypertension. Front Public Health. 2013;1:66. doi: 10.3389/fpubh.2013.00066.

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