BACKGROUND:
Although many advances in the management of hypertension have been made, success in
hypertension control in real-life practice is limited. Control of hypertension is
paramount in primary as well as secondary prevention of cardiovascular disease. Poor
adherence to antihypertensive medication is one possible reason why success in clinical
trials has not been translated into everyday practice. Despite many years of study,
questions remain about why patients do or do not take medicines and what can be done
to change their behavior. Although trends in adherence patterns across hypertensive
patients is briefly documented in the literature, the role of perceived illness burden
in addition to illness perceptions and medication beliefs in elderly people with hypertension
is unclear.
OBJECTIVES:
To assess the collective influence of illness perceptions, medications beliefs, and
illness burden on medication adherence of a sample of elderly people suffering from
hypertension.
METHODS:
A cross-sectional questionnaire survey research design, utilizing convenience sampling
strategies and a battery of self-administered health surveys, was adapted to address
key study objectives. Previously validated instruments, such as the Brief Illness
Perception Questionnaire, Pictorial Representation of Illness and Self Measure Revised
II, Beliefs about Medicines Questionnaire, and Morisky Medication Adherence Scale,
were utilized to assess illness perceptions, perceived illness burden, medication
beliefs, and medication adherence, respectively. Conceptualized associations among
the study variables were explored and tested to assess their individual, as well as
collective, impact on medication adherence. In addition, combined predictive abilities
of key variables in explaining the variations in medication adherence were determined
using appropriate bivariate and multivariate statistics.
RESULTS:
The majority of the sample was white (76.9%); 52.1% was over aged 65 years of which
47.9% attended some college, while 70.1% accessed adult day care centers. A usable
sample of 117 respondents was retained for statistical analysis. From multiple linear
regression analysis, it was observed that perceptions about illness, perceived illness
burden, and beliefs about medication jointly played a significant role in the prediction
of medication adherence (R-squared = 0.328). Significant bivariate correlations among
study variables further indicated that threatening view of illness translated into
higher levels of self-reported adherence with hypertensive medications (r = 0.332,
P less than 0.001), which in turn was associated with lower perceived illness burden
(r = 0.423, -0.444, P less than 0.001). The respondents reported illness-related
“Stress” (49.1%) as a primary cause of hypertension in their opinion, followed by
“Lifestyle” (43.8%) and “Heredity” (7.1%) factors. Perceived concerns about the benefits
of medication played a more significant role in the prediction of adherence and perceived
illness burden than the risks associated with their use.
CONCLUSIONS:
This study provides insights into how perceptions of illness and burden relate to
medication adherence in hypertension. More benign perceptions of illness and greater
perceived illness burden translate to lower medication adherence. Positive beliefs
regarding medications are also crucial for shaping adherence behavior of elderly hypertensive
individuals. Threatening views of illness and stronger beliefs of the necessity of
medications contribute substantially to positive medication adherence. Interventions
and programs aimed at building adherence in elderly hypertension patients need to
recognize the value and importance of patient perceptions of illness and medications
in shaping adherence behavior.