Biopsychosocial determinants of medication adherence among hypertensive patients in Ghana
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Date
2015-04-24
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Abstract
Background
Medication non-adherence is a major public health problem globally. Often, non-adherence
to medication has been a predominant setback in the management of hypertension and
other chronic conditions leading to negative health outcomes.
Objectives
The purpose of this study was to explain adherence behaviour among hypertensive patients
from a Biopsychosocial perspective.
Methods
A hospital-based mixed methods study using quantitative and qualitative approaches was
conducted on hypertensive patients attending Korle-bu and Komfo Anokye Teaching
Hospitals in Ghana from May to November, 2012. The rationale for including the
qualitative phase was to triangulate the quantitative phase of the study. Information was
quantitatively obtained from 400 participants on socio-demographic characteristics,
personality characteristics, negative emotions, belief systems, complementary and
alternative medicine (CAM) use, economic, pharmacological factors and medication
adherence behaviour. The qualitative phase of the study involving 45 participants explored
adherence in relation to perceptions about belief systems, complementary and alternative
therapies and pharmacologically related issues.
Results
Most patients (93%) poorly adhered to their antihypertensive medications. Participants
exhibited features of mixed LoC (both internal and external) usually referred to as bi-local
iv
expectancy. However, orientation was skewed towards external LoC which significantly
related with non-adherence behaviour (p = 0.03). High spiritual and religious beliefs
formed core components of the lifestyles of patients, yet, spirituality (p = 0.018) and not
religiosity (p = 0.474) related directly with medication non-adherence. Although some of
the patients experienced symptoms of anxiety (57%), followed by stress (20%) and
depression (4%), stress was rather significantly associated with medication non-adherence
(p = 0.035). Out of the 400 study participants, 78 (19.5%) reported using CAM with the
majority (65.38%) utilizing biological based therapies. There was no significant
relationship between CAM use and non-adherence (p = 0.176). Medication side effects (p =
0.04) and the number of times per day for taking medicines significantly correlated with
non-adherence (p< 0.0001).
The thematic content analysis of patients‟ belief system pertaining to hypertension and
medication intake focused on the following themes: conceptualizing illness, supernatural
healing, medication non-adherence and holistic healthcare. Likewise, CAM use elicited
the following themes: combination of remedies, categorization, availability, motivation for
use, perceived effect, non-disclosure, medication non-adherence and health provider
involvement. Analysis of pharmacological factors revealed three main themes about
medication use namely: effect and continuance, hindrances to adherence and coping.
Conclusion
This study has demonstrated that there is a significant interplay of psychological, socio-cultural and pharmacological factors associated with medication non-adherence. Multi-faceted intervention programmes highlighting these determinants should be initiated to
improve medication adherence among hypertensive patients in Ghana.
Description
A thesis submitted in fulfillment
of the
requirements for the degree of
Doctor of Philosophy
(Social Pharmacy),