J Gen Intern Med. 2013 Jan;28(1):99-106. doi: 10.1007/s11606-012-2195-1. Epub 2012 Aug 28.
Factors associated with non-adherence to three hypertension self-management behaviors: preliminary data for a new instrument.
SourceCenter for Health Services Research in Primary Care, Durham VA Medical Center, HSR&D (152), 508 Fulton Street, Durham, NC 27705, USA. firstname.lastname@example.org
BACKGROUND:Clinicians have difficulty in identifying patients that are unlikely to adhere to hypertension self-management. Identifying non-adherence is essential to addressing suboptimal blood pressure control and high costs.
OBJECTIVES:1) To identify risk factors associated with non-adherence to three key self-management behaviors in patients with hypertension: proper medication use, diet, and exercise; 2) To evaluate the extent to which an instrument designed to identify the number of risk factors present for non-adherence to each of the three hypertension self-management behaviors would be associated with self-management non-adherence and blood pressure.
DESIGN:Cross-sectional analysis of randomized trial data.
PATIENTS:Six hundred and thirty-six primary care patients with hypertension.
MEASUREMENTS:1) Demographic, socioeconomic, psychosocial, and health belief-related factors; 2) measures of self-reported adherence to recommended medication use, diet recommendations, and exercise recommendations, all collected at baseline assessment; 3) systolic blood pressure (SBP) and diastolic blood pressure (DBP).
RESULTS:We identified patient factors associated with measures of non-adherence to medications, diet, and exercise in hypertension. We then combined risk factors associated with ≥1 adherence measure into an instrument that generated three composite variables (medication, diet, and exercise composites), reflecting the number of risk factors present for non-adherence to the corresponding self-management behavior. These composite variables identified subgroups with higher likelihood of medication non-adherence, difficulty following diet recommendations, and difficulty following exercise recommendations. Composite variable levels representing the highest number of self-management non-adherence risk factors were associated with higher SBP and DBP.
CONCLUSIONS:We identified factors associated with measures of non-adherence to recommended medication use, diet, and exercise in hypertension. We then developed an instrument that was associated with non-adherence to these self-management behaviors, as well as with blood pressure. With further study, this instrument has potential to improve identification of non-adherent patients with hypertension.
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