TITLE:
Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya
AUTHORS:
Charity Ngugi Gikunda, Lucy Gitonga
KEYWORDS:
Hypertension, Nonadherence, Medication, Inhibiting Factors, High Blood Pressure, Patients’ Characteristics
JOURNAL NAME:
Open Journal of Clinical Diagnostics,
Vol.9 No.3,
September
27,
2019
ABSTRACT: Antihypertensive
medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood
pressure control. Hypertensive medication non-adherence continues to become a contributing
factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence
to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but
are difficult to extrapolate. This can partly be because the determinants of
non-adherence to hypertensive may have a locality effect due to many factors
such as culture and health system in
a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence
at a local scale. Descriptive study design was adopted to guide the
implementation of the study. The population comprised of 575 people among
doctors, pharmacists, nurses, record officers and hypertension patients. The
respondents were identified through simple random sampling and a sample size of
81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed
through census method. Data was collected between the month of April and May
2019. Questionnaires were used as data collection tools for the patients while the interview schedule
was conducted to health care providers through an interview guide. Descriptive
and inferential statistics were used for data analysis, aided by SPSS. The
study revealed a significant negative correlation (rpb = −0.227, p 0.05) between age and
non-adherent, insignificant
relationship with marital status (rpb = −0.129), insignificant (rpb = −0.064) correlation with
patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients
stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the
patient, their education level, preference to traditional medicine, and
sociocultural factors together were found to be significant predictors of
non-adherence to hypertension medication, χ2= 17.14, df = 1, N = 81, p 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p 0.05) that were individually, significant predictors
to non-adherence. Non-adherence to hypertension medication is a major problem
at Chuka Level Five Hospital. This was due to lack of funds, time,
forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to
increase motivation in order to address forgetfulness, and supply of constant
and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the
drugs. There is need to reduce out of pocket payment
through establishment and strengthening of the community health insurance
scheme. The study recommends that the hospital should set aside some resources
for making patients’ follow-ups
especially those were treated and left to go home; discussions be made with patients on severity of
non-adherence and importance of adherence; use of positive reinforcement to increase motivation and
mechanism to be put in place to subsidize the cost of medication.