The association between social support and medication adherence in patients with hypertension: A systematic review

The Importance of Social Support in the Management of Hypertension in Brazil

BACKGROUND

The prevalence of hypertension (HTN) is high in Brazil, and control rates are low. Little is known about the factors that contribute to HTN control from a family-based perspective.

OBJECTIVES

Guided by the Family Management Style Framework, specific aims were to (1) describe the prevalence of adequate blood pressure (BP) control in individuals cared for the Family Health Strategy, (2) identify facilitators and barriers to HTN management, and (3) identify individual contextual sociocultural influences (sociocultural context and social and Family Health Strategy support), definition of the situation, and management behaviors that help or interfere with individual functioning (BP control in the individual with HTN).

METHODS

This descriptive, cross-sectional study included 213 individuals with HTN randomly selected from 3 Family Health Strategy units from July 2016 until July 2017.

RESULTS

Most of the individuals were female (n = 139, 65.3%), retired (n = 129, 60.5%), and White (n = 129, 60.2%) and had less than a high school education (n = 123, 57.6%). Family income (n = 166, 77.8%) was less than 5500 reals (US $1117/month). Mean (SD) systolic BP was 137.1 (±24.1) mm Hg, and mean (SD) diastolic BP was 83.8 (±18.6) mm Hg, with 47.9% (n = 102) having uncontrolled BP. In the multivariate logistic model, only high levels of perceived social support were significantly associated (odds ratio, 3.29; 95% confidence interval, 1.44-7.5; P = .005) with controlled BP.

CONCLUSIONS

Social support is strongly associated with BP control. Optimizing support may play an important role in BP control and preventing HTN-related complications.

Trajectory and predictors of adherence to Nucleos(t)ide analogues medication among patients with chronic hepatitis B

Objectives

To investigate the developmental trajectory of medication adherence and its predictors in chronic hepatitis B (CHB) patients taking nucleos(t)ide analogues.

Methods

A longitudinal study was conducted. Patients with CHB who met the inclusion criteria were selected using convenience sampling. Follow-ups were conducted at baseline, 3 months, 6 months, 9 months, and 12 months. Medication adherence was assessed using a medication adherence scale. Group-based trajectory modeling (GBTM) was used to explore medication adherence trajectories, and repeated measures ANOVA was used to describe changes in each trajectory. Unordered multinomial logistic regression analysis was used to explore predictive factors.

Results

A total of 305 patients completed all follow-ups. Medication adherence was categorized into four trajectory groups: low adherence (4.9 %), decreasing adherence (24.3 %), increasing adherence (48.2 %), and high adherence (22.6 %). Multinomial logistic regression results showed that HBV-infected discrimination, depression, self-efficacy, and social support were significantly different among different medication adherence levels (p < 0.05).

Conclusions

Medication adherence trajectories in patients with CHB exhibit heterogeneity. Healthcare professionals can develop personalized treatment plans based on patients' social and psychological characteristics to improve medication adherence.

Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications

Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of effects, plausible pathways, and in some cases a causal link between social connection and later health outcomes. Societal trends across several indicators reveal increasing rates of those who lack social connection, and a significant portion of the population reporting loneliness. The scientific study on social isolation and loneliness has substantially extended over the past two decades, particularly since 2020; however, its relevance to health and mortality remains underappreciated by the public. Despite the breadth of evidence, several challenges remain, including the need for a common language to reconcile the diverse relevant terms across scientific disciplines, consistent multi-factorial measurement to assess risk, and effective solutions to prevent and mitigate risk. The urgency for future health is underscored by the potentially longer-term consequences of the COVID-19 pandemic, and the role of digital technologies in societal shifts, that could contribute to further declines in social, mental and physical health. To reverse these trends and meet these challenges, recommendations are offered to more comprehensively address gaps in our understanding, and to foster social connection and address social isolation and loneliness.

Family Self-management Program for Hypertension Management and Sodium Consumption Adherence: A Parallel Randomized Control Trial Among Family Caregivers and People With Hypertension

BACKGROUND

Hypertension (HTN) has become a serious health problem in developing countries. The family has an important role in maintaining blood pressure (BP) at home, and sodium diet compliance in people with HTN needs to be developed. Therefore, this research aimed to evaluate the effectiveness of a family self-management program (FSMP) in HTN management and compliance with sodium consumption in rural areas of Indonesia. Study Design: A parallel-group, single-blind randomized controlled trial.

METHODS

One hundred twenty-six eligible participants were randomly allocated to an intervention (n=63) and a control group (n=63). Participants in the intervention group received a 24-week (6-month) FSMP intervention. The primary outcome measures included the systolic and diastolic BP, the Score Sodium Questionnaire (SSQ), and the Morisky Medication Adherence Scale 8 (MMAS-8). The Knowledge of Health Care for HTN questionnaire and the Efficacy and Behavior Toward Health Care for Patients with HTN questionnaire were used to assess the secondary outcome.

RESULTS

The final results were analyzed from 121 participants (n=61 intervention and n=60 control group). The repeated analysis of variance (ANOVA) test results demonstrated significant effects on the management of HTN and adherence to sodium consumption as indicated by systolic (P=0.004) and diastolic BP (P=0.006), SSQ (P<0.001), MMAS 8 (P<0.001), caregivers' knowledge (P<0.001), caregivers' self-efficacy (P<0.001), and caregivers' behaviors (P=0.005).

CONCLUSION

The FMSP emerges as a promising strategy for managing BP and adherence to sodium consumption in people with HTN through the support of family caregivers and selfmanagement activities.

Exploring the Influence of Perceived Social Support on Medication Adherence Among Patients With Chronic Hypertension in 2024: A Cross-Sectional Study From Jeddah, Kingdom of Saudi Arabia

Background There is no doubt that hypertension is one of the most widespread global health problems, and it is essential to comply with prescribed medications for optimal control. A lack of studies on the effects of perceived social support (PSS) on medication adherence among hypertension patients, especially in Jeddah, Saudi Arabia, made us conduct this study. Methods This was a cross-sectional study that targeted hypertension patients who were visiting primary healthcare centers under the Ministry of Health in Jeddah, Saudi Arabia. The Morisky Green and Levine (MGL) adherence scale and the Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess adherence and perceived social support, respectively. Results The study included 377 hypertensive patients with a mean age of 57 years (SD = 10). The majority were male (n=226, 59.9%) and married (n=261, 69.2%). Educational levels varied, with 148 (39.3%) completing high school and 79 (21%) holding a bachelor's degree or higher. Income distribution showed 166 (44%) earning less than 5,000 SAR and 47 (12.5%) earning over 15,000 SAR. Medication adherence, assessed using the MGL scale, revealed that 121 (32.1%) had low adherence, 206 (54.6%) had moderate adherence, and 50 (13.3%) had high adherence. Perceived social support, measured using the MSPSS scale, indicated that 219 (58.1%) reported high levels of support. A significant association between medication adherence and perceived social support was found (F = 10.293, p < 0.01), with moderate adherers having higher social support scores. Socio-demographic factors influencing adherence included marital status, education level, income, and occupation, with significant associations for each (p < 0.01). Married participants and those with higher education and income levels had greater adherence. Government employees showed the highest moderate adherence while the unemployed and homemakers had lower adherence. No significant associations were found between gender or age and adherence. Conclusion Higher levels of perceived social support, in addition to the influence of socio-demographic factors, are associated with better medication adherence. Targeted interventions addressing these factors could enhance medication adherence and improve health outcomes in this population.

Empowering WHISE women: usability testing of a mobile application to enhance blood pressure control

Background

High blood pressure (hypertension) disproportionately affects African American/Black (Black) women. Previous research suggests that self-managing hypertension may be challenging, yet mobile applications (apps) can help to empower patients and increase medication adherence. We developed questions to test the usability of evaluating the WHISE (Wellness, Hypertension, Information Sharing, Self-Management, Education) mobile app for Black women with hypertension.

Methods

Fifteen participants completed usability testing; five were potential app users (Black women with hypertension); each invited two of their peers to participate. Each testing session (n=5) included a brief overview of the app, time for participants to complete surveys and have an active discussion about the app (concurrent and retrospective think-aloud, concurrent and retrospective probing, per usability.gov), and observation of participants' body language during the session. Testing sessions were designed to familiarize participants with the app's features and examine their navigating ability.

Results

The app received overwhelmingly positive feedback, with 80% of participants finding it to be a valuable tool in hypertension management. Participants praised the app's user-friendliness and educational value, with one stating, 'It is a good educational piece for helping people manage hypertension, at least to understand its basics.' Another participant highlighted the potential for community support, saying, 'Having a community, having some people to be accountable, to check in with and see how things are going, could encourage and motivate people to be more diligent about managing their hypertension.' Some participants also provided constructive feedback, suggesting font size adjustments (73%) and color scheme changes (60%) for certain screens.

Conclusions

Based on the feedback we received, we were able to mitigate the participants' concerns about font size and color and create tutorial videos to guide future users in using the app. We completed these changes prior to deploying the app in our randomized clinical controlled trial.

The Social Prescription: Dispensing Wellness Beyond the Medication

In the realm of healthcare, the significance of social connections cannot be overstated. Beyond the traditional focus on pharmacological interventions and medical procedures, recognizing and nurturing positive social relationships has emerged as a fundamental aspect of lifestyle medicine. This article delves into the multifaceted nature of social connections and their profound impact on health outcomes, particularly in the context of chronic diseases like hypertension, mental health disorders, heart disease, and dementia. Moreover, it explores strategies for healthcare practitioners, with a special emphasis on pharmacists, to foster positive connections with patients, thereby enhancing shared decision-making, self-management, and overall well-being.

The Prevalence of Internet Use as a Source of Information Among Patients With Hypertension

Background and objective The incidence of hypertension is growing at an alarming rate globally. In the United States, nearly half of the adult population suffers from hypertension, a disease potentially associated with long-term dire consequences and comorbidities. While Internet access has proliferated, and free Internet-based education resources for healthy lifestyles have exponentially increased over the past two decades, little is known about whether Internet-based information can be or is used as a self-learning tool for hypertension management in a community setting. With almost no published data, if and to what degree Internet-based, self-directed learning tools are used for hypertension management needs to be assessed. In light of this, we aimed to evaluate the prevalence of Internet use as a source of information in patients with known diagnoses of hypertension who presented to our Internal Medicine clinic at Texas Tech University Health Sciences Center, El Paso. Materials and methods We conducted a single-center, cohort-based observational study at our teaching hospital's internal medicine clinic. A survey questionnaire was distributed to all adults aged more than 18 years with a known diagnosis of hypertension. Consent for participation was obtained from all participants. Of the total studied population, 93.6% (190/203) were of Hispanic descent. Moreover, 67.5% (137/203) identified as female. Of note, 22.7% (46/203) reported using the Internet to learn about hypertension. Internet users were younger, with a mean age of 61.4 years compared to 68.7 (p=0.02) years for non-Internet users, attended institutions of a higher grade of education, and mostly received information regarding hypertension from their families (91.3% vs 2.5%, p<0.001). While most patients used the Internet for making treatment decisions and were satisfied with their choices, more than a quarter felt confused and anxious after using Internet-based resources. Results Most patients in the study were found to not use the Internet as a resource tool for hypertension management (157/203; 77.3%). Among the 22.7% of patients who used the Internet for hypertension management, the most commonly utilized resource was Google.com, as an initial step to hypertension research (26/46, 58.6%, p<0.001), followed by multiple resources within a predetermined list on the provided survey (14/46, 30.4%). The survey also assessed the reasons for using Internet-based resources, with the primary reason being evaluating treatment options (19/46, 41.5%), followed by developing coping skills (13/46, 28.2%), and lastly aiding in decision-making (10/46, 21.5%). Conclusions Internet-based educational tools are mushrooming as the Internet is becoming more pervasive. This study shows that within this predominant Hispanic population, nearly one-quarter of patients with hypertension are using Internet-based, self-learning tools. This highlights a slow shift in medical education which providers have to be prepared for as patients will be using these tools as secondary information sources for medical decision-making more frequently going forward. Further studies need to be conducted to evaluate the current and longitudinal impact of these new information sources.

Effects of a medication adherence app among medically underserved adults with chronic illness: a randomized controlled trial

For individuals living with a chronic illness who require use of long-term medications, adherence is a vital aspect of successful symptom management and outcomes. This study investigated the effect of a smartphone app on adherence, self-efficacy, knowledge, and medication social support in a medically underserved adult population with various chronic illnesses. Participants were randomized to a group who used the app for one month or a control group provided with a printed medication list. Compared to the control group, participants receiving the intervention had significantly greater medication adherence (Cohen's d = -0.52, p = .014) and medication self-efficacy (Cohen's d = 0.43, p = .035). No significant effects were observed related to knowledge or social support. The findings suggest use of the app could positively impact chronic disease management in a medically underserved population in the United States.

Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review

Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.

Social support and medication adherence among adult myasthenia gravis patients in China: the mediating role of mental health and self-efficacy

BACKGROUND

Myasthenia gravis (MG), a rare chronic neuromuscular disorder, is characterized by progressive physical decline and requires long-term pharmacological treatment. Due to the decline of physical and social abilities, MG patients are in great need of social support, including tangible and emotional support. This study aims to examine the association between social support and medication adherence and the possible mediating effects of mental health and self-efficacy among MG patients.

METHODS

A cross-sectional analysis of a nationwide MG registry was conducted on 865 patients under oral medication treatment in China between June and July 2022. Validated scales were used to measure the respondent's mental distress (Four-item Patient Health Questionnaire), social support (Modified Medical Outcomes Study Social Support Scale), self-efficacy for medication use (Self-efficacy for Appropriate Medication Use Scale), and medication adherence (Morisky Medication Adherence Scale, MMAS).

RESULTS

The association between social support and medication adherence and possible mediating effects of mental distress and self-efficacy were tested by structural equation model, with significant demographic and disease-related factors adjusted. The respondents showed a very low level of medication adherence (71.2% poor adherence; 1.4% high adherence; mean MMAS = 4.65). The level of social support was positively associated with medication adherence, and such association was fully mediated by two indirect pathways: through self-efficacy (β = 0.07, proportion mediated = 63.8%); and through mental distress and then self-efficacy (β = 0.01, proportion mediated = 6.7%).

CONCLUSION

Provision of social support and interventions on mental health with emphasis on improving self-efficacy for medication use may effectively improve medication adherence among MG patients.

Subjective memory complaints and medication adherence among hypertensive Korean older adults with multimorbidity: mediating effect of depression and social support

BACKGROUND & AIM(S)

Medication adherence (MA) is a key factor in maintaining adequate blood pressure and preventing complications. However, some older adults experience difficulties in taking medicine properly due to declines in cognitive function. Although subjective memory complaints (SMC) are recognized as early markers of cognitive impairment, previous studies concerning the relationship between MA and cognitive function have focused only on objective cognitive function. Furthermore, while depression has a high correlation with SMC, low MA, and social support, there is limited evidence on their relationship. This study aims to understand the effect of SMC on MA and the mediating effect of depression and social support.

METHOD(S)

This study is a descriptive cross-sectional investigation. A sample of 195 community-dwelling hypertensive older adults with multimorbidity from 3 community senior centers in Gwangju, South Korea were recruited through convenience sampling. Data was collected through face-to-face survey from January to March 2018. The PROCESS macro v4.2 program [Model 6] was used to analyze the mediating effect of depression and social support in the relationship between SMC and MA. Data analysis was performed using SPSS/WIN 26.0 and STATA MP 17.0.

RESULTS

The average MA was 6.74. There were significant differences in MA according to awareness of prescribed drugs, awareness of side effects, insomnia, and healthcare accessibility. SMC was positively correlated with depression, while social support and MA were negatively correlated. While depression was a significant mediator of the effect of SMC on MA, the mediating effect of social support was not significant. The multiple mediation effect of depression and social support was not significant.

CONCLUSION

The results suggest that medication management of older adults in community settings should be accompanied by a comprehensive health assessment of associated factors. Health professionals should explore strategies to improve memory as well as prevent and alleviate depression to increase MA among hypertensive older adults with multimorbidity.

Educational Interventions in Immigrants for Asthma and COPD: A Systematic Review

Objective

Asthma and COPD are prevalent respiratory conditions among immigrants, yet many individuals in this population do not effectively utilize available therapies, resulting in exacerbations and limitations in their daily lives. This systematic review seeks to describe asthma/COPD educational interventions specifically tailored for immigrant patients and assess their variability and outcomes, with the ultimate goal of improving self-management and achieving better asthma or COPD control in this population.

Design

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A comprehensive literature search was conducted using four electronic databases (CINAHL, PubMed, Embase and PsycInfo). Articles were included if they focused on asthma or COPD interventions conducted in immigrant populations. The Mixed Methods Appraisal Tool was used to assess the quality of included articles.

Results

Out of the initial 1173 articles identified, 812 were assessed for eligibility. Six articles met the inclusion criteria for educational interventions targeting immigrants with asthma or COPD. These studies explored the effectiveness of interventions on various immigrant populations using different methodologies including group discussion of photographs and classroom-based interventions. The interventions varied in terms of settings, educational materials, and delivery methods. Positive outcomes were observed in areas such as knowledge, understanding of instructions, and inhaler technique. However, the included studies had limitations in assessing the impact on asthma and COPD self-management and sustainability.

Conclusion

More research is needed on asthma and COPD management in immigrants. The interventions included in this review had positive effects on outcomes like inhaler technique and asthma knowledge. However, due to variability in outcome measures, it is difficult to directly compare the interventions. Future studies should include diverse immigrant populations, consider the specific migration status of the immigrants, long-term sustainability of the intervention and use culturally tailored approaches to improve respiratory health in this population.

Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment

The prevalence of atrial flutter (AFL) is increasing among the elderly population, and managing this condition presents specific challenges within this demographic. As patients age, they often exhibit reduced responsiveness to conservative treatment, necessitating a more invasive approach. We present a case of a 93-year-old female who presented to the hospital with acute decompensated heart failure (ADHF) and AFL. A year prior, she was diagnosed with arrhythmia-induced cardiomyopathy. Despite recovering her ejection fraction (EF) through guideline-directed medical therapy (GDMT), her EF deteriorated again. The patient declined invasive management for her arrhythmia on multiple occasions. Managing such patients is challenging since the approach with pharmacotherapy alone often fails to maintain sinus rhythm or adequately control the ventricular rate. Growing evidence shows that invasive management, especially ablation, may be a safe and effective procedure for this patient population. Furthermore, the studies suggest that ablation may yield particular benefits for patients with simultaneous heart failure and atrial fibrillation/AFL (AF/AFL). Unfortunately, limited data exist regarding the invasive management of AFL in the elderly. Therefore, this case report aims to provide a comprehensive review of the current evidence regarding the safety and efficacy of ablation as a therapeutic option for AFL in elderly patients, with a particular focus on how patients with concomitant heart failure may benefit from ablation.

"Take the tablet or don't take the tablet?"-A qualitative study of patients' experiences of self-administering anti-cancer medications related to adherence and managing side effects

PURPOSE

Medication non-adherence is a well-recognised problem in cancer care, negatively impacting health outcomes and healthcare resources. Patient-related factors influencing medication adherence (MA) are complicated and interrelated. There is a need for qualitative research to better understand their underlying interaction processes and patients' needs to facilitate the development of effective patient-tailored complex interventions. This study aimed to explore experiences, perceptions, and needs relating to MA and side effect management of patients who are self-administering anti-cancer treatment.

METHODS

Semi-structured audio-recorded interviews with patients who have haematological cancer were conducted. A comparative, iterative, and predominantly inductive thematic analysis approach was employed.

RESULTS

Twenty-five patients from a specialist cancer hospital were interviewed. While self-administering cancer medications at home, patients' motivation to adhere was affected by cancer-related physical reactions, fears, cancer literacy and beliefs, and healthcare professional (HCP) and informal support. Patients desired need for regular follow-ups from respectful, encouraging, informative, responsive, and consistent HCPs as part of routine care. Motivated patients can develop high adherence and side effect self-management over time, especially when being supported by HCPs and informal networks.

CONCLUSION

Patients with cancer need varied support to medically adhere to and manage side effects at home. HCPs should adapt their practices to meet the patients' expectations to further support them during treatment. We propose a multi-dimensional and technology- and theory-based intervention, which incorporates regular HCP consultations providing tailored education and support to facilitate and maintain patient MA and side effect self-management.

Health Social Networks of Black Women With Hypertension

BACKGROUND

The prevalence of hypertension is 55% among African American/Black women, who have a higher risk for poor health outcomes compared to women from other racial and ethnic groups, in part because of uncontrolled blood pressure. Previous research results suggest that peers may positively influence self-management of chronic conditions like hypertension. However, few studies have described the personal characteristics of peers in the health social networks of Black women.

OBJECTIVE

This substudy aimed to examine health social networks and describe the peers' characteristics, as reported by a convenience sample of Black women with hypertension.

METHODS

In this analysis of data from a larger study, 94 Black women with hypertension attending a church conference participated in a cross-sectional, descriptive study. Their mean age was 59 years, and their mean systolic blood pressure was 143 mm Hg. All participants completed a survey to gather data about (a) the characteristics of individuals they discussed health matters with (their peers or health social network) and (b) their perceptions about hypertension status and knowledge of hypertension among the peers in their health social network.

RESULTS

Collectively, participants from the larger study named a total of 658 peers who were part of their health social networks; the mean health social network size was six peers. The peers were mostly women, Black, family members, and, on average, 54 years old. The participants discussed hypertension with 71% of the peers, reported that 36% had hypertension, and felt that 67% were somewhat or very knowledgeable about the condition. A small, positive correlation existed between the participants' health social network size (number of peers named) and their systolic blood pressure levels.

DISCUSSION

The health social network peers were similar to those in the larger study, with most of the same gender, race, and age. The findings of this analysis may be used to help practitioners and scientists guide patients in building health social networks for support in self-managing hypertension and conducting future studies to examine the best strategies for developing and using health social networks to improve health outcomes and reduce health disparities.

The effect of family support on self-reported adherence to ART among adolescents perinatally infected with HIV in Uganda: A mediation analysis

INTRODUCTION

This study examined the mechanisms through which family support affects self-reported adherence to antiretroviral therapy among adolescents perinatally infected with HIV in Uganda.

METHODS

Longitudinal data from 702 adolescent boys and girls (10-16 years) were analyzed. Structural equation models were conducted to assess the direct, indirect, and total effects of family support on adherence.

RESULTS

Results showed a significant indirect effect of family support on adherence (β = .112, 95% confidence interval [CI]: 0.052-0.173, p < .001). Specific indirect effects of family support through saving attitudes (β = .058, 95% CI: 0.008-0.108, p = .024), and communication with the guardian (β = .056, 95% CI: 0.012-0.100), p = .013), as well as the total effect of family support on adherence (β = .146 (95% CI: 0.032-0.259, p = .012), were statistically significant. Mediation contributed 76.7% of the total effects.

CONCLUSION

Findings support strategies to help promote family support and strengthen open communication between adolescents living with HIV and their caregivers.

Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study

BACKGROUND

Previous studies have examined the associations of health literacy and social support with medication adherence among patients with hypertension. However, limited evidence exists regarding the mechanisms underlying the relationship between these factors and medication adherence.

PURPOSE

To explore the prevalence of medication adherence and its determinants in patients with hypertension in Shanghai.

METHODS

A community-based cross-sectional study was conducted among 1697 participants with hypertension. We collected sociodemographic and clinical characteristics as well as data regarding health literacy, social support, and medication adherence using questionnaires. We examined interactions among the factors using a structural equation model.

RESULTS

The participants included 654 (38.54%) patients with a low degree of medication adherence and 1043 (61.46%) patients with a medium/high degree of adherence. Social support directly influenced adherence (β = 0.165, P < 0.001) and indirectly influenced adherence through health literacy (β = 0.087, P < 0.001). Health literacy directly influenced adherence (β = 0.291, P < 0.001). Education indirectly affected adherence through both social support (β = 0.048, P < 0.001) and health literacy (β = 0.080, P < 0.001). Moreover, there was a sequential mediating effect of social support and health literacy on the association between education and adherence (β = 0.025, P < 0.001). After controlling for age and marital status, similar results were also obtained, indicating a good model fit.

CONCLUSIONS

The degree of medication adherence among hypertensive patients needs to improve. Health literacy and social support had both direct and indirect effects on adherence, and thus, these factors should be considered as tools to improve adherence.

Effectiveness of self-financing patient-led support groups in the management of hypertension and diabetes in low- and middle-income countries: Systematic review

OBJECTIVE

There is insufficient evidence on the role of self-financing patient support groups in the control of blood pressure (BP) and/or diabetes in low- and middle-income countries (LMICs). We conducted a systematic review to investigate the effectiveness of these groups in BP and glycaemic control.

METHODS

We searched PubMed, Embase, SCOPUS, Web of Science, Global Health, African Journals Online, CINAHL and African Index Medicus for published peer-reviewed articles from inception up to November 2021. Grey literature was obtained from OpenGrey. Studies on patient support groups for hypertension and/or diabetes with a component of pooling financial resources, conducted in LMICs, were included. Narrative reviews, commentaries, editorials and articles published in languages other than English and French were excluded. Study quality and risk of bias were assessed using the National Institutes of Health Quality assessment tool and the revised Cochrane risk-of-bias tool. Results are reported according to PRISMA guidelines.

RESULTS

Of 724 records screened, three studies met the criteria: two trials conducted in Kenya and a retrospective cohort study conducted in Cambodia. All studies reported improvement in BP control after 12 months follow-up with reductions in systolic BP of 23, 14.8, and 16.9 mmHg, respectively. Two studies reported diabetes parameters. The first reported improvement in HbA1c (reduction from baseline 10.8%, to 10.6% at 6 months) and random blood sugar (baseline 8.9 mmol/L, to 8.5 mmol/L at 6 months) but these changes did not achieve statistical significance. The second reported a reduction in fasting blood glucose (baseline-216 mg/dl, 12 months-159 mg/dl) in diabetic patients on medication.

CONCLUSION

Self-financing patient support groups for diabetes and hypertension are potentially effective in the control of BP and diabetes in LMICs. More studies are needed to add to the scarce evidence base on the role of self-financing patient support groups.

Effectiveness of a provider and patient-focused intervention to improve hypertension management and control in the primary health care setting in Cuba: a controlled before-after study

BACKGROUND

Implementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices.

METHODS

We conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention.

RESULTS

Seventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients -51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73-3.22) in the provider and 2.00 (95% CI, 1.68-2.37) in the provider plus patient intervention arm.

CONCLUSIONS

The intervention's patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.

Self-Care Behaviors in Patients with Hypertension to Prevent Hypertensive Emergencies: a Qualitative Study Based on the Theory of Planned Behavior

Background: Hypertension is a crucial general health issue. Severe and acute hypertension needs urgent medical intervention. Self-care behaviors can help patients with hypertension in controlling blood pressure and preventing hypertensive emergencies. This study aimed to determine the perception of hypertension towards self-care behaviors using constructs of the theory of planned behavior (TPB) in critically ill patients with hypertension to prevent hypertensive emergencies.

Material and Methods: This study was conducted based on the directed qualitative content analysis of 33 critically ill patients with hypertension who participated in semi-structured interviews and focus group discussions. Results: The data were analyzed based on the four main categories of TPB. The attitude category consisted of positive and negative subcategories. The subjective norms category consisted of authority of healthcare staff, family support and approval, and influence of friends subcategories. The perceived behavioral control category included discipline, self-control, receiving consultation, individual concerns, financial problems, access to medicine, food culture, and coronavirus limitations subcategories. The behavioral intention category had intention to perform the behavior and intention to continue a behavior subcategories.

Conclusion: The results revealed the requirement for a multidimensional approach to improve attitude, subjective norms, and behavioral control for performing self-care behaviors to reduce the number of hypertensive emergencies in critically ill patients with hypertension. Factors affecting self-care included socioeconomic status, family support, governmental organizations, and participants’ health condition.

Exploring Perceived Barriers to Physical Activity in Korean Older Patients with Hypertension: Photovoice Inquiry

This study attempted to explore the barriers to physical activity of older patients with Hypertension. It aimed to provide robust evidence produced through their eyes. First, through the data analysis of the accelerometer and the decision of the research team, 10 out of the 30 applicants were invited to participate in a photovoice study. Photovoice is one example of participatory action research. Photovoice participants can communicate their unique experiences through photographs, providing a highly realistic and authentic perspective that is not possible to be understood with traditional qualitative research. This study inductively identified four main themes; health illiteracy, distortion of health information, fear of physical activity, and rejection of any life changes. Based on a specific understanding of the population's perception of physical activity, this study attempted to provide evidence of why many elderly Korean patients with Hypertension stay inactive.

The Implications of Family Members’ Absence from Hospital Visits during the COVID-19 Pandemic: Nurses’ Perceptions

Background: In response to the COVID-19 pandemic, several measures were taken to prevent the transmission of infection in the hospital environment, including the restriction of visits. Little is known about the consequences of these directives, but it is expected that they will have various implications. Thus, this study aimed to understand the consequences of measures to restrict visits to hospitalized individuals. Methods: A qualitative interpretive study was conducted through semistructured interviews with 10 nurses chosen by convenience. Content analysis was performed using Atlas.ti software, version 22 (Berlin, Germany). Results: Twenty-two categories and eight subcategories were identified and grouped according to their scope: implications for the patient, implications for the family, and implications for care practice. Conclusions: The identified categories of implications of restricting hospital visits (implications for patients, relatives, and care practices) are incomparably more negative than positive and have a strong potential to cause safety events in the short to long term, also jeopardizing the quality of care. There is the risk of stagnation and even setback due to this removal of families from the hospital environment, not only in terms of safety and quality of care but also with regard to person- and family-centered care.

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model

BACKGROUND

Medication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART.

METHODS

A cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05.

RESULTS

The magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9-72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03-5.62)], having social support [AOR = 1.11, (95% CI 1.02-1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93-5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04-1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01-3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level.

CONCLUSIONS

A large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

Family Participation to Promote Medication Adherence Among Thai-Muslim Older Adults With Hypertension: Action Research Study

INTRODUCTION

Nonadherence to antihypertensive medications has been found increasingly prevalent in Thailand, yet the critical cultural resources of Islamic belief systems and family support are seldom mobilized to support adherence. Our study aimed to develop, implement, and evaluate an Islamic-based intervention program to promote medication adherence among Muslim older adults with uncontrolled hypertension in southern Thailand.

METHOD

An action research with codesign and family participation principles was utilized. Within action research cycles, interviews with Thai-Muslim older adults, family primary caregivers, and health care professionals were undertaken alongside participant observations.

RESULTS

A qualitative audit demonstrated an improved medication adherence with all stakeholders expressing their desire to further engage and maintain the new intervention program.

DISCUSSION

Engaging with Islamic doctrine and concepts of family participation could support an improvement in antihypertensive medication adherence for Muslim older adults. Codesigning enables recognition of community belief systems, forming an important step toward improving community-based medication adherence.

Factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan, Iran: the application of the extended theory of planned behavior during Covid-19 pandemic

Purpose

This study aimed to identify the factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan based on the Extended Theory of Planned Behavior (ETPB) during the covid-19 pandemic.

Methods

This cross-sectional study was conducted from January to March 2021 in Hamadan, Iran. 191 hemodialysis patients were recruited who were referred to hemodialysis centers via the census method. Data were collected by a questionnaire containing items on socio-demographic information, End-Stage Renal Disease Adherence (ESRD-Adherence) Questionnaire, and ETPB constructs scale. Data analysis was performed using descriptive statistics and structural equation modeling.

Results

The mean (SD) age of participants was 62.49 (10.66). Also, the mean (SD) hemodialysis vintage/Month of them was 36.56 (43.34). Moreover, Treatment Adherence Behaviors are associated with education level, sex, and marital status (p < 0.001). Besides, Perceive Behavior Control (β = 0.414, t-value = 3.810) associated with intention. Also, intention (β = 0.158, t-value = 1.976) was associated to adherence behaviors. No significant associations were observed between positive attitudes, subjective norms, a perceived threat with intention, and adherence behaviors. The model explained about 54% of the variance of adherence behaviors. Finally, the goodness of fit index of 0.78, indicating the model good fit.

Conclusion

The present study demonstrates that some of the ETPB constructs such as perceived behavior control and intention are useful to improve adherence among the oldest hemodialysis patients. Also. This framework is revealed alongside the theory of planned behavior (TPB) applicable in the treatment adherence of old-age hemodialysis patients.

Medication Adherence and Perceived Social Support of Hypertensive Patients in China: A Community-Based Survey Study

PURPOSE

Previous studies suggested perceived social support has impact on medication adherence among hypertensive patients, but did not simultaneously elucidate the different contents or key providers of social support that patients perceived. This study was to identify the contents and providers of perceived social support beneficial for improving medication adherence among hypertensive patients in China, which could prove important for targeted interventions.

PATIENTS AND METHODS

Following a multi-stage stratified sampling framework, a total of 903 hypertensive patients from 12 primary health institutions across a middle-income city were recruited from April to June 2021. Medication adherence was measured using the Chinese version of the Morisky, Green and Levine scale; perceived social support was determined using the name generator method. A binary logistic regression model was performed to identify the association between medication adherence and perceived social support. The contents of support included informational, emotional, and instrumental support (finances and caregiving). The support providers included spouse/partner, children, parents, siblings, other relatives, and friends.

RESULTS

A total of 506 (56.04%) patients optimally adhered to their antihypertensive medication. Female, older, urban patients, patients with shorter duration of hypertension and antihypertensive medications used showed better adherence (P<0.05). Optimal medication adherence was positively associated with the overall score of caregiving support (adjusted odds ratio [AOR] = 1.128; 95% confidence interval [CI] = [1.013-1.257]), informational support from the spouse/partner (AOR = 1.574; 95% CI = [1.112-2.227]), emotional support from the spouse/partner (AOR = 1.430; 95% CI = [1.032-1.981]), financial support from the spouse/partner (AOR = 1.439; 95% CI = [1.069-1.937]) and caregiving support from the spouse/partner (AOR = 1.652; 95% CI = [1.130-2.414]), whereas optimal medication adherence was negatively associated with caregiving support from friends (AOR = 0.499; 95% CI = [0.286-0.872]).

CONCLUSION

Informational, emotional, financial and caregiving support from spouses/partners have positive impacts on optimal medication adherence of hypertensive patients of community-level. Community-based interventions designed to improve medication adherence of hypertensive patients should target both patients and their spouses/partners; spouses/partners could be encouraged to provide various support to improve the medication adherence of hypertensive patients.