Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension

Development and validation of a 13-item short version of the inflammatory bowel disease self-efficacy scale

BACKGROUND

The inflammatory bowel disease self-efficacy scale (IBD-SES) is an instrument used across many countries to measure important health outcomes of patients with inflammatory bowel disease (IBD). We aimed to develop and validate a substantially shorter version of this scale to reduce patients' response burden.

METHODS

A total of 919 patients with IBD, 482 recruited from an IBD clinic and 437 recruited online, completed the Japanese version of the original, 29-item IBD-SES. These data were then used to develop a shorter version of the scale. The original 29 items of the IBD-SES were reduced with three analytic steps: assessing ceiling and floor effect, testing correlation between items, and assessing test-retest reliability. The resulting 13-item IBD-SES was evaluated for construct validity by confirmatory factor analysis, criterion validity by Pearson correlation coefficients with original version, and internal consistency by item-total correlations and the Cronbach's α coefficient.

RESULTS

The short version consisted of the same four subscales "managing stress and emotions," "managing medical care," "managing symptoms and disease," and "maintaining remission" as the original scale. The fit indices of the final model were as follows: normed chi-square, 7.18 (p < 0.001); comparative fit index, 0.94; goodness-of-fit index, 0.93; adjusted goodness-of-fit index, 0.89; parsimony goodness-of-fit index, 0.60; and root mean square error of approximation, 0.084. Correlation of each subscale with the original scale was high (0.97-0.98). Cronbach's α for each subscale ranged from 0.68 to 0.86.

CONCLUSIONS

A short version of the IBD-SES was developed. The results confirmed the improved validity, reliability, and psychometric properties of the IBD-SES.

TRIAL REGISTRATION

Not applicable.

Medication Adherence of Older Adults with Hypertension: A Systematic Review

Objective

Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN.

Methods

We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis.

Results

Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review's aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified.

Conclusion

The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.

Specific Medication Literacy in Older Adults with Asthma

Purpose

To explore specific medication literacy (SML) of older adults and associations of SML strength.

Methods

This was an observational study. Participants were at least 60 years old, with an asthma diagnosis and in good health. Data were collected by a registered nurse researcher. The SML data collection instrument gathered information about each medication a participant used: name, purpose, how taken, special instructions, adverse effects, and drug-drug or drug-disease interactions. An SML scoring rubric was developed.

Results

All could provide name, and most provided purpose, how taken. The lowest SML domains were side effects and interactions. Age at time of asthma diagnosis correlated with stronger SML scores and living in a disadvantaged neighborhood correlated with lower SML scores.

Discussion

Gaps in medication literacy may create less ability to self-monitor. Patients want medication literacy but struggle with appropriate, individualized, information.

Conclusion

The study provides insights on gaps and opportunities for SML.

Patient Knowledge, Medication Adherence, and Influencing Factors: A Cross-Sectional Study among Hypertensive Patients in Greece

This study aimed to investigate the knowledge of patients with hypertension about their condition, adherence to antihypertensive medication, and the factors influencing it. A cross-sectional study was conducted in two cardiology outpatient clinics of two tertiary hospitals, in Greece. The study included 188 patients diagnosed with hypertension. The patients' knowledge about their disease and adherence to medication were assessed by using the HK-LS and A-14 scales, respectively. Patients had sufficient knowledge levels about their disease, but significantly low levels of adherence to medication. Patients with higher knowledge levels were more adherent to medications [r(188) = 0.885, p < 0.001]. By using multivariate analysis, higher age (p = 0.018), residence in a more populous area (p = 0.041), more years with the disease (p = 0.012), and a lower number of medications (p = 0.03) were associated with higher levels of knowledge. Conversely, younger age (p = 0.036), lower educational levels (p = 0.048), fewer years with the disease (p = 0.001), and a higher number of medications (p = 0.003) were associated with lower adherence to medication. The Greek patients' hypertension knowledge was sufficient; however, adherence to medication was significantly low. Healthcare managers could utilize our findings to design targeted interventions for improving adherence to medication for these patients.

Association between medication literacy and blood pressure control among hypertensive patients

AIM

This study aimed to explore the association between medication literacy and blood pressure control among hypertensive patients.

BACKGROUND

Blood pressure control is a challenge for global health systems. Medication literacy is essential for medication self-management in hypertensive patients and a basis for managers to develop comprehensive intervention strategies for hypertension medication use.

DESIGN

A cross-sectional observational study was conducted.

METHODS

A total of 378 hypertensive patients was selected by convenience sampling from two tertiary hospitals and four community health service centres from December 2021 to January 2022 in Changsha, China. Associations between medication literacy and blood pressure control were identified with chi-square, independent samples t-tests and logistic regression analyses.

RESULTS

The average medication literacy score of the hypertensive patients investigated was low. Over a third of patients had uncontrolled blood pressure. Logistic regression analysis showed that medication literacy was an influencing factor for blood pressure control rate in hypertensive patients.

CONCLUSIONS

Medication literacy and blood pressure control among hypertensive patients was poor. Medication literacy was a facilitator of blood pressure control so improving medication literacy may be of value to improve blood pressure control in hypertensive patients.

Hypertension doctors' awareness and practice of medication adherence in hypertensive patients: a questionnaire-based survey

Background

Poor adherence to antihypertensive drugs is a major cause of unsatisfactory blood pressure control. Hypertension doctors play an integral role in improving medication adherence in hypertensive patients. Although most existing studies have recognized the status quo and influencing factors of medication adherence, little attention has been paid to hypertension doctors' awareness and practice in hypertension management. Therefore, in this study, we aimed to investigate hypertension doctors' awareness and practice of medication adherence in hypertensive patients.

Methods

This is a cross-sectional survey. A self-reported questionnaire was developed and sent to hypertension doctors in Hunan province, China, between May 1, 2022 and July 1, 2022. Univariate and generalized linear models were used to identify the factors influencing hypertension doctors' awareness and practice. The correlation between awareness and practice was determined using Spearman's correlation coefficient.

Results

In total, 236 valid questionnaires were collected (valid response rate, 73.5%). Of the respondents, 44.1% were chief physicians and 64.4% were females. Approximately half of the respondents were ≥40 years old and had over 14 years of working experience. Most respondents (87.7%) did not have hypertension, but 54.2% had a family history of hypertension. The average awareness and practice scores were 29.8 ± 8.8 and 39.4 ± 7.1, respectively, out of 50, with higher scores indicating higher levels of awareness or practice. More hypertension consultations and more antihypertensive prescriptions issued were associated with better awareness and practice among respondents (ps < 0.05). Respondents with higher education and professional titles had higher awareness (ps < 0.05). Moreover, respondents with 6-13 years of work experience had better practice than those with <5 years of work experience (p = 0.017). There was a significant correlation between hypertension doctors' awareness and practice of medication adherence in hypertensive patients (R = 0.682, p < 0.001). These findings indicate that misconceptions persist in hypertension doctors' awareness and practice of patient medication adherence.

Conclusion

Hypertension doctors lack sufficient and correct awareness and practice of medication adherence in hypertensive patients.

Concurrent Medication Adherence in Hypertensive Patients With High-Risk Comorbidities

BACKGROUND

Hypertensive patients with high-risk comorbidities require medications for each condition, leading to greater burden. The number of chronic conditions can affect patients' concurrent medication adherence.

OBJECTIVE

We aimed to compare the characteristics of groups based on their concurrent medication adherence and investigate the association between the number of high-risk comorbidities and concurrent medication adherence for patients with hypertension and high-risk comorbidities.

METHODS

A secondary data analysis was performed with the 2018 Korea Health Panel Survey, including 2230 patients with hypertension and at least 1 high-risk comorbidity who were prescribed medications for at least 2 conditions. Using medication adherence for each condition, we identified 3 concurrent medication adherence groups: adherent, suboptimal, and nonadherent groups. Multinominal logistic regression was used to determine the association between the number of high-risk comorbidities and the concurrent medication adherence groups.

RESULTS

Adherent, suboptimal, and nonadherent groups included 85%, 11%, and 4% of the patients, respectively. Whereas having more high-risk comorbidities was associated with belonging to the suboptimal group compared with the adherent group (adjusted odds ratio, 1.46), having fewer high-risk comorbidities was associated with belonging to the nonadherent group compared with the adherent group (adjusted odds ratio, 0.52).

CONCLUSIONS

We identified 3 groups based on their concurrent medication adherence. Our results indicated that the relationship of the number of high-risk comorbidities with the concurrent medication adherence group was inconsistent.

Factors influencing self-care among patients with primary hypertension: path analysis of mediating roles of self-efficacy and depressive symptoms

AIMS

Blood pressure control requires medication adherence and lifestyle modifications. Social cognitive theory suggests social support, psychological adaptation, and self-efficacy can reinforce lifestyle modifications. This study investigated if self-efficacy was a mediator between self-rated health status (SRHS), social support, depressive symptoms, anxiety, and self-care among patients with hypertension.

METHOD AND RESULTS

This cross-sectional study recruited patients with primary hypertension by convenience sampling (N = 318) from an outpatient cardiology clinic. Data included participant characteristics and self-report scales for social support, SRHS, anxiety, depressive symptoms, Self-efficacy and self-care diet quality and weight management. We used path analysis to test the hypothesized model. The mean age of participants was 63.91 ± 11.80 years. Mean scale scores for social support and depressive symptoms were 54.23 ± 13.26 and 6.14 ± 3.14, respectively; SRHS was 66.91 ± 13.80, self-efficacy was 34.31 ± 11.62, self-care for diet quality and weight management were 36.50 ± 13.19 and 27.38 ± 8.64, respectively. Bootstrapping demonstrated self-efficacy was the mediator between social support and self-care for diet quality and weight management; depressive symptoms mediated the relationship between social support and self-efficacy. In addition, the variable of depressive symptoms was also a mediator between SRHS and self-efficacy. The final model showed SRHS, social support, depressive symptoms, and self-efficacy explained 28% of self-care.

CONCLUSION

Our findings suggest developing theory-based interventions for patients with hypertension that provide education and/or psychological support for increasing patients' self-efficacy and reducing depressive symptoms simultaneously to facilitate their long-term self-care behaviours.

Factors Influencing Medication Adherence in Elderly Patients with Hypertension: A Single Center Study in Western China

Purpose

To develop and empirically test a conceptual model that explains the factors influencing antihypertensive medication adherence behavior in elderly patients in a city in western China.

Patients and Methods

The conceptual model was based on the Theory of Planned Behavior and the Health Belief Model and was empirically tested using cross-sectional survey data from Nanchong City, a city in western China, collected between October and December 2020. Data were analyzed using structural equation modeling.

Results

Behavioral intentions were the main predictor of medication adherence behavior (path coefficient of 0.353). Perceived benefits and perceived barriers directly (path coefficient = 0.201 and -0.150, respectively), and indirectly (path coefficient = 0.118 and -0.060) through behavioral intentions, influenced medication adherence behavior. Perceived susceptibility (path coefficient = 0.390) and perceived severity (path coefficient = 0.408) influenced behavioral attitudes, which influenced behavioral intentions (path coefficient = 0.298).

Conclusion

The conceptual model demonstrates a robust ability to predict and explain medication adherence behavior among elderly patients with hypertension, facilitating the adoption and maintenance of changes in adherence behavior and the potential for preventing disease progression and improving quality of life.

The Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients with Type 2 Diabetes

Background

Patients with type 2 diabetes have poor medication adherence. Medication literacy is one of the influencing factors of medication adherence among patients with type 2 diabetes. However, the mechanism by which medication literacy affects medication adherence among patients with type 2 diabetes is unclear. The aim of this study was to verify the mediating role of self-efficacy in the relationship between medication literacy and medication adherence.

Methods

A total of 402 patients with type 2 diabetes were enrolled in this study. The Chinese versions of the Medication Literacy Scale, the Self-Efficacy for Appropriate Medication Use Scale and the Morisky Medication Adherence Scale-8 were used in the survey. Pearson correlation analysis was used to find correlations among medication literacy, self-efficacy and medication adherence. The PROCESS macro (Version 4.1) with Model 4 for SPSS was used to verify the mediating role of self-efficacy.

Results

Twenty-four percent of the participants had poor medication adherence. Self-efficacy and medication literacy (r=0.499, p < 0.01) and medication adherence (r=0.499, p < 0.01) were significantly and positively correlated. Self-efficacy partially mediated the relationship between medication knowledge and medication adherence among patients with type 2 diabetes, accounting for 36.7% of the total effect.

Conclusion

Self-efficacy had a partial mediating effect on the relationship between medication literacy and medication adherence among patients with type 2 diabetes. Self-efficacy should be improved through effective measures to increase patients' confidence in adherence to antihyperglycemic drugs.

Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity

BACKGROUND

Multimorbidity has a significant impact on public health and primary care. Medication adherence is recognized as the most effective measure for managing and preventing multimorbidity. Studies have shown that medication literacy has a positive effect on medication adherence in patients with multimorbidity. However, limited knowledge exists regarding the underlying mechanisms of this relationship in older adults with multimorbidity. Therefore, the aim of this study was to investigate the mediating role of self-efficacy in the association between medication literacy and medication adherence in this population.

METHODS

This study employed a cross-sectional design and convenience sampling method to survey older patients with multimorbidity in six communities in Zhengzhou, China, from July 12, 2021, to December 15, 2021. Participants were assessed using a demographic questionnaire, the Chinese Version of the Medication Literacy Scale (C-MLS), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8). Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analysis, and mediation analysis.

RESULTS

A total of 350 elderly patients met the inclusion criteria, and 328 valid questionnaires were collected. The mean age of the participants was 74.90 ± 7.37 years, with a slightly higher proportion of males (55.8%) than females (44.2%). The mean score for medication adherence was 4.85 ± 1.57, indicating poor medication adherence among the participants. Medication adherence scores varied significantly among participants of different ages, education levels, employment statuses and kinds of medication (p < 0.01). Scores for medication literacy and self-efficacy showed a significant positive correlation with medication adherence scores (all p < 0.001). The standardized coefficient for the total effect and direct effect of medication literacy on medication adherence was 0.268 (95% CI: 0.201, 0.335) and 0.187 (95% CI: 0.123, 0.252), respectively. After introducing self-efficacy into the model, the standardized coefficient for the indirect effect was 0.081 (95% CI: 0.049, 0.120), indicating that self-efficacy partially mediated the relationship between medication literacy and medication adherence, accounting for 30.22% of the total effect.

CONCLUSION

This study might suggest that medication literacy indirectly affected medication adherence in older people with multimorbidity through self-efficacy. Health care providers should be aware of the importance of improving medication literacy and implement strategies aimed at increasing self-efficacy to achieve the goal of improving medication adherence in older adults with multimorbidity.

Influencing factors of medication literacy among community-dwelling older adult patients with hypertension: a study based on social learning theory

Objective: This study aimed to examine the factors affecting medication literacy in community-dwelling older adults with hypertension, guided by social learning theory. It sought to analyze the pathways these factors influenced and provide a theoretical foundation for designing targeted intervention programs. Study design: This is a cross-sectional study. Methods: From October 2022 to February 2023, a total of 432 community-dwelling older adults with hypertension from Linghe District, Guta District, and Taihe District, Jinzhou City, Liaoning Province, China, were selected using convenience sampling. Data were collected using a socio-demographic questionnaire, a medication literacy questionnaire, the Brief Illness Perception Questionnaire, the General Self-efficacy Scale, and the Perceived Social Support Scale. The collected data were analyzed with Kruskal-Wallis and Mann-Whitney tests, correlation analysis, multiple stepwise regression analysis, and structural equation modeling (SEM). Results: The medication literacy score among the participants was 3.83 ± 1.91. Multi-factor analysis revealed key factors affecting their medication literacy, including blood pressure-control status, utilization of community health education resources, receiving guidance for medication usage, marital status, number of annual visits, social support, self-efficacy, and disease perception. The SEM based on social learning theory showed that general self-efficacy mediated the relationship between social support, disease perception, and medication literacy. Conclusion: The present study developed a model and provided potential intervention strategies to improve medication literacy, knowledge, and safety among community-dwelling older adults with hypertension, considering the relationships between the identified variables.

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.

Health literacy and health outcomes among older patients suffering from chronic diseases: A moderated mediation model

Introduction

Aging brings with an increased risk of chronic diseases among older adults, which could affect health outcomes. Evidence has showed that health literacy is associated with health outcomes. However, limited studies explore the underlying mechanism between health literacy and health outcomes. Hence, this study aimed to determine whether self-efficacy for managing chronic disease mediates the relationship between health literacy and health outcomes among older patients with chronic diseases, and to explore whether disease duration moderates the relationship between health literacy, self-efficacy for managing chronic disease, and health outcomes.

Methods

Participants were recruited from tertiary hospitals in Zhejiang Province, China from May 2019 to June 2020 using a convenience sampling method. A total of 471 older patients with chronic diseases completed questionnaires measuring demographics, disease-related information, health literacy, self-efficacy for managing chronic disease, and health outcomes. The mediation effect was examined using the structural equation model method, based on the bias-corrected bootstrapping method. The moderation effect was tested by the multiple-group analysis.

Results

A good fit model suggested that self-efficacy for managing chronic disease partially mediated the relationships between health literacy and health outcomes. In addition, disease duration moderated the relationships between health literacy, self-efficacy for managing chronic disease, and health outcomes.

Discussion

The findings highlight that adequate health literacy improved health outcomes among older patients with chronic diseases, which was further promoted by self-efficacy for managing chronic diseases. Moreover, a long disease duration could enhance the effect.

Is first pregnancy age associated with hypertension in the Chinese rural women population?

Introduction

The purpose of this study was to investigate the relationship between first pregnancy age and hypertension later in the life of women from Chinese rural areas.

Methods

In total, 13,493 women were enrolled in the Henan Rural Cohort study. Logistic regression and linear regression were used to evaluate the association between first pregnancy age and hypertension and blood pressure indicators [including systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)]. The restricted cubic spline was used to examine the dose-response relationship between the first pregnancy age and hypertension or blood pressure indicators.

Results

After adjusting for potential confounders, each 1-year increase in first pregnancy age was associated with a 0.221 mmHg increase in SBP values, a 0.153 mmHg increase in DBP values, and a 0.176 mmHg decrease in MAP values (all P < 0.05). The β of SBP, DBP, and MAP showed a trend of first increasing and then decreasing with increasing first pregnancy age and there was no statistical significance after first pregnancy age beyond 33 years on SBP, DBP, and MAP, respectively. A 1-year increment in first pregnancy age was associated with a 2.9% [OR (95% CI): 1.029 (1.010, 1.048)] higher odds of prevalent hypertension. The odds of hypertension increased sharply and then eventually leveled off with an increment of first pregnancy age after adjusting for potential confounders.

Conclusion

First pregnancy age might increase the risk of hypertension later in life and might be an independent risk factor for hypertension in women.

Illness Perception, Self-Efficacy, and Medication Adherence in Patients With Coronary Artery Disease: A Path Analysis of Conceptual Model

Introduction

Illness perception and self-efficacy in patients with coronary artery disease (CAD) may affect medication adherence, which is one of the most important challenges in disease management in this group of patients.

Objective

The present study aimed to investigate the factors influencing medication adherence in CAD patients, especially the effect of illness perception and self-efficacy.

Methods

This study was cross-sectional and conducted from April to September 2021. A total of 259 patients with confirmed CAD were selected by convenience sampling method based on inclusion criteria. Illness perception, self-efficacy, and medication adherence were investigated using Brief IPQ, SCSES, and MARS_10 questionnaires, respectively. The data were analyzed using the STATA software (version 14) and the regression path analysis method.

Results

Patients had moderate illness perception and high self-efficacy, and 61.8 of them adhered to their medication regimen. Greater illness perception, better self-efficacy, and higher education had a positive effect on medication adherence, and increasing age had a negative effect on it. The final path model shows a good fit of the data in the model (χ2: 0.37, df: 274, χ2/df: 0.36, CFI: 1, IFI: 0.95, TLI: 1.07, and RMSEA: 0.00).

Conclusion

The results of the present study suggest that patients' illness perception can play an important role in predicting self-efficacy in disease management and the level of medication adherence in patients with CAD. To improve self-efficacy and medication adherence, future intervention studies should focus on the patient's illness perceptions and their improvement.

Medication Literacy in Chinese Patients with Stroke and Associated Factors: A Cross-Sectional Study

In China, stroke is characterized by high incidence, recurrence, disability, economic burden, and mortality. Regular and effective medication therapy can reduce stroke recurrence. High medication literacy is vital for the success of tertiary prevention measures aimed at preventing recurrence and minimizing disability. A cross-sectional survey using a medication literacy questionnaire was conducted between January and May 2022 on 307 inpatients of a Class III Grade A hospital in Hefei, Anhui Province, China. The demographic and clinical data of the patients were obtained from medical records. The health literacy of the patients was moderate, with 36.8% exhibiting adequate medication literacy. Univariate analysis identified significant differences in the medication literacy of the patients, depending on education level, annual income, family history of stroke, number of health problems, age, daily medication times, and brain surgery history. Multiple regression analysis revealed that education level, annual income, family history of stroke, and number of health problems significantly influenced medication literacy. In patients with stroke who are older and have a low education level, more health problems, no history of surgery, or no family history of stroke or medication guidance, medication knowledge and attitude can be improved to enhance medication safety and guarantee tertiary-level prevention of stroke.

The Association of Midday Napping With Hypertension Among Chinese Adults Older Than 45 Years: Cross-sectional Study

BACKGROUND

Hypertension is one of the main public health issues around worldwide, and midday napping is a popular habit. The association between the two remains to be explored.

OBJECTIVE

The goal of the research was to explore the association of midday napping with hypertension.

METHODS

This study separately selected 11,439, 12,689, and 9464 Chinese respondents aged over 45 years from the China Health and Retirement Longitudinal Study 2011, 2015, and 2018 data sets. Binary logistic regression was used to explore the association of midday napping with hypertension, and the 3-step method was used to test the mediation effect of BMI.

RESULTS

Among all respondents, the prevalence rates of hypertension were 24.6% (2818/11439) in 2011, 21.1% (2683/12689) in 2015, and 22.1% (2092/9464) in 2018. Midday napping was positively correlated with hypertension. In 2011 and 2015, napping 60 to 90 minutes had the greatest odds ratios [OR] (OR₂₀₁₁ 1.705, OR₂₀₁₅ 1.494). In 2018, the biggest OR came from the group napping 30 to 60 minutes (OR 1.223), and ORs of different napping durations decreased from 2011 to 2018. In addition, BMI had a partial mediation effect in 2015 and 2018.

CONCLUSIONS

Midday napping is a potential risk factor for hypertension with BMI acting as a mediator. To prevent hypertension, avoiding prolonged duration of midday napping and taking action to maintain a normal BMI level are recommended.

A web-based self-care program to promote healthy lifestyles and control blood pressure in patients with primary hypertension: A randomized controlled trial

BACKGROUND

Hypertension is a major risk factor for cardiovascular diseases, which contributes to the worldwide mortality rate. Successful blood pressure control requires adherence to medications and lifestyle modifications. However, motivating patients with primary hypertension to change and sustain behaviors long-term is challenging. A web-based self-care program centered on self-efficacy theory could provide feedback for effective control of blood pressure.

PURPOSE

To examine the effect of a web-based self-care program for patients with primary hypertension on cardiovascular risk-factors (pulse pressure and lipids), self-efficacy, and self-care behaviors (medication adherence and lifestyle).

DESIGN

A two-armed randomized controlled trial with 3-month and 6-month follow-ups.

SETTING AND PARTICIPANTS

A total of 222 patients with primary hypertension were recruited between February 2017 and August 2018 at a cardiology clinic of a medical center in Taipei, Taiwan.

METHODS

Eligible patients were randomized by permuted block randomization into the intervention group (n = 111) and control group (n = 111). Patients in the intervention group received a 6-month web-based self-care program, based on the theory of self-efficacy, while patients in the control group received usual care. Baseline and outcome measures (3 and 6 months) included self-efficacy, evaluated with the Chinese version of the 6-item Self-Efficacy for Managing Chronic Diseases (SEMC6), self-care, using subscales of the Hypertension Self-Care Activity Level Effects Scale (H-SCALE) for lifestyle and medication adherence, and blood pressure and serum lipid data, collected through web-based self-reports and chart review. Generalized estimating equations evaluated the effects of the intervention.

FINDINGS

At baseline, the control group had higher scores on the SEMC6, and lower cholesterol (HDL) compared with the intervention group (t = -2.70, p < 0.05; and t = 1.76, p < 0.05, respectively). Pulse pressure decreased significantly (β = -20.30, 95% CI -23.76, -16.83), and serum triglycerides and low-density lipoprotein cholesterol levels were significantly lower compared with controls at 6 months (all p < 0.001). At 6 months, the intervention group had significantly higher mean scores for the SEMC6 compared with the control group (β = 21.84, 95% confidence interval [CI] 19.25, 24.42) and H-SCALE subscale for medication adherence, diet, weight management, and physical activity compared with controls at 6 months (all, p < 0.001).

CONCLUSIONS AND CLINICAL RELEVANCE

The greatest benefit of this program was allowing participants to immediately consult with the researchers about self-care issues via the website. Lifestyles vary from person to person; therefore, the individuality of each participant was considered when providing feedback. We provided devising interventions for participants that would increase their confidence in self-care for hypertension and ultimately achieve home blood pressure control. We encourage incorporating this program into standard clinical care for patients with hypertension.

Status and influencing factors of medication literacy among Chinese caregivers of discharged children with Kawasaki disease

Background

The information on medication literacy among Chinese caregivers of discharged children with Kawasaki disease (KD) is unknown. We aimed to investigate the status of medication literacy among caregivers of discharged children with KD and evaluate the influencing factors of medication literacy.

Methods

From March 2020 to February 2021, 106 caregivers with a KD child were recruited for the present study. We collected the sociodemographic characteristics of the KD caregivers using structured interviews. The medication literacy of the KD caregivers was assessed by the Chinese version of Medication Literacy Assessment. KD patients' demographic and clinical data were obtained from the medical records. The multiple logistic regression was performed to identify factors associated with medication literacy.

Results

(1) The average medication literacy score was 4.91 ± 1.51. (2) Most of the Chinese KD caregivers had insufficient medication literacy (≤ 5 scores), and only 39.2% of the caregivers had adequate medication literacy (>5 scores). (3) The multiple logistic regression shows that education level, monthly income, and duration of hospitalization are the independent influencing factors on the medication literacy of KD caregivers.

Conclusion

There is preliminary evidence that medication literacy among KD caregivers is low and needs improvement. A higher level of education, higher income, and longer duration of hospitalization were influencing factors of adequate medication literacy.

General self-efficacy and hypertension treatment adherence in Algerian private clinical settings

Background

The purpose of this study was to investigate the connection between self-efficacy and treatment adherence, working on the assumption that self-efficacy plays a role in determining treatment adherence in chronic diseases. Hypertension affects one-third of the world’s population. In Africa, hypertension is a leading cause of death from a non-communicable disease. Modifications to lifestyle and behavior, as well as increased access to pharmaceuticals, are necessary for every African nation to bring the prevalence of hypertension and cardiovascular disorders under control.

Methods

In order to assess the predictive association between the two, we conducted research on 216 hypertensive patients who were treated in private clinics in Algeria. These patients were given two assessments to fill out: one was called the general self-efficacy scale (GSES), and the other was called the treatment adherence scale. Comparisons of male and female self-efficacy and adherence were made with the help of Pearson’s correlation coefficient and a sample independent t-test (selfefficacy, adherence to treatment).

Conclusions

Self-efficacy in general has been shown to be connected with adherence to hypertension therapy (r(214) = 0.496, p=0.01, <0.05). There is no significant difference between the sexes in either selfefficacy (t(214)=0.985, p=0.326, >0.05) or hypertension treatment adherence (t(214)=0.034, p=0.973, >0.05). A higher level of self-efficacy was found to have a positive correlation with a higher level of treatment adherence; it is possible to increase the medication adherence of hypertension patients by enhancing their level of self-efficacy. It is important for those working in health care to acknowledge the significance that self-care plays in overall health.

Global Burden, Regional Differences, Trends, and Health Consequences of Medication Nonadherence for Hypertension During 2010 to 2020: A Meta-Analysis Involving 27 Million Patients

Background

Nonadherence to antihypertensive medications is the leading cause of poor blood pressure control and thereby cardiovascular diseases and mortality worldwide.

Methods and Results

We investigated the global epidemiology, regional differences, and trend of antihypertensive medication nonadherence via a systematic review and meta‐analyses of data from 2010 to 2020. Multiple medical databases and clinicaltrials.gov were searched for articles. Observational studies reporting the proportion of patients with anti‐hypertensive medication nonadherence were included. The proportion of nonadherence, publication year, year of first recruitment, country, and health outcomes attributable to antihypertensive medication nonadherence were extracted. Two reviewers screened abstracts and full texts, classified countries according to levels of income and locations, and extracted data. The Joanna Briggs Institute prevalence critical appraisal tool was used to rate the included studies. Prevalence meta‐analyses were conducted using a fixed‐effects model, and trends in prevalence were analyzed using meta‐regression. The certainty of evidence concerning the effect of health consequences of nonadherence was rated according to Grading of Recommendations, Assessment, Development and Evaluations. A total of 161 studies were included. Subject to different detection methods, the global prevalence of anti‐hypertensive medication nonadherence was 27% to 40%. Nonadherence was more prevalent in low‐ to middle‐income countries than in high‐income countries, and in non‐Western countries than in Western countries. No significant trend in prevalence was detected between 2010 and 2020. Patients with antihypertensive medication nonadherence had suboptimal blood pressure control, complications from hypertension, all‐cause hospitalization, and all‐cause mortality.

Conclusions

While high prevalence of anti‐hypertensive medication nonadherence was detected worldwide, higher prevalence was detected in low‐ to middle‐income and non‐Western countries. Interventions are urgently required, especially in these regions. Current evidence is limited by high heterogeneity.

Registration

URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021259860.

Psychometric properties and validation of the revised Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP-R)

Background

Medication literacy is one of the key indicators that can affect the self-management of medications and medication safety. This study aimed to revise the Chinese Medication Literacy Scale for hypertensive patients (C-MLSHP) and test the reliability and validity of the revised scale.

Methods

We revised the C-MLSHP by several methods, i.e., focus group discussion, expert consultation, patient interview, and pilot study, based on the established evaluation index system of medication literacy for hypertensive patients. Then, a formal survey using the revised Chinese Medication Literacy Scale for hypertensive patients (C-MLSHP-R) was carried out on hypertensive patients from hospitals and community healthcare centers in Changsha city of China to test its reliability and validity. The reliability was evaluated with Cronbach's α coefficient, split-half reliability, and test–retest reliability. The validity was evaluated with content validity, construct validity, convergent validity, discriminant validity, and criterion-related validity.

Results

The C-MLSHP-R contained 18 items within four domains, i.e., the knowledge domain included four items, the attitude domain had three items, the skill domain involved seven items, and the practice domain included four items. A total of 339 hypertensive patients participated in the formal survey. The results showed that the Cronbach's α coefficient of C-MLSHP-R was 0.802, and for each domain ranged from 0.639 to 0.815. The split-half reliability coefficient of C-MLSHP-R was 0.709, and for each domain ranged from 0.648 to 0.792. The test–retest reliability coefficient of C-MLSHP-R was 0.851, and for each domain ranged from 0.655 to 0.857. The I-CVI of each item ranged from 0.833 to 1.000, the S-CVI/Ave of C-MLSHP-R was 0.981, the S-CVI/UA was 0.889, and for each domain ranged from 0.958 to 1.000. Confirmatory factor analysis results showed that the model fitted well. The convergent validity of C-MLSHP-R was acceptable, and the discriminant validity was good. The criterion coefficient between C-MLSHP-R and C-MLSHP was 0.797, and for each domain ranged from 0.609 to 0.755.

Conclusion

Compared with C-MLSHP, the C-MLSHP-R with 18 items was much shorter for measuring, and had decreased reliability within the acceptable range and better validity, which was more appropriate and time-saving to assess the medication literacy level for hypertensive patients scientifically and conveniently.

Predictors of Nonadherence to Medications among Hypertensive Patients in Ghana: An Application of the Health Belief Model

Introduction. Hypertension (HPT) is recognized as a significant public health problem worldwide from a health and economic perspective. This study determined predictors of nonadherence to HPT medications in Ghana using the health belief model. Methods. A cross-sectional descriptive survey employing a quantitative approach was conducted among HPT patients who routinely attend clinics at selected hospitals in the Brong Ahafo region of Ghana. Respondents (n = 399) were recruited using a multistage sampling technique. Results. The prevalence of nonadherence was 63.7% (n = 254). Nonadherence to hypertension medication was associated with lower education status ( $p=0.009$ ). In logistic regression analysis, patients with high “perceived susceptibility” and “perceived severity” were more likely to forfeit their HPT medication schedules, while patients with high “perceived barriers” and “cues to action” were less likely to skip their medication. Conclusion. The present study suggests a plausible path to improving medication adherence in this population. Given the high prevalence of nonadherence, policymakers need to urgently design tailor-made health promotion interventions to ensure optimal health outcomes.

Proposed Mechanism of Adherence in Caregivers Providing Care to Adults Living with a Left Ventricular Assist Device

INTRODUCTION

The left ventricular assist device (VAD) is commonly used as the bridge-to-transplantation therapy for heart failure patients who are on waitlist of heart transplant. The caregivers' adherence to the homecare regimen plays a vital role in patient outcomes. There is little evidence about the factors related to the caregiver adherence. The purpose of this study was to determine the factors influencing adherence in caring for patients living with a left ventricular device.

METHODS

The data were collected from 4 online caregiver support groups. Multiple linear regression models were used to determine associations between key variables. The structure equation modeling was used to identify the mediators of caregiver adherence.

RESULTS

A total of 96 participants' data entered the final analysis. The average age of the participants was 49.8 (SD = 12.88) years, majority were white (84%), female (80%), and married (81%). Caregiver self-efficacy was positively related to their adherence (r = 0.460, P < 0.001). Caregiver knowledge did not mediate the effect of training on self-efficacy. Caregiver self-efficacy did not mediate the effect of knowledge on adherence. There was no interaction between practice hours and knowledge on adherence.

DISCUSSION

The findings suggest significant association between caregiver self-efficacy and adherence to left ventricular assist home-care regimens. Additional research is needed to identify factors influencing caregiver adherence, leading to the development of evidence-based practice guidelines and to improve the outcomes in advanced heart failure patients living with left VAD.

Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model

Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms. Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy. Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes's PROCESS macro, based on the bootstrapping method. Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = -0.36, 95% CI: (-0.50, -0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β = 0.36, 95% CI: (0.23, 0.50)]. Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.

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.

Medication Adherence and Associated Factors in Patients With Type 2 Diabetes: A Structural Equation Model

Background: The number of patients with type 2 diabetes (T2D) is increasing. Medication treatment is of great importance to stabilize blood glucose. Previous studies have reported that neuroticism, self-efficacy, and social support are factors associated with medication adherence, but few studies have fully investigated the mechanisms between these factors and medication adherence in patients with T2D. Purpose: To explore the prevalence of medication adherence and the factors associated with medication adherence in patients with T2D. Methods: A cross-sectional study consisting of 483 patients with T2D was conducted from July to December 2020. Questionnaires containing sociodemographic and clinical characteristics, the Morisky Medication Adherence Scale-8 (MMAS-8), the neuroticism subscale of the Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Diabetes Management Self-efficacy Scale (DMSES) were used to collect data. The structural equation model (SEM) was used to test the hypotheses. Results: This study included 305 (63.1%) medication adherence and 178 (36.9%) medication non-adherence patients with T2D. Social support directly influenced medication adherence (β = 0.115, P = 0.029) and indirectly influenced medication adherence through self-efficacy (β = 0.044, P = 0.016). Self-efficacy directly influenced medication adherence (β = 0.139, P = 0.023). Neuroticism indirectly affected medication adherence through social support (β = -0.027, P = 0.023) and self-efficacy (β = -0.019, P = 0.014). Moreover, there was a sequential mediating effect of social support and self-efficacy on the relationship between neuroticism and medication adherence (β = -0.010, P = 0.012). After controlling for age and gender, similar results were obtained. The model fit indices showed a good fit. Conclusions: The medication adherence of patients with T2D needs to be improved. Neuroticism, social support, and self-efficacy had direct or indirect effects on medication adherence in patients with T2D. Healthcare providers should comprehensively develop intervention programs based on neuroticism, social support, and self-efficacy to improve medication adherence in patients with T2D.

Multidimensional factors affecting medication adherence among patients with chronic obstructive pulmonary disease

AIMS AND OBJECTIVES

This study aimed to investigate the effects of socioeconomic-, patient-, treatment-, condition- and health system-related factors on medication adherence in patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND

Medication adherence is essential for the management of chronic diseases. The World Health Organization created a Multidimensional Adherence Model (MAM) and showed that medication adherence is affected by a combination of numerous factors.

DESIGN

A descriptive correlational study was conducted.

METHODS

A total of 114 patients with COPD were included. Data were collected on five dimensions based on the MAM framework. Medication adherence, self-efficacy and symptoms were evaluated using the Adherence to Refills and Medications Scale-7 (ARMS-7), COPD Self-Efficacy Scale (CSES) and COPD Assessment Test (CAT), respectively. The data were analysed using descriptive statistics, correlational statistics and structural equation modelling. The STROBE checklist was used.

RESULTS

The ARMS-7 scores were associated with the body mass index of patients (F = 4.245, p = .017), smoke pack-years (r = .277, p = .004) and the CSES total score (β = -0.249, p = .002) in patient-related factors. The ARMS-7 score was not associated with socio-economic and health system-related factors. The ARMS-7 score showed a significant correlation between COPD diagnosis duration (r = -.276, p = .003) and the total number of drugs (r = -.215, p = .022) in treatment-related factors. The ARMS-7 scores were associated with the number of comorbid illnesses of patients with COPD in condition-related factors (F = 3.533, p = .033).

CONCLUSION

This study showed that medication adherence in COPD was mostly affected by patient-, treatment- and condition-related factors.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should establish training and counselling programs to increase the medication adherence level of patients, particularly for patients who are newly diagnosed, require multiple drugs and have comorbid diseases or low self-efficacy.