Social support and management of hypertension in South-west Nigeria

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.

Family Management of Hypertension in Brazil: A Cross-Sectional Study

In Brazil, research indicates that primary family members are the main source of support for individuals with chronic conditions such as hypertension (HTN). The burden of caregiving not only hinders effective HTN management but can also cause stress and anxiety, potentially leading to HTN in caregivers. Despite this, few studies have explored the impact of caregiving on these family members. Aims of the study were to: (1) Describe the prevalence of blood pressure (BP) control in family members of individuals with HTN; (2) identify family member perspectives on facilitators and barriers to HTN management; and (3) identify influences that help or interfere with family member functioning (levels of stress, quality of life [QOL], and caregiver burden). This descriptive, cross-sectional study included 213 family members randomly selected from 3 Family Health Strategy units. Family members were largely female (n = 143; 67.1%); the mean age was 60.1 years (SD ± 17.02) and 42.6% (n = 96) had less than a high school education. The three most important facilitators and barriers were related to medication, medical visits, healthy eating, physical activity, and stress. The mean systolic BP was 132.7 (SD ± 21.9) mmHg and a diastolic BP of 85.9 (SD ± 18.1) mmHg with 120 (56.3%) of family members classified as having normal BP. In regard to family member contributions to the self-care of the individual with HTN, family members displayed low levels of self-care maintenance (n = 148; 69.4%) and management (n = 47; 71.2%) support, while a slight majority (n = 114; 53.5%) had adequate levels of self-care confidence in supporting the individual with HTN. Family members (n = 189; 88.8%) showed moderate-to-high levels of perceived stress, but good physical (n = 189; 88.7%) and mental QOL (n = 196; 92%) and low levels of caregiver burden (n = 113; 53.1%). A variety of contextual sociocultural influences were associated with the outcomes under study. Family-based interventions are urgently needed to address the inadequate management of HTN.

Screening for hepatitis B in the Bronx West African community with a blood pressure cuff: a cohort study

Background

Hepatitis B (HBV) and hypertension (HTN) are prevalent in West Africa (WA). Inadequate control is common, and evaluation and management are challenging among immigrants due to unfamiliarity with the United States (US) healthcare system. While HBV is stigmatised, HTN is recognised as an important condition. We describe how a HTN screening program can facilitate HBV screening in the Bronx WA community.

Methods

Thirty-minute HTN educational programs were delivered in collaboration with faith-based organisations, and 5-min presentations were presented upon request at community gatherings. Arrangements were made for those interested in a clinic visit where a questionnaire was completed, blood pressure (BP) measured, a free BP cuff provided, HBV testing performed, and referrals made. For those without ongoing care, insurance was arranged, and linkage to care provided.

Findings

Seven 30-min and five 5-min presentations were conducted. After the 30-min presentation, 204 of 445 attendees (45.8%) requested a visit, and 68 (33.3%) attended the visit. After the 5-min presentation, 80 requested a visit and 51 (63.8%) attended the visit. A BP >140/90 mmHg was present in 122 individuals (48.4%), including 43 (17.1%) without a history of HTN and 39 (15.5%) with BP >160/90 mmHg. All except two who reported previous testing agreed to HBV testing. 19 (7.5%) were hepatitis B surface antigen positive. Transition into ongoing care was provided for 60 (33.9%) with HTN who were not integrated into the US healthcare system.

Interpretation

HTN screening with a free BP cuff promotes HBV screening and US healthcare integration.

Funding

No funding.

Relationship Between Social Support and Clinical Outcomes: An Evaluation of Participant-Nominated Treatment Supporters in the HOPE 4 Intervention

BACKGROUND

The HOPE 4 trial (Heart Outcomes Prevention and Evaluation 4) investigated the effectiveness of a comprehensive, collaborative model of care, implemented in Colombia and Malaysia, which aimed to reduce cardiovascular disease risk in individuals with hypertension. One component of this intervention was the nomination of a treatment supporter, where participants could select a family member or friend to assist them with their care. The purpose of this study was to investigate the impact of these individuals on participant outcomes, as well as the relationship dynamics between participants and their treatment supporter.

METHODS

Participants in the HOPE 4 intervention group with baseline and 12 months of follow-up were included for analysis. They were divided into Every Visit (n=339) and

RESULTS

Groups were majority female (53% versus 62%) with a mean age of 63 and 66 years. Country of origin differed between groups (22% versus 86%; Colombia). A 15.5% ([95% CI, 6.2%-24.8%] P=0.004) greater increase in statin medication use was reported in the Every Visit group at 12 months compared with the

CONCLUSIONS

Long-term support from a nominated treatment supporter was associated with improved adherence, risk factor management, and medication use among individuals with hypertension.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01826019.

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Key Words

• cardiovascular diseases
• hypertension
• medical adherence
• risk factors
• social support

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MESH Headings

• Humans
• Female
• Middle Aged
• Aged
• Hypertension/diagnosis
• Hypertension/drug therapy
• Hypertension/epidemiology
• Blood Pressure
• Medication Adherence
• Risk Factors
• Social Support

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Affiliation(s)

Anastasia Drakos Faculty of Medicine, University of Ottawa, ON, Canada (A.D.) Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (A.D., T.M., S.I., S.Y., J.D.S.)
Tara McCready Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (A.D., T.M., S.I., S.Y., J.D.S.)
Patricio Lopez-Jaramillo Research Institute, Fundación Oftalmológica de Santander, Floridablanca, Colombia (P.L.-J.) Masira Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia (P.L.-J.)
Shofiqul Islam Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (A.D., T.M., S.I., S.Y., J.D.S.)
Martin McKee Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom (M.M.)
Salim Yusuf Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (A.D., T.M., S.I., S.Y., J.D.S.) Department of Health Research Methods, Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada (S.Y.)
J D Schwalm Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (A.D., T.M., S.I., S.Y., J.D.S.)

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Role of Perceived Social Support in Adherence to Antihypertensives and Controlled Hypertension: Findings of a Community Survey from Urban Nepal

Introduction

Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management.

Methods

We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale -8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals.

Results

We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives.

Discussion

Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.

Research on the control rate of hypertension under family physician-contracted service

BACKGROUND

Hypertension is one of the global public health problems. Family physician-contracted service (FPCS) is widely used in the health management of hypertension patients in China. The purpose of this study was to assess the effect of FPCS on hypertension control.

METHODS

PubMed, Web of Science, the Cochrane Library, China National Knowledge Network, Chinese Scientific and Technological Journal Database (CQVIP), and Wanfang Database were searched for randomized controlled trials related to family physician-contracted service and hypertension control effect, and meta-analysis was performed on the literature meeting the inclusion criteria. The source of heterogeneity was discovered by meta-regression, and it was further investigated by subgroup analysis. The risk difference (RD) and 95% confidence interval (CI) were utilized as effect values. Evaluations of publication bias and sensitivity analysis were also conducted.

RESULTS

A total of 46 studies were included, and the pooled RD suggested that FPCS could effectively improve the control rate by 19% (RD = 0.19; 95%CI: 0.16-0.21; P < 0.001; I2 = 59.3%). The average age (β = 0.28; P = 0.05) and the intervention mode (β = 0.36; P < 0.001) were found to be heterogeneous sources by the meta-regression. According to subgroup analysis, the hypertension control rates of the elderly and working-age population in the experimental group were 93.6% and 90.1%, respectively; the control rates of the "family physician" mode (FP), "family physician + patient" mode (FPP) and "family physician + patient + family member" mode (FPPF) in the experimental group were 90.1%, 94.4%, and 92.6%, respectively. The sensitivity analysis revealed steady results, with no discernible publication bias.

CONCLUSIONS

The FPCS is beneficial to the control of hypertension. The control effect is influenced by average age and intervention mode. The control effect of hypertension in the elderly is better than that in the working-age population, and FPP and FPPF are more beneficial to the management of hypertension than FP. The quality and continuity of FPCS should receive more focus in the future, patient self-management and family support are also essential for managing hypertension.

Barriers and Facilitators to Risk Reduction of Cardiovascular Disease in Hypertensive Patients in Nigeria

Background

In Sub-Saharan Africa (SSA), the prevalence of hypertension is increasing due to many factors like rapid population growth, globalization, stress, and urbanization. We aimed to characterize the perceptions of cardiovascular disease (CVD) risk among individuals with hypertension living in Nigeria and identify barriers and facilitators to optimal hypertension management.

Methods

This cross-sectional survey study was conducted at a large teaching hospital in Lagos, Nigeria. We used a convenient sample of males and females, aged 18 or older, with a diagnosis of hypertension who presented for outpatient visits in the cardiology, nephrology, or family medicine clinics between November 1 and 30, 2020. A semiquantitative approach was utilized with a survey consisting of closed and open-ended questionnaires focused on patient knowledge, perceptions of CVD risk, and barriers and facilitators of behavioral modifications to reduce CVD risk.

Results

There were 256 subjects, and 62% were female. The mean age was 58.3 years (standard deviation (SD) = 12.6). The mean duration of the hypertension diagnosis was 10.1 years. Most participants were quite knowledgeable about hypertension; however, we observed some knowledge gaps, including a belief that too much "worrying or overthinking" was a major cause of hypertension and that an absence of symptoms indicated that hypertension was under control. Barriers to hypertension management include age, discomfort or pain, and lack of time as barriers to exercise. Tasteless meals and having to cook for multiple household members were barriers to decreasing salt intake. Cost and difficulty obtaining medications were barriers to medication adherence. Primary facilitators were family support or encouragement and incorporating lifestyle modifications into daily routines.

Conclusion

We identified knowledge gaps about hypertension and CVD among our study population. These gaps enable opportunities to develop targeted interventions by healthcare providers, healthcare systems, and local governments. Our findings also help in the promotion of community-based interventions that address barriers to hypertension control and promote community and family involvement in hypertension management in these settings.

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.

Complementary support in later life: investigating the gender disparities in patterns and determinants among older adults in South-Western Nigeria

Old-age needs are multifaceted and require multiple support sources, yet caregiving roles for older Nigerians are largely shifted to adult children. However, the children also declining capacity to respond. The extent to which older adults access support from other sources remains under-researched. This study investigates the patterns and determinants of access to complementary supports among older adults in South-Western Nigeria, taking Oyo State as the case study. The study is cross-sectional and utilized primary data of 827 older adults aged ≥ 65 years selected using a multi-stage sampling design. Box plot was used to determine the patterns while multiple ordinary least square regression was used to predict the determinants of access to complementary support. Expressed in percentage, the median complementary support score of older adults in Oyo State was 30 (interquartile range [IQR] = 24) with a slightly higher score for men (median = 32, IQR = 24) compared to women (median = 28, IQR = 20). Access to complementary support was lower for the widow(er)s, the lower socioeconomic group and self-dependent older adults across genders, and for urban women with secondary/higher education compared to the otherwise groups. Increased access to complementary support was significantly associated with primary/no education (β = 4.365; p < 0.01 95% C.I. = 1.511–7.218), affiliation to Islamic/Traditional religion (β = 5.100; p < 0.001; 95% C.I. = 3.000–7.200), rich wealth status (β = 3.315; p < 0.05; 95% C.I. = 0.667–5.963) and depending on both self and children/family for income (β = 5.510; p < 0.05; 95% C.I. = 1.710–9.309) with some gender disparities. However, reduced complementary support was associated with ages 80 years or over (β = -3.649; p < 0.05; 95% C.I. = -6.460 – -0.838) and widowhood (β = -6.285; p < 0.001; 95% C.I. = -8.556 – -4.015). The study suggests the need for welfare plans among professional, social, and religious groups, institutionalised social support systems, and community engagement to escalate welfare support for older adults. It also recommends intensified attention on the more vulnerable groups, especially the widows, childless and lower socioeconomic groups.

Gaps in Hypertension Management in a Middle-Income Community of Quito-Ecuador: A Population-Based Study

Optimal hypertension care and control at population level significantly reduces cardiovascular morbidity and mortality. The study objective was to measure the gaps in the diagnosis, care, and control of hypertension in residents of an urban community in Quito, Ecuador. A cross-sectional population-based study with a sample of 2160 persons was performed using a survey and direct blood pressure measurement. Logistical regression models were used for analyzing factors associated with the gaps, expressed as percentages. The prevalence of hypertension was 17.6% [CI 95% 17.3-17.9%]. The diagnosis gap was 6.1% [CI 95% 5.9-6.2%] among the entire population and 34.5% [CI 95% 33.7-35.3%] among persons with hypertension. No access gaps were detected; whereas the follow-up gap was 22.7% [CI 95% 21.8-23.6%] and control gap reached 43.5% [CI 95% 42.6-44.2%]. Results indicated that being male, older than 64 years, an employee, without health insurance, and not perceiving a need for healthcare, increased the risk of experiencing these gaps. Data showed appropriate access to health services and high coverage in the diagnosis was due to the application of a community and family healthcare model. Notwithstanding, we found significant gaps in the follow-up and control of hypertensive patients, especially among older males, which should warrant the attention of the Ministry of Health.

Predictors of poor medication adherence of older people with hypertension

Aims

To explore the risk factors for poor medication adherence in older people with hypertension.

Design

A cross‐sectional study.

Methods

Participants were administered with a self‐report questionnaire about their demographic characteristics; additionally, their four‐item Morisky Medication Adherence Scale scores were calculated. The STROBE checklist was applied as the reporting guideline for this study (File S1).

Results

Univariate analysis indicated that the following five factors were statistically significantly associated with medication adherence: education level (χ² = 8.073, p = .045), co‐living (χ² = 11.364, p = .010), hypertension complications (χ² = 10.968, p = .001), admission blood pressure (χ² = 8.876, p = .003), and falls (χ² = 6.703, p = .010). Multivariable binary logistic regression analysis showed that there were four statistically significant predictors, such as people who lived with spouses and offspring (OR = 3.004, p = .017), and those who had high admission blood pressure (OR = 1.910, p = .003) had a greater risk of poor medication adherence, whereas those without hypertension complications (OR = 0.591, p = .026) and those without falls (OR = 0.530, p = .046) had a lower risk.

Relevance to clinical practice

We believe that these findings contribute to the identification of high‐risk people with poor adherence, allowing nurses to identify people with poor adherence in a timely manner, and pay attention to the people's medication.

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.

Race, geographical location and other risk factors for hypertension: South African National Health and Nutrition Examination Survey 2011/12

BACKGROUND

Hypertension is the leading cardiovascular disease in Africa. It is increasing in prevalence due partly to the epidemiological transition that African countries, including South Africa, are undergoing. This epidemiological transition is characterised by a nutrition transition andurbanisation; resulting in behavioural, environmental and stress changes that are subject to racial and geographic divides. The South African National Health and Nutrition Examination Survey (SANHANES) examined the association of traditional risk factors; and less traditional risk factors such as race, geographical location, social stressors and psychological distress with hypertension in a national population-based sample of South Africans.

METHODS

Data were analysed on individuals ≥15 years who underwent a physical examination in the SANHANES (n = 7443). Hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension medication usage. Stepwise regression examined the association of demographic, socioeconomic, life stressors, and health risk factors with systolic blood pressure, diastolic blood pressure, and hypertension. Secondly, the risk factor associations and geographical location effects were investigated separately for the African race group.

RESULTS

Increasing age (AOR = 1.069, p < 0.001); male gender (AOR = 1.413, p = 0.037); diabetes (AOR = 1.66, p = 0.002); family history of high blood pressure (AOR = 1.721, p < 0.001); and normal weight, overweight and obesity (relative to underweight: AOR = 1.782, p = 0.008; AOR = 2.232, p < 0.001; AOR = 3.874, p < 0.001 respectively) were associated with hypertension. Amongst African participants (n = 5315) age (AOR = 1.068, p < 0.001); male gender (AOR = 1.556, p = 0.001); diabetes (AOR = 1.717, p = 0.002); normal weight, overweight and obesity (relative to underweight: AOR = 1.958, p = 0.006; AOR = 2.118, p = 0.002; AOR = 3.931, p < 0.001); family history of high blood pressure (AOR = 1.485, p = 0.005); and household crowding (AOR = 0.745, p = 0.037) were associated with hypertension. There was a significantly lower prevalence of hypertension in rural informal compared to urban formal settings amongst African participants (AOR = 0.611, p = 0.005). Other social stressors and psychological distress were not significantly associated with hypertension.

CONCLUSION

There was no significant association between social stressors or psychological distress and hypertension. However, the study provides evidence of high-risk groups for whom hypertension screening and management should be prioritised, including older ages, males, people with diabetes or with family history of hypertension, and Africans who live in urban formal localities.

Effects of a social support family caregiver training program on changing blood pressure and lipid levels among elderly at risk of hypertension in a northern Thai community

Hypertension is becoming increasingly prevalent among the elderly. Family caregivers play an important role in caring for elderly people and empowering them to care for themselves. This study’s goal was to see how social support training for family caregivers affected changes in hypertension, total cholesterol, and high-density lipoprotein (HDL), and how such support led to the prevention of hypertension behaviors among the elderly in rural areas. This was a quasi-experimental study with 268 elderly people at risk of hypertension and their caregivers. Sixty seven pairs of elderly people and their caregivers were assigned to the intervention and control groups. Baseline data were collected in November 2020. The intervention group received the Social Support Family Caregiver Training Program (SSFCTP), while the control group received a regular program from the local health authority. The activity lasted 12 weeks, with home visits and telephone check-ups along the way, and data collection took place after the program ended. The final data were collected three months after the end of the intervention. An analysis of repeated measures ANOVA showed the overall effect of the SSFCTP on knowledge, self-efficacy, health care behaviors, and blood pressure among elderly people during three different time periods (p<0.05). Furthermore, the intervention program had a time-dependent effect on knowledge, blood pressure, and total cholesterol levels (p<0.05). In terms of caregiver outcomes, there was an overall difference among the degrees of knowledge, self-efficacy, and behaviors toward health care displayed by elderly hypertensive patients during the three different time periods (p<0.05). The average knowledge and self-efficacy of the participants improved after the intervention. As a result, better self-care behaviors and lower blood pressure and total cholesterol levels were observed among the elderly participants after the intervention. The programs emphasized the importance of caregivers’ roles in providing social support, boosting confidence, and encouraging participation in caring, monitoring, and assisting the elderly in controlling blood pressure and other health issues.

Gender differences in family support to older adults and implications for social work in south-east Nigeria

The increase in the number of older adults in Nigeria is a significant demographic trend, requiring adequate and sustainable attention. Usually, these older adults depend on family members for support due to increasing frailty and/or disengagement from the civil service or other income-earning pursuits. Studies that depict differences in gender vis a vis access to social support from family networks are limited. This study will attempt to contribute to filling this gap. Four focus group discussions and 16 in-depth interviews were conducted on a sample of (N = 56) older adults aged 70 years and above and their 23 to 46 year old family carers. The generated data were analysed in themes. Findings revealed no differences in access to health support by gender; however, females received more financial, emotional as well as material support, and were more involved in social activities than their male counterparts. This study will facilitate a better understanding of gender differences in social support for older adults in Nigeria. This could, in turn, inform inclusive social policies guided by social workers which have greater focus on the needs of older adults.

Investigating predictors of self-care behavior among homebound older adults: The role of self-efficacy, eHealth literacy, and perceived social support

PURPOSE

This study aimed to investigate the predictors of self-care behavior among homebound older adults using the Health Empowerment theory as a framework.

DESIGN

This was a cross-sectional, predictive correlational study.

METHODS

Sixty-eight participants were randomly selected from five Hong Kong community centers from May 21, 2020 through July 20, 2020. Self-care behaviors were assessed using the Chinese version of Partners in Health. Self-efficacy, eHealth literacy, and perceived social support were assessed as potential predictors of self-care behaviors. A multiple linear regression analysis was adopted to examine the predictive effects.

RESULTS

The age of the sample ranged from 61 to 85 years (mean = 71.7, SD = 6.0). Participants who reported having sufficient or more than sufficient financial resources had better self-care behaviors than those who claimed to have insufficient financial resources (F = 5.08, p = 0.009). Statistically significant correlations were found between the participants' eHealth literacy (r = 0.54, p < 0.001), perceived social support (r = 0.60, p < 0.001), and self-care behaviors. eHealth literacy (β = 0.13, p = 0.007) and perceived social support (β = 0.13, p < 0.001) were significant predictors of self-care behaviors. Collectively, the three variables accounted for 41% of the variances in self-care behaviors.

CONCLUSIONS

The findings in this study suggest that eHealth literacy and perceived social support are two key factors that predicted the self-care behaviors of this vulnerable population.

CLINICAL RELEVANCE

In this technological era, the use of eHealth, together with enhanced social support, can lead to better self-care among older adults, particularly those who are homebound.

The Effect of Social Support on Treatment Adherence in Hypertension in China

OBJECTIVE

Treatment nonadherence is a major problem in the management of hypertension. There are many factors influencing the treatment adherence of hypertensive patients. The aim of this study was to examine the effect of social support on the treatment adherence in hypertension in China.

PATIENTS AND METHODS

A total of 453 patients with hypertension hospitalized in a tertiary hospital in Xi'an, China were invited to participate in this cross-sectional study. Data were collected by "modified Chinese Hill-Bone compliance to high blood pressure therapy scale" and "Chinese Family Support Scale".

RESULTS

It was found that 31.1% of patients were adherent with their antihypertensive treatments. Gender, duration of antihypertensive drug used, number of antihypertensive drugs used and social support were independently associated with hypertensive treatment adherence. Social support was strongly and positively associated with the hypertensive treatment adherence (P<0.001, OR = 0.752, 95% CI: 0.678-0.833). Family social support was provided to hypertensive patients mainly through their nuclear family, that is spouses, partner or children. Treatment adherence of hypertensive patients was positively correlated to the three subgroups of social support. It was found that social support provided to patients from social resource (r=0.568) had greater impact on treatment adherence than that from kinship (r=0.364) and nuclear family (r=0.262).

CONCLUSION

Treatment adherence of patients with hypertension was found to increase positively as their social support increased. In addition to the support given to patients from nuclear family members, other social support especially professional agencies and community organizations should also be promoted and strengthened.

Effects of a family dyadic partnership program for people with hypertension in a rural community: A pilot randomised controlled trial

OBJECTIVE

To evaluate the feasibility, acceptability and preliminary effectiveness of a theory-based patient-family carer partnership intervention for people with hypertension in a Chinese rural community.

DESIGN

A pilot randomised controlled trial using pretest and post-test design.

SETTING

Rural China PARTICIPANTS: Forty-four hypertensive patients and their family carers (family dyads) were randomly recruited from a village clinic located in China between November 2019 and January 2020.

INTERVENTIONS

Participants were randomised to either an intervention group receiving a five-session patient-family carer partnership intervention over 10 weeks or a control group receiving usual care.

MAIN OUTCOME MEASURES

The feasibility and acceptability of patient-family carer partnership intervention and the changes in patients' systolic blood pressure, diastolic blood pressure and percentage of normal controlled blood pressure.

RESULTS

The patient-family carer partnership intervention was a feasible and acceptable program with high recruitment (81.5%) and completion rates (95.5%) and positive feedback from participants. Greater improvement in the percentage of normal controlled blood pressure was identified in the intervention group tested by the χ² tests, with P = .03. Two-way ANOVA results indicated its interaction (Group × Time) effects on patients' systolic blood pressure (P < .001), diastolic blood pressure (P < .001), dyadic partnership quality (P = .002), self-care (P < .001), self-efficacy (P = .02), antihypertensive drug treatment rate (P = .02), prescription adjustment (P = .03), perceived anxiety (P < .001) and health-related quality of life (EuroQol five-dimensional five-level: P = .02; EuroQol visual analogue scale: P < .001); family carers' dyadic partnership quality (P = .002), perceived depression (P = .04) and health-related quality of life (P = .02) were significant.

CONCLUSION

Our findings support the feasibility and acceptability of the patient-family carer partnership intervention and indicate benefits in improving patients' blood pressure control, dyadic relationship and psychological well-being of family dyads in rural area. Further research to test the longer-term effect in a large-sized population is recommended.

Undiagnosed Depression among Hypertensive Individuals in Gaza: A Cross-sectional Survey from Palestine

BACKGROUND

The aim of this study was to estimate the prevalence and to determine the associated factors of undiagnosed depression amongst hypertensive patients (HTNP) at primary health care centers (PHCC) in Gaza.

METHODS

A cross-sectional survey was conducted including 538 HTNP as a recruitment phase of a clustered randomized controlled trial. Data were collected through face-to-face structured interview, and depression status was assessed by Beck's Depression Inventory (BDI-II). Data were analyzed by STATA version 14 using standard complex survey analyses, accounted for unresponsiveness and clustering approach. Generalized linear regression analysis was performed to assess associations.

RESULTS

The prevalence of undiagnosed clinical depression was 11.6% (95% confidence interval [CI]: 8.1, 16.3). Moreover, prevalence of 15.4% (95% CI: 10.8, 21.6) was found for mild depression symptoms. We found that non-adherence to antihypertensive medications (AHTNM) (β = 0.9, 95% CI: 0.17, 1.7), having more health-care system support (β = 2.8, 95% CI: 1.6, 3.9) and number of AHTNM (β = 1.5, 95% CI: 0.6, 2.5) remain significantly positively associated with BDI-II score. On the other hand, older age (β = -0.1, 95% CI: -0.2, -0.02), having better social support (β = -6.8, 95% CI: -8.9, -4.7) and having stronger patient-doctor relationship (β = -4.1, 95% CI: -6.9, -1.2) kept significantly negative association.

CONCLUSION

The prevalence of undiagnosed depression was about one-quarter of all cases; half of them were moderate to severe. Routine screening of depression status should be a part of the care of HTNP in PHCC.

Influence of Hostility on 24-Hour Diastolic Blood Pressure Load in Hypertension Patients with Depressive Disorders

BACKGROUND Hostility in hypertension patients combined with depressive disorders indicates a worse outcome for hypertension management. This study was designed to explore the influence of hostility on 24-h diastolic blood pressure in hypertension patients who also had depressive disorders. MATERIAL AND METHODS A total of 130 people with primary hypertension and depressive disorders were collected through unstructured psychiatric interview by a professional psychiatrist and ambulatory blood pressure monitor in this cross-sectional study. During the study, dynamic blood pressure was examined for 24 h by ambulatory blood pressure monitoring. Patients were divided into 3 groups according to the hostility level. Hostility was defined by hostile factors of the Symptom Checklist 90. The association between hostility and 24-h dynamic blood pressure was analyzed by multivariable logistic regression. RESULTS 30.8% (40 of 130) patients had a high level of 24-h dynamic blood pressure load (>30%), in which 14.6% was for male and 16.2% for female respectively. In male, the proportion of high 24 h DBP load (>30%) in highest hostility group was greater than that of low hostility group and median hostility group significantly (p=0.03). No significant differences were revealed among 3 groups in female. The age-adjusted odds-ratio (OR) 95% confidence interval of diastolic blood pressure across the categories of hostility were: in males, 1.44 (0.60, 3.47) (1 for reference), and in females, 5.86 (0.58, 59.06) (P for trend=0.04). CONCLUSIONS Our results showed that hostility may be a risk factor for increased 24-h diastolic blood pressure in hypertension patients who also have depressive disorders, especially in males. The clinical meaning of the study is that hypertension management should contain psychological interventions for better effects.

The effect of loneliness and perceived social support on medication adherence self-efficacy in hypertensive patients: An example of Turkey

This study was conducted to investigate the effect of loneliness and perceived social support on medication adherence self-efficacy in hypertensive patients. This descriptive cross-sectional study was conducted between March and June 2015 at 5 Family Health Centers in central Erzincan in eastern Turkey. The data were collected through face-to-face interviews using a descriptive questionnaire, the UCLA Loneliness Scale, the Multidimensional Scale of Perceived Social Support, and the Medication Adherence Self-Efficacy Scale Short Form. The mean score obtained from the UCLA Loneliness Scale was 38.35 ± 9.85, from the Multidimensional Scale of Perceived Social Support 64.10 ± 18.31, and from the Medication Adherence Self-Efficacy Scale 40.27 ± 11.97. The mean UCLA Loneliness Scale score was found to have a low negative correlation with the mean Medication Adherence Self-Efficacy Scale score and a highly significant negative correlation with the mean Multidimensional Scale of Perceived Social Support score (P < .001). There was also a very low positive significant correlation between the mean scores of the Multidimensional Scale of Perceived Social Support and the Medication Adherence Self-Efficacy Scale (P < .001). This study revealed that individuals with hypertension perceived a moderate level of loneliness, and their perceived social support and medication adherence self-efficacy were higher than the moderate level. Perceived loneliness and perceived social support were significant indicators of perceived medication adherence self-efficacy. Therefore, effective consultancy services should be provided to hypertensive patients to increase their social support and to make positive changes in their perceived loneliness so that their perceived medication adherence self-efficacy can be improved.

Adherence to Antihypertensive Treatment and Associated Factors in Central Ethiopia

Background

Adherence to treatment is a primary determinant of treatment success. Nonadherence attenuates clinical benefits to the recipients of the treatment. However, monitoring adherence to long treatment regimens is not given due emphasis in low-income contexts. This study aimed to assess adherence to antihypertensive treatment and factors associated with it in Central Ethiopia.

Method

This is an institution-based cross-sectional study conducted in 4 public hospitals in Central Ethiopia from December 4, 2016, to September 25, 2017. The Morisky Medication Adherence Scale (MMAS-8) was used to assess the level of adherence. The Revised Illness Perception Questionnaire (IPQ-R) was used to assess illness perception. The MMAS-8 score ranges from 0 to 8, a score of 8 reflects high adherence, 6 to 7 medium adherence, and <6 low adherence.

Results

A total of 989 hypertensive patients participated in the study, of which 36.0% were assessed to have high adherence, 31.7% medium adherence, and 32.3% low adherence. We found that treatment adherence was significantly and positively associated with having family support (AOR: 1.65; 95% CI = 1.23, 2.22), high perception about consequences of hypertension (AOR: 1.51; 95% CI = 1.17, 1.95), and high perception about the severity of the disease (AOR: 1.42; 95% CI = 1.09, 1.86).

Conclusion

The treatment adherence to antihypertensive medications is low in Central Ethiopia. Engaging family members in the treatment plan and improving patients' understanding of the illness are critical in achieving high adherence to medication in this context.

Factors Associated with Antihypertensive Medication Non-Adherence: A Cross-Sectional Study Among Lebanese Hypertensive Adults

BACKGROUND

Poor adherence to antihypertensives is associated with negative outcome of the disease as well as loss of health-care resources. Addressing the epidemic of poor adherence requires identifying factors associated with this behaviour. The aim of this study is to describe adherence to antihypertensive medication among Lebanese hypertensive patients and to evaluate the association between socio-economic, patient- and conditions-related factors and non-adherence.

METHODS

A cross-sectional study was carried out on adherence to antihypertensive medications covering all governorates of Lebanon. This study was conducted between February 2018 and January 2019 on a random sample of 1497 hypertensive patients. A face-to-face questionnaire was used to assess adherence to antihypertensive medication and its determinants according to the five World Health Organization (WHO) main categories. Logistic regression analysis was performed to test the adjusted association between the multiple exposure factors, and drug adherence data were collected by trained interviewers.

RESULTS

Adherence to antihypertensive medications was reported by 1253 (83.7%) of the patients. After multivariate analysis, patients who tried to control their stress level (OR = 0.77, 95% CI [0.38-0.95]), those who had normal BP readings (OR =0.49, 95% CI [0.18-0.97]), and those who believed in the effectiveness of their treatment (OR = 0.31, 95% CI [0.14-0.76]) had a significantly lower chance to exhibit non-adherence to their treatment. However, older patients (OR= 1.87, 95% CI [1.23-2.21]), divorced/separated patients (OR= 2.14, 95% CI [1.31-5.48]), married (OR=1.96, 95% CI [1.27-3.90]), widowed (OR=2.11, 95% CI [1.62-6.50]), obese patients (OR = 1.76, 95% CI [1.21-1.94]), and patients who smoked hookah and cigarettes (OR = 2.62, 95% CI [1.17-6.76]) were more likely to exhibit non-adherence.

CONCLUSION

Our study highlights the influence of factors such as old age, marital status, BMI and high level of emotional stress on non-adherence to medication in hypertensive patients. These determinants should be incorporated into adherence improving strategies.

Exploring a New Natural Treating Agent for Primary Hypertension: Recent Findings and Forthcoming Perspectives

Primary hypertension describes abnormally-high systolic/diastolic blood pressure in a resting condition caused by various genetic or environmental risk factors. Remarkably, severe complications, such as ischemic cardiovascular disease, stroke, and chronic renal disease have led to primary hypertension becoming a huge burden for almost one-third of the total population. Medication is the major regimen for treating primary hypertension; however, recent medications may have adverse effects that attenuate energy levels. Hence, the search for new hypotensive agents from folk or traditional medicine may be fruitful in the discovery and development of new drugs. This review assembles recent findings for natural antihypertensive agents, extracts, or decoctions published in PubMed, and provides insights into the search for new hypotensive compounds based on blood-pressure regulating mechanisms, including the renin-angiotensin-aldosterone system and the sympathetic/adrenergic receptor/calcium channel system.

State-of-the-Science Review of Non-Chemical Stressors Found in a Child's Social Environment

Background: Children are exposed to chemical and non-chemical stressors from their built, natural, and social environments. Research is needed to advance our scientific understanding of non-chemical stressors, evaluate how they alter the biological response to a chemical stressor, and determine how they impact children’s health and well-being. To do this, we conducted a state-of-the-science review of non-chemical stressors found in a child’s social environment. Methods: Studies eligible for inclusion in this review were identified through a search of the peer-reviewed literature using PubMed and PsycINFO. Combinations of words associated with non-chemical stressors and children were used to form search strings. Filters were used to limit the search to studies published in peer-reviewed journals from 2000–2016 and written in English. Publications found using the search strings and filters went through two rounds of screening. Results: A total of 146 studies met the inclusion criteria. From these studies, 245 non-chemical stressors were evaluated. The non-chemical stressors were then organized into 13 general topic areas: acculturation, adverse childhood experiences, economic, education, family dynamics, food, greenspace, neighborhood, social, stress, urbanicity, violence, and other. Additional information on health outcomes, studies evaluating both chemical and non-chemical stressors, and animal studies are provided. This review provides evidence that non-chemical stressors found in a child’s social environment do influence their health and well-being in both beneficial (e.g., salutatory effects of greenspace and social support) and adverse (e.g., poor relationships between health and selected non-chemical stressors such as economics, educational attainment, exposure to violence, stress) ways. Conclusions: This literature review identified a paucity of studies addressing the combined effects of chemical and non-chemical stressors and children’s health and well-being. This literature review was further complicated by inconsistencies in terminology, methodologies, and the value of non-chemical stressor research in different scientific disciplines. Despite these limitations, this review showed the importance of considering non-chemical stressors from a child’s social environment when addressing children’s environmental health considerations.

Social Support and Depression Related to Older Adults' Hypertension Control in Rural China

OBJECTIVE

This study aimed to investigate association between social support and hypertension (HTN) control in rural China older adults, and to what extent depression mediates this relationship. The authors hypothesized that depression severity mediated the relationship between social support and HTN control.

METHODS

Data for the analyses were obtained from baseline data from a randomized controlled clinical trial of a collaborative depression care management intervention conducted in rural villages of China, with older adults with comorbid depression and HTN. Data included baseline assessments of 2,351 subjects aged 60 years and older, whose blood pressure and depression severity were measured using a calibrated manual sphygmomanometer and the 17-item Hamilton Depression Rating Scale (HDRS-17), respectively. Social support was measured using the 20-item Medical Outcomes Study-Social Support Survey.

RESULTS

Uncontrolled HTN was associated with older age (t[df = 2349] = 3.16; p < 0.01), higher HDRS-17 score (t[df = 1488] = 5.89; p < 0.001), and lower social support (t[df = 2349] = 5.37; p < 0.001). A significant indirect effect of social support via depression severity in relation to HTN control (a × b = -0.04[0.01]), bootstrap p = 0.0015, and 95% confidence interval (-0.07, -0.02), accounting for 11% of the effect of social support on HTN control.

CONCLUSION

These findings imply that social support impacts HTN control directly and indirectly through depression. Intervention approaches such as primary care-based collaborative care models should address social support to achieve greater outcomes for depression and HTN management.

Is social support associated with hypertension control among Ghanaian migrants in Europe and non-migrants in Ghana? The RODAM study

Hypertension (HTN) control is crucial in preventing HTN-related complications such as stroke and coronary heart disease. Yet, HTN control remains suboptimal particularly among sub-Saharan African (SSA) populations partly due to poor self-management. Self-management of HTN is influenced by social support, but the evidence on the role of social support on HTN control particularly among SSA populations is limited. This study assessed the association between multiple proxies for social support and HTN control among Ghanaians resident in Ghana and Europe. The Research on Obesity and Diabetes among African Migrants (RODAM) study participants with HTN and who self-reported HTN (n = 1327) were included in this analysis. Logistic regression was used to assess the association between proxies of social support and HTN control (SBP < 140 mmHg and DBP < 90 mmHg) with adjustments for age and socioeconomic status (SES). Among Ghanaian males in both Europe and Ghana, cohabiting with more than two persons was associated with increased odds of having HTN controlled. Male hypertensive patients cohabiting with ≥ 5 persons had the highest odds of having HTN controlled after adjustment for age and SES (OR 0.30; 95% CI 0.16-0.57; 0.60; 0.34-1.04, respectively). This association was not observed among females. Relationship status, frequency of religious activity attendance and satisfaction with social support did not show any significant association with HTN control. Our study shows that cohabitation is significantly associated with HTN control but in males only. The other proxies for social support appeared not to be associated with HTN control. Involving persons living with Ghanaian men with HTN in the treatment process may help to improve adherence to HTN treatment. Further research is needed to explore in-depth, how these social support proxies could contribute to improved HTN control among SSA populations.

Compliance with care and poor sleep quality among hypertensive adults in a mountainous area of Hubei Province, People's Republic of China

BACKGROUND

Little information is available concerning the relationship between compliance with hypertensive care and poor quality of sleep among Chinese adults in rural areas. This study aimed to evaluate the association between the compliance with hypertensive care and sleep quality for hypertension of adults in a mountainous area in People's Republic of China.

METHODS

A total of 551 hypertensive patients (30-96 years of age) living in a remote mountainous area were recruited. Poor sleep quality was assessed using the standard Pittsburgh Sleep Quality Index (PSQI), and compliance with care was measured based on the Compliance of Hypertensive Patients Scale (CHPS). Hypertension was defined as blood pressure ≥140/90 mmHg or treated with antihypertensive medication. The associations between sleep quality and compliance variables were examined using Pearson's correlation. Multiple linear regressions were established to verify significant variables associated with respondents' compliance with care and poor sleep quality.

RESULTS

The average age of the sample was 67.15 years (SD=10.20), and 56.44% of the participants were female. The mean CHPS total score was 41.97 (SD=5.91), and the PSQI total score was 7.91 on average (SD=4.10). Correlation analysis revealed that patients with higher intention, healthier lifestyle, positive attitude and total compliance were more likely to have an increased risk of poor sleep quality. According to the results of multiple linear regression analyses, hypertension compliance was significantly associated with being female, married, non-rural residence and years of hypertension, while poor sleep quality had a significant association with living in rural areas, having concomitant disease and poor hypertension compliance.

CONCLUSIONS

There is a significant association between hypertension compliance and poor sleep quality. Future intervention programs should focus on improving compliance behavior as a modifiable background factor for sleep quality.

Health-Related Quality of Life of Hypertension Patients: A Population-Based Cross-Sectional Study in Chongqing, China

Purpose: Hypertension is a major risk factor for cardiovascular diseases and stroke, and it requires lifelong medication. This study aimed to investigate the factors impacting on Health-Related Quality of Life (HRQoL) among hypertensive patients in Chongqing, China, and to provide evidence-based strategies to improve their HRQoL. Methods: This cross-sectional survey was conducted in Chongqing, China. Of 600 randomly selected patients, 586 patients agreed to participate and 567 patients completed the survey. A SF-36 (Medical Outcomes Study (MOS) Short Form Health Survey questionnaire) that included eight domains: physical functioning, role limitations due to physical problems, body pain, general health, vitality, social function, role limitations due to emotional problems, and mental health was used to measure HRQoL. Linear regressions were used; each domain of HRQoL was measured in the stratification of sex. Results: Self-perceived relatively low economic burden caused by hypertension and regular physical activity had a positive impact on HRQoL (p < 0.05) for both men and women. For women, younger age was associated with higher scores of measuring physical functioning and body pain. Living with more than three family members had a positive impact on domains, including physical functioning. Emotional self-regulation had a positive association with women’s mental health. Alcohol use for men was associated with higher scores in physical and mental health measures, and emotional self-regulation showed some positive impact on general health. Conclusion: Perceived economic burden caused by hypertension was the most common factor impacting on patients’ HRQoL. Female patients were more susceptible when compared to male patients. Health intervention strategies need to be further explored and adapted to the context of improving HRQoL for patients who suffer from hypertension and other chronic non-communicable diseases.

Dimensions of internal migration and their relationship to blood pressure in South Africa

Hypertension prevalence is on the rise in low- and middle-income countries (LMICs) like South Africa, and migration and its concomitant urbanization are often considered to be associated with this rise. However, relatively little is known about the relationship between blood pressure (BP) and internal migration - a highly prevalent population process in LMICs. This study employed data for a group of 194 adult men and women from an original pilot dataset drawn from the Agincourt Health and Demographic Surveillance System in north-east South Africa conducted in 2012. Migrants in the sample were identified, tracked and interviewed. The relationship between BP and migration distance and the number of months an individual spent away from his/her home village was estimated using robust OLS regression, controlling for a series of socioeconomic, health and behavioural characteristics. It was found that migrants who moved a longer distance and for longer durations had significantly higher systolic and diastolic blood pressures compared with shorter-term migrants and those who remained nearby or in their home village. These associations remained robust and statistically significant when adjusting for measures of socioeconomic conditions, as well as body mass index and the number of meals consumed per day. Migration, both in terms of distance and time away, explained significant variation in the blood pressure of migrants in this typical South African context. The findings suggest the need for further studies of the nutritional and psycho-social factors associated with geographic mobility that may be important to understand rising hypertension levels in LMICs.

Effect of social support on the treatment adherence of hypertension patients

This descriptive study was conducted to determine the effect of social support on drug treatment adherence in patients with hypertension. The sample of this study consisted of 259 patients who met the research criteria, agreed to participate in the research, and admitted to the cardiology clinic of a university hospital in Turkey between January and June 2017. Data were collected by "Patient Information Form", "Adherence to Drug Treatment Self-Efficacy Scale", and "Multidimensional Perceived Social Support Scale". It was determined that 48.3% of the patients participating in the study were in the 61-75 age group, 58.7% were female, 91.9% were married, and 66.4% were living in the city. It was also found that 71% of the patients had at least one relative or person with hypertension in the family, 79.2% were using at least one blood pressure medication, 61% adhered to his/her diet, and 72.2% adhered to the disease. The average score of the Medication Adherence Self-Efficacy Scale was calculated as 64.24 ± 16.89, whereas the total score average of the Multidimensional Perceived Social Support Scale was calculated as 53.74 ± 23.30. Besides, a statistically significant positive correlation was found among Medication Adherence Self-Efficacy Scale score average, Multidimensional Perceived Social Support Scale total score, and all subgroup score averages (P = .000).In conclusion, in this study, treatment adherence and social support levels of the patients were found to be substantially good; besides, adherence to drug treatment was found to increase positively as the social support of patients with hypertension increase.

Social support, disclosure and stigma and the association with non-adherence in the six months after antiretroviral therapy initiation among a cohort of HIV-positive adults in rural KwaZulu-Natal, South Africa

The World Health Organisation (WHO) recommends antiretroviral treatment (ART) initiation at human immunodeficiency virus (HIV) diagnosis. As ART programmes expand, addressing barriers to adherence is vital. Past mixed findings on the association between social support, stigma and non-disclosure with ART adherence highlights the need for further research. The primary aim of this study was to examine how these factors are associated with ART non-adherence in the six months after ART initiation. The secondary aim was to explore how other factors are associated with non-adherence. We conducted secondary analysis of prospective data from HIV-positive adults initiating ART. Social support, disclosure patterns, perceived stigma and other demographic factors were collected at ART initiation and six months follow-up. Logistic regression models were used to examine factors associated with self-reported ART non-adherence in the last six months and the last month before the six month follow-up (“recent”). Non-adherence in the last six months was twenty-five percent and recent non-adherence was nine percent. There was no association between non-adherence and social support, stigma or non-disclosure of HIV status. In the final model the odds of non-adherence in the last six months were significantly higher for those: with incomplete ART knowledge (aOR 2.10, 95%CI 1.21–3.66); who visited a healthcare provider for conditions other than HIV (aOR1.98, 95%CI 1.14–3.43); had higher CD4 counts at ART initiation (CD4 100–199:aOR 2.50, 95%CI 1.30–4.81; CD4 ≥ 200:aOR 2.85, 95%CI 1.10–7.40;referent CD4 < 100 cells/mm³); had tested HIV-positive in the last year (aOR 2.00, 95%CI 1.10–3.72; referent testing HIV-positive outside the last year); experienced a rash/itching secondary to ART (aOR 2.48, 95%CI 1.37–4.52); and significantly lower for those ≥48 years (aOR 0.65, 95%CI 0.46–0.90). Early non-adherence remains a concern. Incorporation of adherence monitoring and ART knowledge enhancement into appointments for ART collection may be beneficial.

Evaluation of antihypertensive adherence and its determinants at primary healthcare facilities in rural South Africa

Aim: To evaluate adherence to antihypertensive treatment in rural South Africa and identify potential determinants given concerns with adherence and its impact in this priority disease area. Patients & methods: Face-to-face interviews with hypertensive patients and rating their adherence to treatment using defined categorized responses. Associations between adherence and patient characteristics assessed and sensitivity analyses performed. Results: 54.6% of patients were adherent to treatment. Controlled blood pressure (BP; odds ratios [OR] = 2.1; 95% CI: 1.1, 3.8; p = 0.019), comorbidity (OR = 2.0; 95% CI: 1.1, 3.6; p = 0.032) and smoking (OR = 0.3; 95% CI: 0.1, 0.8; p = 0.018) were associated with adherence. Conclusion: Adherence and BP control were suboptimal, only smoking was an independent risk factor for adherence. Adherent patients were twice as likely to have controlled BP, although results were sensitive to the definition of adherence. Initiatives are in place to improve adherence, which will be monitored.

The association between self-care and quality of life in hypertensive patients: findings from the Azar cohort study in the North West of Iran

Background: Hypertension affects the quality of life of patients and their caregivers. The aim of this study was to assess the knowledge and self-care behaviors and health-related quality of life (HRQOL) among hypertensive people. Methods: All people aged 35 years and older with hypertension were invited to participate in this study. Information on self-care behavior for hypertension (H-scale), and health-related quality of life (WHOHRQOL-BRFF) were completed by trained interviewer. Data analysis was done using SPSS 16. Results: The median age of hypertensive patients was 62.5(25th to 75th percentile: 55 to 72 years), the correlation between quality of life and overall self-care scores was not significant(r =-0.048, P =0.520). Physical activity was the only significant predictor for quality of life,showing that the quality of life of hypertensive people increased by 3.371 units per day of being physically active in the cohort study (β =0.223, P<0.01). The only significant predictor of quality of life among the elderly was medication use (β =-0.572, P<0.001). Quality of life of participants decreased 3.456 units per day as a result of medication adherence. Conclusion: No association was observed between self-care and HRQOL total score in hypertensive patients in the study. Among the self-care domains, only medication adherence and physical activity had significant association with social health. There was a reverse association between smoking and HRQOL.

Social Support, Treatment Adherence and Outcome among Hypertensive and Type 2 Diabetes Patients in Ambulatory Care Settings in southwestern Nigeria

OBJECTIVES

To evaluate available and desired sources and types of social-support among hypertensive and type-2-diabetes (T2D) patients. Associations of medication adherence and clinical outcome with access to most available social-support and medicine affordability were subsequently investigated.

DESIGN

Cross-sectional questionnaire-guided interview among 250-hypertensive and 200-T2D patients, and review of medical records to retrieve disease-specific clinical parameters.

SETTINGS

University College Hospital and Ring-Road State Hospital, Ibadan, southwestern Nigeria.

PARTICIPANTS

Adults out-patients with hypertension, T2D, and T2D comorbid with hypertension were enrolled, while in-patients were excluded.

RESULTS

Family source of support was the most available [hypertensive (225; 90.0%); T2D (174; 87.0%)], but government and non-governmental organisation support were largely desired, with financial support preferred, 233(93.2%) hypertensive and 190(95.0%) T2D, respectively. Adherent hypertensive patients with or without access to family support were (127; 56.4%) versus (18; 72.0%), p=0.135; while for T2D were (103; 59.2%) versus (21; 80.8%), p=0.035. Mean systolic blood pressure of hypertensive and fasting plasma glucose of T2D with access to family and financial support were better than their counterparts without access (p>0.05). Hypertensive (110; 76.4%) and T2D (87; 87.0%) participants who consistently afford medicine expenses had significantly better adherence and outcome (p<0.05).

CONCLUSIONS

Family source of support is the most accessible, but government and non-governmental organisation support were largely desired. Access to family support did not positively influence medication adherence, while access to financial support marginally impacted on outcome among hypertensive and T2D patients. However, unwavering tendency for therapy affordability significantly influenced adherence and outcome, thus, the need for expanded social-support system in order to consistently ensure improved outcome.

FUNDING

None declared.

Hypertension Impact on Health-Related Quality of Life: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China

Hypertension is a major risk factor of cardiovascular disease in China, and yet little is known about health-related quality of life (HRQOL) and its associations with demographic and social-economic characteristics in middle-aged patients with hypertension. A cross-sectional survey was undertaken in Chongqing, China, using a multistage stratified random sampling methodology. Data was collected on 1,224 eligible adults, aged between 45 and 53 years, including the Medical Outcomes Survey Short Form-36 to measure HRQOL. Hypertension was associated with poor state of physical functioning, role-physical, bodily pain, general health, vitality, and social function (p < 0.05 for all). In multivariable analyses, education level, job conditions, average monthly income, smoking status, sleep quality, perception of relationship with family, childhood breastfeeding history, and body mass index were associated with domains of SF36 among those with hypertension (p < 0.05 for all). Hypertensive respondents with high education, marital status, breastfeeding, higher incomes, good quality of sleep, positive relationship with family, and higher body mass index have better HRQOL in middle-aged people with hypertension. Those unemployed had a better state of general health and had a poorer state of social function. Nonsmokers had a poorer state of bodily pain than smokers. This study provides detailed information of the implications for health care providers to gain a more complete picture of their hypertension patients' health.

Association between patients' beliefs and oral antidiabetic medication adherence in a Chinese type 2 diabetic population

PURPOSE

The objective of this study was to identify, using the theory of planned behavior (TPB), patients' beliefs about taking oral antidiabetic drugs (OADs) as prescribed, and to measure the correlations between beliefs and medication adherence.

PATIENTS AND METHODS

We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs) relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Spearman's rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05.

RESULTS

From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037) was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000), not accepting the disease (P=0.000), ignorance of life-long drug adherence (P=0.038), being busy (P=0.001), or poor memory (P=0.008) were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011).

CONCLUSION

The results indicate that the TPB model could be used to examine adherence to OADs. One facilitating control belief, and most of the barrier control beliefs of TPB were related to medication adherence among Chinese type 2 diabetes inpatients. It will be helpful to understand patients' self-medication and provide methods to develop instruments for identifying factors that influence OAD adherence.