The Role of Training and Reminder Wristwatche in Hypertension
Condition: Hypertension; Adherence, Medication
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      This study is a randomized controlled study. The study was completed to with randomized
      selected 30 training and reminder by watch (experiment), 30 education (experiment) and 30
      control group total of 90 hypertensive patients. Patients in the experimental group received
      training on hypertension and treatment adherence. In addition, the participants in the
      training and reminder by watch group wore a medication reminder wristwatch. Statistically
      significant differences were found in the post-test between scale scores of the experimental
      and control groups (p<.05). It was observed that the initial blood pressure measurements were
      high in the patients in all three groups, while the highest decrease was found in the
      training and reminder by wristwatch group at the final measurement (p<.05). Hypertension
      education program and using a medication reminder wristwatch were found to be effective in
      increasing treatment adherence.
    

Detailed description: 
      Design and Participants This study was conducted a randomized controlled trial. The
      population of the research was the patients who received service from this center, who were
      65 years of age and older, who had hypertension, and who were using at least one
      antihypertensive drug (n=90). Power analysis was conducted to determine the sample size; it
      was based on the difference in Compliance with Drug Therapy Scale mean scores of hypertensive
      patients from previous studies.16 The sample size of at least 60 individuals was calculated
      by taking α = 0.05, power = 0.99, and effect size = 0.863. Keeping in mind that the number of
      participants may decrease during the study owing to factors such as a health problems or die
      , 90 subjects were included in the study.

      Participants were randomized to medication reminder wristwatch group (n = 30), training group
      (n = 30) and control (n = 30) groups. In randomization, participants were stratified
      participants was ensured through the use of stratified sampling method. The patients in all
      three groups were stratified according to gender (female, male). The patients who were 65 and
      older, who were diagnosed with hypertension, who used at least one antihypertensive drug, who
      are literate and open to communication and cooperation, who had blood pressure of 140/90mmHg
      or above prior to the research, who had a score of 8 and above from the Compliance with Drug
      Therapy Scale, and who were willing to participate were included in the study. The patients
      who met the inclusion criteria constituted the sample of the study.

      A questionnaire form, Hypertension Information Form (HIF), Antihypertensive Medication
      Treatment Adherence Scale (AMTAS), Medication Adherence Self-Efficacy Scale Short Form
      (MASES-SF) were used to collect data. The questionnaire form was developed by using relevant
      literature and included 33 closed-ended questions about the sociodemographic, health/disease
      and treatment compliance characteristics of elderly individuals.

      Hypertension Information Form (HIF) was prepared by the researcher in line with the
      literature in order to measure the effectiveness of the hypertension education program. It
      contains 26 statements about drug use, blood pressure monitoring, and disease management. The
      questions are Yes/No questions. The "yes" answers receive 1 point, while the "no" answers
      receive 0 point. The maximum score that can be obtained from the form is 26. A score of 13
      and above indicates that patients' knowledge level about hypertension has increased. The
      current study found Cronbach α = 0.77.

      AMTAS is a questionnaire developed by Morisky et al to evaluate medication adherence of
      individuals with hypertensive in 2003. The scale includes 9 statements to diagnose the
      medication behavior and the total score varies between 1 and 13. Individuals with a score
      between 1 and 7 are defined as compliant with treatment, while individuals with a score of 8
      and above are defined as non-compliant with treatment. The Turkish version of the AMTAS was
      validated by Demirezen et al with Cronbach α = 0.82. In this study, the Cronbach's alpha of
      the scale was determined as 0.51.

      MASES-SF was developed in 2012 by Hacıhasanoğlu et al and include of 13 questions on a Likert
      scale. The total score of the scale is between 13 and 52, and an increase in the score
      indicates that the individual's level of compliance with antihypertensive drug treatment is
      good. The Cronbach's alpha was reported as 0.94. In this study, the Cronbach's alpha of the
      scale was found to be 0.83.

      The study was conducted between April 2019 and November 2020. In the first meeting, The
      questionnaire form, HIF, AMTAS, MASES-SF were administered. Data were collected using the
      face-to-face interview method.

      Ethical approval was obtained from the ethical board (February 18, 2018, No. 83116987-662)
      and permission was given from the Provincial Health Directorate (February 28, 2019, No.
      87064461-044). Participants were informed about the scope of the study and verbal and written
      informed consent was obtained. Educational material was given to participants of the control
      group after the last home visit.

      The data were analyzed using the SPSS 23.0. Chi-square and Fisher's Exact Tests were used to
      compare the categorical variables across the groups. One-way Analysis of Variance was used to
      compare the data that show normal distribution according to groups of three or more, and the
      Kruskal Wallis Test was used to compare data that were not normally distributed. The paired
      two-sample t-test was used to compare normally distributed data according to paired time, and
      the Wilcoxon Test was used to compare the data that did not show normal distribution. The
      McNemar Test was used to compare the categorical variables according to pretest and posttest.
      For statistical significance, P < .05 was used.
    

Intervention name(s): The Role of Training and Reminder Wristwatche in Hypertension (RoT-ReWiH)
Intervention type(s): Behavioral
Intervention description(s): The present study revealed that multiple interventions such as home visits to elderly hypertensive patients, training program, telephone counseling, and the use of medication reminder wristwatch are effective in increasing treatment adherence and self-efficacy, and in controlling blood pressure. In this direction, health professionals working in primary care are recommended that they make regular home visits, encourage patients to take responsibility for health, and organize regular and interdisciplinary training and counseling programs in the management of hypertension.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized controlled experimental design
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Elderly; Hypertension; Treatment Adherence; Training; Medication Reminder