Biopsychosocial determinants of medication adherence among hypertensive patients in Ghana

Background Medication non-adherence is a major public health problem globally. Often, non-adherence to medication has been a predominant setback in the management of hypertension and other chronic conditions leading to negative health outcomes. Objectives The purpose of this study was to explain adherence behaviour among hypertensive patients from a Biopsychosocial perspective. Methods A hospital-based mixed methods study using quantitative and qualitative approaches was conducted on hypertensive patients attending Korle-bu and Komfo Anokye Teaching Hospitals in Ghana from May to November, 2012. The rationale for including the qualitative phase was to triangulate the quantitative phase of the study. Information was quantitatively obtained from 400 participants on socio-demographic characteristics, personality characteristics, negative emotions, belief systems, complementary and alternative medicine (CAM) use, economic, pharmacological factors and medication adherence behaviour. The qualitative phase of the study involving 45 participants explored adherence in relation to perceptions about belief systems, complementary and alternative therapies and pharmacologically related issues. Results Most patients (93%) poorly adhered to their antihypertensive medications. Participants exhibited features of mixed LoC (both internal and external) usually referred to as bi-local iv expectancy. However, orientation was skewed towards external LoC which significantly related with non-adherence behaviour (p = 0.03). High spiritual and religious beliefs formed core components of the lifestyles of patients, yet, spirituality (p = 0.018) and not religiosity (p = 0.474) related directly with medication non-adherence. Although some of the patients experienced symptoms of anxiety (57%), followed by stress (20%) and depression (4%), stress was rather significantly associated with medication non-adherence (p = 0.035). Out of the 400 study participants, 78 (19.5%) reported using CAM with the majority (65.38%) utilizing biological based therapies. There was no significant relationship between CAM use and non-adherence (p = 0.176). Medication side effects (p = 0.04) and the number of times per day for taking medicines significantly correlated with non-adherence (p< 0.0001). The thematic content analysis of patients‟ belief system pertaining to hypertension and medication intake focused on the following themes: conceptualizing illness, supernatural healing, medication non-adherence and holistic healthcare. Likewise, CAM use elicited the following themes: combination of remedies, categorization, availability, motivation for use, perceived effect, non-disclosure, medication non-adherence and health provider involvement. Analysis of pharmacological factors revealed three main themes about medication use namely: effect and continuance, hindrances to adherence and coping. Conclusion This study has demonstrated that there is a significant interplay of psychological, socio-cultural and pharmacological factors associated with medication non-adherence. Multi-faceted intervention programmes highlighting these determinants should be initiated to improve medication adherence among hypertensive patients in Ghana.

Source: KNUST