Journal of General Internal Medicine

, Volume 28, Issue 1, pp 99–106

Factors Associated with Non-Adherence to Three Hypertension Self-Management Behaviors: Preliminary Data for a New Instrument

  • Matthew J. Crowley
  • Janet M. Grubber
  • Maren K. Olsen
  • Hayden B. Bosworth
Original Research

DOI: 10.1007/s11606-012-2195-1

Cite this article as:
Crowley, M.J., Grubber, J.M., Olsen, M.K. et al. J GEN INTERN MED (2013) 28: 99. doi:10.1007/s11606-012-2195-1



Clinicians have difficulty in identifying patients that are unlikely to adhere to hypertension self-management. Identifying non-adherence is essential to addressing suboptimal blood pressure control and high costs.


1) To identify risk factors associated with non-adherence to three key self-management behaviors in patients with hypertension: proper medication use, diet, and exercise; 2) To evaluate the extent to which an instrument designed to identify the number of risk factors present for non-adherence to each of the three hypertension self-management behaviors would be associated with self-management non-adherence and blood pressure.


Cross-sectional analysis of randomized trial data.


Six hundred and thirty-six primary care patients with hypertension.


1) Demographic, socioeconomic, psychosocial, and health belief-related factors; 2) measures of self-reported adherence to recommended medication use, diet recommendations, and exercise recommendations, all collected at baseline assessment; 3) systolic blood pressure (SBP) and diastolic blood pressure (DBP).


We identified patient factors associated with measures of non-adherence to medications, diet, and exercise in hypertension. We then combined risk factors associated with ≥1 adherence measure into an instrument that generated three composite variables (medication, diet, and exercise composites), reflecting the number of risk factors present for non-adherence to the corresponding self-management behavior. These composite variables identified subgroups with higher likelihood of medication non-adherence, difficulty following diet recommendations, and difficulty following exercise recommendations. Composite variable levels representing the highest number of self-management non-adherence risk factors were associated with higher SBP and DBP.


We identified factors associated with measures of non-adherence to recommended medication use, diet, and exercise in hypertension. We then developed an instrument that was associated with non-adherence to these self-management behaviors, as well as with blood pressure. With further study, this instrument has potential to improve identification of non-adherent patients with hypertension.


hypertensionself-managementmedication adherencedietexercise

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Matthew J. Crowley
    • 1
    • 2
  • Janet M. Grubber
    • 1
  • Maren K. Olsen
    • 1
    • 3
  • Hayden B. Bosworth
    • 1
    • 4
    • 5
  1. 1.Center for Health Services Research in Primary CareDurham VA Medical Center, HSR&D (152)DurhamUSA
  2. 2.Department of Medicine, Division of Endocrinology, Diabetes, and MetabolismDuke UniversityDurhamUSA
  3. 3.Department of Biostatistics and BioinformaticsDuke UniversityDurhamUSA
  4. 4.Department of Medicine, Division of General Internal MedicineDuke UniversityDurhamUSA
  5. 5.Department of Psychiatry and Behavioral Sciences, and School of NursingDuke UniversityDurhamUSA