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

Authors

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

ABSTRACT

BACKGROUND

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.

OBJECTIVES

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.

DESIGN

Cross-sectional analysis of randomized trial data.

PATIENTS

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

MEASUREMENTS

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).

RESULTS

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.

CONCLUSIONS

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.

KEY WORDS

hypertensionself-managementmedication adherencedietexercise

Copyright information

© Society of General Internal Medicine 2012