Effectiveness of Theory Based Education on Medication Adherence in Older Adults with Hypertension

Document Type : Original Article


1 Assistant Professor of Psychiatry,Department of Psychiatry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Assistant Professor of Public Health.Department of Public Health, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran.

3 Associate Professor of Public Health.Department of Public Health, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran.


Background and Objective: Effective control of hypertension is essential step for reducing its complications. ThisQuasi-experimental study tested the effectiveness of theory-based educational intervention to improve antihypertensive adherence behavior among elderly patients. 
Subject and Methods:One hundred and forty older adults who were taking at least 1 antihypertensive medication were randomly divided into intervention and control groups. Intervention-group participants received three 35 min educational sessions based on need assessment and behavioral theory associated with motivational interviewing. Self-administrative questionnaire was used for measuring demographic and psychological variable and anti-hypertension adherence. Data were described using SPSS 17.0 and analyzed by statistical tests such as T test, Mann-Whitney U tests and Wilcoxon.
Results: Average age of participants was 68.15 ± 11.3 y and approximately 55% of patients were female. Average duration of diagnosis of hypertension in patients was 14.8 y. A non-significant difference was noted in baseline regarding outcome variable specially medication adherence (MA) between groups. At the end of the education, the intervention group had significant change in antihypertensive MA than did the control group (P < 0.001). Systolic (from 142.5 to 134.2) and diastolic (from 86.3 to 81.4) BP improved in intervention group in follow up measurement in the treatment group (P < 0.05). Psychological variables that impact on medication adherence were significantly different in pre –and- post assessment (P<0.05).
Conclusion: Results showed that theory-based training with motivational interviewing have the potential to improve medication adherence in elderly patients with hypertension.


1-Shelton JD. A public health approach to hypertension. Lancet 2015 May 9; 385(9980):1833-4. 
2-Angell SY, De Cock KM, Frieden TR. A public health approach to global management of hypertension. Lancet 2015 Feb 28; 385(9970):825-7. 
3-Musaiger AO, Al-Hazzaa HM. Prevalence and risk factors associated with nutrition-related noncommunicable diseases in the Eastern Mediterranean region. Int J Gen Med 2012; 5:199-217.
4-Motlagh B, O'Donnell M, Yusuf S. Prevalence of cardiovascular risk factors in the Middle East: a systematic review. Eur J Cardiovasc Prev Rehabil 2009 Jun; 16(3):268-80.
5-Azizi F, Ghanbarian A, Madjid M, Rahmani M. Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study (TLGS), 1999-2000. J Hum Hypertens 2002 May; 16(5):305-12.
6-Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: hypertension at the core. Can J Cardiol 2015 May; 31(5):569-71. 
7-Chiong JR. Controlling hypertension from a public health perspective. Int J Cardiol 2008 Jul 4; 127(2):151-6.
8-Brankovic S, Pilav A, Cilovic-Lagarija S, Segalo M. Evaluation of patient's cooperation in hypertension control. Mater Sociomed 2014 Apr; 26(2):109-11.
9-Basu S, Millett C. Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study. Hypertension 2013 Jul; 62(1):18-26.
10-Hyman DJ, Pavlik V. Medication adherence and resistant hypertension. J Hum Hypertens 2015; 29(4):213-8.
11-Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ 2008; 336: 1114-17.
12-Berrut G. The medication adherence in the elderly: a collective goal. Geriatr Psychol Neuropsychiatr Vieil 2014 Jun; 12(2):121-2. 
13-Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother 2011 Feb; 9(1):11-23.
14-Takane AK, Balignasay M.D, Nigg CR. Poly-pharmacy reviews among elderly populations project: assessing needs in patient-provider communication. Hawai'i J Med Public Health 2013; 72(1):15.
15-Jin H, Kim Y, Rhie SJ. Factors affecting medication adherence in elderly people. Patient Prefer Adherence 2016 Oct 19; 10: 2117-2125.
16-Blake VK. WHO Study on global ageing. Int J Aging Hum Dev 2014; 79(4): 326-8.
17-Kiani S, Bayanzadeh M, Tavallaee M, Hogg RS. The Iranian population is graying: are we ready? Arch Iran Med. 2010 Jul; 13(4):333-9.
18-Rattan SI. Biology of ageing: principles, challenges and perspectives. Rom J Morphol Embryol 2015; 56(4):1251-3.
19-Maurice J. WHO puts healthy ageing on the front burner. Lancet. 2016 Jan 9; 387(10014):109-10. 
20-Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R. Medication related falls in the elderly: causative factors and preventive strategies. Drugs Aging 2012; 29(5):359- 76.
21-Nobili A, Marengoni A, Tettamanti M, Salerno F, Pasina L, Franchi C, et al. Association between clusters of diseases and poly-pharmacy in hospitalized elderly patients: results from the REPOSI study. Eur J Intern  Med 2011; 22(6):597-602.
22-Kaambwa B, Bryan S, Jowett S, Mant J, Bray EP, Hobbs FD, Holder R, Jones MI, Little P, Williams B, McManus RJ. Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis. Eur J Prev Cardiol 2014 Dec; 21(12):1517-30.
23-Mc Namara KP, Versace VL, Marriott JL, Dunbar JA. Patient engagement strategies used for hypertension and their influence on self-managementattributes. Fam Pract 2014 Aug; 31(4):437-44. 
24-Margolis KL, Asche SE, Bergdall AR, Dehmer SP, Maciosek MV, Nyboer RA, et al. A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work? J Gen Intern Med 2015 Nov; 30(11):1665-72.
26-Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N: Changing the behavior of healthcare professionals: The use of theory in promoting the uptake of research findings. J Clin Epidemiol2005; 58:107-112.
28-Ceccato NE, Ferris LE, Manuel D, Grimshaw JM. Adopting health behavior change theory throughout the clinical practice guideline process. J Contin Educ Health Prof 2007 Fall; 27(4):201-7.

29-Stacey FGJames ELChapman KCourneya KSLubans DR. Integrated Theory of Health Behavior Change: background and intervention development. Clin Nurse Spec 2009 May-Jun; 23(3):161-70; quiz 171-2. 

30-Hackman CL, Knowlden AP. Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: a systematic review. Adolesc Health Med Ther 2014 Jun 6; 5: 101-14. 

31-Armitag CJ, Arden MA. Exploring discontinuity patterns in the transtheoretical model: An application of the theory of planned behavior. Br J Health Psychol 2002; 7: 89-103.
32-Seyedian M, Falah M, Norozian M, Nejat S, Delavar A, Ghasemzadeh H. Preparation and validity of Persian version of the Mini-Mental State Examination. Journal of Medical Council of Iran 2007; 25 (4): 414-8. (In Persian)
33-Fishbein M, Ajzen I. Theory-based behavior change interventions: Comments on Hobbis and Sutton (in press). J Health Psychol 2005; 10 (1): 27-31.
34-Ogedegbe G, Mancuso CA, Allegrante JP, Charlson ME. Development and evaluation of a medication adherence self-efficacy scale in hypertensive African-American patients. J Clin Epidemiol 2003 Jun; 56(6):520-9.
36-JNC-7. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. J Am Med Assoc 2003; 289(19): 2560-72.
37-Williams AManias E. Exploring motivation and confidence in taking prescribed medicines in coexisting diseases: a qualitative study. J Clin Nurs 2014 Feb; 23(3-4):471-81.

38-Canadian Hypertension Education Program. The 2008 Canadian Hypertension Education Program recommendations: the scientific summary - an annual update. Can J Cardiol 2008 Jun; 24(6):447-52.

39-Ribeiro CD, Resqueti VR, Lima Í, Dias FA, Glynn L, Fregonezi GA Educational interventions for improving control of blood pressure in patients with hypertension: a systematic review protocol. BMJ Open 2015 Mar 31; 5(3):e006583.

40-Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract Apr 2005; 55(513):305-12.
41-Ren YYang HBrowning CThomas SLiu M. Therapeutic effects of motivational interviewing on blood pressure control: a meta-analysis of randomized controlled trials. Int J Cardiol 2014 Mar 15; 172(2):509-11.
43-Braverman J, Dedier J. Predictors of medication adherence for African American patients diagnosed with hypertension. Ethn Dis 2009 Autumn; 19(4):396-400.
44-Nagelkerk J, Reick K, Meengs L. Perceived barriers and effective strategies to diabetes self management. J Adv Nurs 2006 Apr; 54(2): 151-8.
45-Wu PH, Yang CY, Yao ZL, Lin WZ, Wu LW, Chang CC. Relationship of blood pressure control and hospitalization risk to medication adherence among patients with hypertension in Taiwan. Am J Hypertens 2010 Feb; 23(2):155-60. 
47-Lee SG, Jeon SY. The knowledge, attitude and practice of blood pressure management from the patient's viewpoint: a qualitative study. J Prev Med Public Health 2008 Jul; 41(4):255-64. 
48-Karaeren H, Yokusoglu M, Uzun S, Baysan O. The effect of the content of the knowledge on adherence to medication in hypertensive patients. Ana do lu Kar di yol Derg 2009; 9: 183-8
49-Chaves ES, Lúcio IM, de Araújo TL, Damasceno MM. Efficiency of health education programs for adults with high blood pressure. Rev Bras Enferm 2006 Jul-Aug; 59(4):543-7.
50-Roumie CL, Elasy TA, Greevy R, Griffin MR, Liu X, Stone WJ, Wallston KA, Dittus RS, Alvarez V, Cobb J, Speroff T. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Ann Intern Med 2006 Aug 1; 145(3):165-75.
51-Marquez Contreras E, Vegazo Garcia O, Claros NM. Efficacy of telephone and mail intervention in patient compliance with antihypertensive drugs in hypertension. ETECUM-HTA study. Blood Press 2005; 14: 151-158.
52-Moultry AM, Pounds K, Poon IO. Managing Medication Adherence in Elderly Hypertensive Patients ThroughPharmacist Home Visits. Consult Pharm 2015 Dec; 30(12):710-9.
53-Trivedi RB, Piette JD. Shedding light on the association between social support and adherence in hypertension: a comment on Magrin et Al. Ann Behav Med 2015 Jun; 49(3):297-8. 
54-Osamor PE. Social support and management of hypertension in South-west Nigeria. Cardiovasc J Afr 2015 Jan-Feb; 26(1):29-33.