Predicting the Intention to Adhere to Hypertensive Medication among Seniors: A Cross-Sectional Survey
Keywords:
beliefs, hypertension, medication adherence, seniors, Theory of Planned Behavior
Abstract
Non-adherence to hypertension treatment is a wide problem, especially among senior citizens. Several approaches are needed to improve adherence, including identifying and prioritizing problems related to adherence. A formative study employing Theory of Planned Behavior (TPB) has revealed some salient beliefs underlying the intention to adhere to hypertension medication among seniors. To be the priority in a medication adherence strategy, the correlation of these beliefs on adherence needs to be further investigated. This study aims to determine which beliefs correlate most to the intention to hypertension medication adherence among seniors. A cross-sectional survey was conducted to seniors with hypertension in Yogyakarta and its surroundings. A questionnaire based on TPB was developed and utilized in this study. The questionnaire was distributed conveniently through two senior communities (offline) as well as Google Form link to some WhatsApp group of seniors (online) during September-October 2023. The data were analyzed using multiple linear regressions. Thirty-seven seniors completed the offline questionnaire, and 60 seniors completed the online questionnaire. The age of participants was 64.70 ± 7.123 years. Subjective norms and perceived behavioral control accounted significantly (p<0.001) for 59,3% of the variance in the adherence intention, but not attitude. Perceived behavioral control had the strongest correlation on intention. Participants’ beliefs of knowing how high their blood pressure was had the highest correlation to perceived behavioral control. Understanding which belief correlates most with intention to adherence provides insight to develop strategy to improve adherence among seniors.
References
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Foley, L., Prapavessis, H., Maddison, R., Burke, S., McGowan, E., & Gillanders, L. (2008). Predicting physical activity intention and behavior in school-age children. Pediatric Exercise Science, 20(3), 342–356.
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Kamran, A., Sadeghieh Ahari, S., Biria, M., Malepour, A., & Heydari, H. (2014). Determinants of Patient’s Adherence to Hypertension Medications: Application of Health Belief Model Among Rural Patients. Annals of Medical and Health Sciences Research, 4(6), 922–927. https://doi.org/10.4103/2141-9248.144914
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Kementerian Kesehatan Republik Indonesia. (2018). Hasil utama Riskesdas 2018 [Main results of basic health research 2018]. Kementerian Kesehatan Republik Indonesia.
Kopelowicz, A., Zarate, R., Wallace, C. J., Liberman, R. P., Lopez, S. R., & Mintz, J. (2015). Using the theory of planned behavior to improve treatment adherence in Mexican Americans with schizophrenia. Journal of Consulting and Clinical Psychology, 83(5), 985–993. https://doi.org/10.1037/a0039346
MacLaughlin, E. J., & Saseen, J. J. (2023). Hypertension. In J. T. DiPiro, G. C. Yee, S. T. Haines, T. D. Nolin, V. L. Ellingrod, & L. M. Posey (Eds.), DiPiro’s Pharmacotherapy: A Pathophysiologic Approach, 12th Edition. McGraw Hill.
Mahmood, S., Jalal, Z., Hadi, M. A., Khan, T. M., Haque, M. S., & Shah, K. U. (2021). Prevalence of non-adherence to antihypertensive medication in Asia: a systematic review and meta-analysis. International Journal of Clinical Pharmacy, 43(3), 486–501. https://doi.org/10.1007/s11096-021-01236-z
Management Sciences for Health. (2012). MDS-3: managing access to medicines and health technologies. Management Sciences for Health.
Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., … Lim, S. S. (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2
Nazihah, N. Z., & Rahmawati, R. (2022). Knowledge About Hypertension and Its Treatment Among Patients and Lay Health Workers in the Posyandu Lansia. 3rd International Conference on Cardiovascular Diseases (ICCvD 2021), 215–229.
Pasina, L., Brucato, A. L., Falcone, C., Cucchi, E., Bresciani, A., Sottocorno, M., Taddei, G. C., Casati, M., Franchi, C., Djade, C. D., & Nobili, A. (2014). Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs & Aging, 31(4), 283–289. https://doi.org/10.1007/s40266-014-0163-7
Rahmawati, R., & Bajorek, B. (2015). A Community Health Worker-Based Program for Elderly People With Hypertension in Indonesia: A Qualitative Study, 2013. Preventing Chronic Disease, 12, E175. https://doi.org/10.5888/pcd12.140530
Rajeh, M. T. (2022). Modeling the theory of planned behavior to predict adults’ intentions to improve oral health behaviors. BMC Public Health, 22(1), 1391. https://doi.org/10.1186/s12889-022-13796-4
Smith, A. (2014). Older adults and technology use.
Steinmetz, H., Knappstein, M., Ajzen, I., Schmidt, P., & Kabst, R. (2016). How effective are behavior change interventions based on the Theory of Planned Behavior?: a three-level meta-analysis. Zeitschrift Für Psychologie, 224, 216–233. https://doi.org/10.1027/2151-2604/a000255
Suh, K. H. (2021). Verification of a theory of planned behavior model of medication adherence in Korean adults: focused on moderating effects of optimistic or present bias. BMC Public Health, 21(1), 1391. https://doi.org/10.1186/s12889-021-11460-x
Widyakusuma, N. N., Suryawati, S., Wiedyaningsih, C., & Probosuseno. (2023). What Do Seniors Believe About Medication Adherence? A Qualitative Study Among Seniors with Chronic Conditions in Yogyakarta, Indonesia. Patient Preference and Adherence, 17, 1381–1392. https://doi.org/10.2147/PPA.S412981
Wiedyaningsih, C., Hakimi, M., Soenarto, Y., & Suryawat, S. (2016). The Use of The Theory of Planned Behavior to Predict Factors Influencing Physicians’ Decision to Prescribe Extemporaneous Compounding Dosage Form for Pediatric Outpatients. Asian Journal of Pharmaceutical and Clinical Research, 288–291.
Yue, Z., Li, C., Weilin, Q., & Bin, W. (2015). Application of the health belief model to improve the understanding of antihypertensive medication adherence among Chinese patients. Patient Education and Counseling, 98(5), 669–673. https://doi.org/10.1016/j.pec.2015.02.007
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/https://doi.org/10.1016/0749-5978(91)90020-T
Ajzen, I. (2019). Constructing a Theory of Planned Behavior questionnaire. Citeseer. https://people.umass.edu/aizen/pdf/tpb.measurement.pdf
Ajzen, I. (2020). The theory of planned behavior: Frequently asked questions. Human Behavior and Emerging Technologies, 2(4), 314–324. https://doi.org/https://doi.org/10.1002/hbe2.195
Al-Ruthia, Y. S., Hong, S. H., Graff, C., Kocak, M., Solomon, D., & Nolly, R. (2017). Examining the relationship between antihypertensive medication satisfaction and adherence in older patients. Research in Social and Administrative Pharmacy, 13(3), 602–613. https://doi.org/https://doi.org/10.1016/j.sapharm.2016.06.013
Bane, C., Hughe, C. M., & McElnay, J. C. (2006). Determinants of medication adherence in hypertensive patients: an application of self-efficacy and the Theory of Planned Behaviour. International Journal of Pharmacy Practice, 14(3), 197–204. https://doi.org/10.1211/ijpp.14.3.0006
Bicchieri, C., & Mercier, H. (2014). Norms and beliefs: how change occurs. In M. Xenitidou & B. Edmonds (Eds.), The complexity of social norms (pp. 37–54). Springer International Publishing. https://doi.org/10.1007/978-3-319-05308-0_3
Bish, A., Sutton, S., & Golombok, S. (2000). Predicting uptake of a routine cervical smear test: A comparison of the health belief model and the theory of planned behaviour. Psychology and Health, 15(1), 35–50.
Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares? Mayo Clinic Proceedings, 86(4), 304–314.
Cross AJ, E. R. A. P. K. K. L., & George, J. (2020). Interventions for improving medication‐taking ability and adherence in older adults prescribed multiple medications. Cochrane Database of Systematic Reviews, 5. https://doi.org/10.1002/14651858.CD012419.pub2
Foley, L., Prapavessis, H., Maddison, R., Burke, S., McGowan, E., & Gillanders, L. (2008). Predicting physical activity intention and behavior in school-age children. Pediatric Exercise Science, 20(3), 342–356.
Francis, J., Eccles, M. P., Johnston, M., Walker, A. E., Grimshaw, J. M., Foy, R., Kaner, E. F. S., Smith, L., & Bonetti, D. (2004). Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers.
Gibran, D., & Rahmawati, R. (2020). Factors Affecting the Effectiveness of Screening for Hypertension in Rural Community.
He, Q.-H., Zheng, J., Liu, J.-L., Wang, J., & You, L.-M. (2022). Predictors of Medication Adherence of Patients With Coronary Heart Disease After Percutaneous Coronary Intervention: A Structural Equation Modeling Based on the Extended Theory of Planned Behavior. Journal of Cardiovascular Nursing, 37(4).
Ho, C. P., & Lee, T. J. F. (2014). An Evaluation Of Medication Adherence In Hypertensive Patients Using The Theory Of Planned Behavior. Value in Health, 17(7), A763. https://doi.org/10.1016/j.jval.2014.08.270
Holmes, E. A. F., Hughes, D. A., & Morrison, V. L. (2014). Predicting Adherence to Medications Using Health Psychology Theories: A Systematic Review of 20 Years of Empirical Research. Value in Health, 17(8), 863–876. https://doi.org/https://doi.org/10.1016/j.jval.2014.08.2671
International Health Metrics Monitoring and Evaluation. (2019). Indonesia Profile. Seattle, WA; IHME, University of Washington. http://www.healthdata.org/INDONESIA
Javaran, E., Sharifi, H., Hasani, M., Borhaninejad, V., & Iranpour, A. (2020). Effectiveness of a Theory of Planned Behavior-Based Intervention for Promoting Medication Adherence among Rural Elderly Hypertensive Patients in Iran. Elderly Health Journal, 6. https://doi.org/10.18502/ehj.v6i1.3410
Kamran, A., Sadeghieh Ahari, S., Biria, M., Malepour, A., & Heydari, H. (2014). Determinants of Patient’s Adherence to Hypertension Medications: Application of Health Belief Model Among Rural Patients. Annals of Medical and Health Sciences Research, 4(6), 922–927. https://doi.org/10.4103/2141-9248.144914
Kementerian Kesehatan Republik Indonesia. (2016). Peraturan Menteri Kesehatan Republik Indonesia Nomor 25 Tahun 2016 Tentang Rencana Aksi Nasional Kesehatan Lanjut Usia Tahun 2016-2019. Peraturan Menteri Kesehatan Republik Indonesia Nomor 25 Tahun 2016 Tentang Rencana Aksi Nasional Kesehatan Lanjut Usia. PMK_No. _25_ttg_Rencana_Aksi_Nasional_K Esehatan_Lanjut_Usia_Tahun_2016-2019_. Pdf.
Kementerian Kesehatan Republik Indonesia. (2018). Hasil utama Riskesdas 2018 [Main results of basic health research 2018]. Kementerian Kesehatan Republik Indonesia.
Kopelowicz, A., Zarate, R., Wallace, C. J., Liberman, R. P., Lopez, S. R., & Mintz, J. (2015). Using the theory of planned behavior to improve treatment adherence in Mexican Americans with schizophrenia. Journal of Consulting and Clinical Psychology, 83(5), 985–993. https://doi.org/10.1037/a0039346
MacLaughlin, E. J., & Saseen, J. J. (2023). Hypertension. In J. T. DiPiro, G. C. Yee, S. T. Haines, T. D. Nolin, V. L. Ellingrod, & L. M. Posey (Eds.), DiPiro’s Pharmacotherapy: A Pathophysiologic Approach, 12th Edition. McGraw Hill.
Mahmood, S., Jalal, Z., Hadi, M. A., Khan, T. M., Haque, M. S., & Shah, K. U. (2021). Prevalence of non-adherence to antihypertensive medication in Asia: a systematic review and meta-analysis. International Journal of Clinical Pharmacy, 43(3), 486–501. https://doi.org/10.1007/s11096-021-01236-z
Management Sciences for Health. (2012). MDS-3: managing access to medicines and health technologies. Management Sciences for Health.
Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., … Lim, S. S. (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2
Nazihah, N. Z., & Rahmawati, R. (2022). Knowledge About Hypertension and Its Treatment Among Patients and Lay Health Workers in the Posyandu Lansia. 3rd International Conference on Cardiovascular Diseases (ICCvD 2021), 215–229.
Pasina, L., Brucato, A. L., Falcone, C., Cucchi, E., Bresciani, A., Sottocorno, M., Taddei, G. C., Casati, M., Franchi, C., Djade, C. D., & Nobili, A. (2014). Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs & Aging, 31(4), 283–289. https://doi.org/10.1007/s40266-014-0163-7
Rahmawati, R., & Bajorek, B. (2015). A Community Health Worker-Based Program for Elderly People With Hypertension in Indonesia: A Qualitative Study, 2013. Preventing Chronic Disease, 12, E175. https://doi.org/10.5888/pcd12.140530
Rajeh, M. T. (2022). Modeling the theory of planned behavior to predict adults’ intentions to improve oral health behaviors. BMC Public Health, 22(1), 1391. https://doi.org/10.1186/s12889-022-13796-4
Smith, A. (2014). Older adults and technology use.
Steinmetz, H., Knappstein, M., Ajzen, I., Schmidt, P., & Kabst, R. (2016). How effective are behavior change interventions based on the Theory of Planned Behavior?: a three-level meta-analysis. Zeitschrift Für Psychologie, 224, 216–233. https://doi.org/10.1027/2151-2604/a000255
Suh, K. H. (2021). Verification of a theory of planned behavior model of medication adherence in Korean adults: focused on moderating effects of optimistic or present bias. BMC Public Health, 21(1), 1391. https://doi.org/10.1186/s12889-021-11460-x
Widyakusuma, N. N., Suryawati, S., Wiedyaningsih, C., & Probosuseno. (2023). What Do Seniors Believe About Medication Adherence? A Qualitative Study Among Seniors with Chronic Conditions in Yogyakarta, Indonesia. Patient Preference and Adherence, 17, 1381–1392. https://doi.org/10.2147/PPA.S412981
Wiedyaningsih, C., Hakimi, M., Soenarto, Y., & Suryawat, S. (2016). The Use of The Theory of Planned Behavior to Predict Factors Influencing Physicians’ Decision to Prescribe Extemporaneous Compounding Dosage Form for Pediatric Outpatients. Asian Journal of Pharmaceutical and Clinical Research, 288–291.
Yue, Z., Li, C., Weilin, Q., & Bin, W. (2015). Application of the health belief model to improve the understanding of antihypertensive medication adherence among Chinese patients. Patient Education and Counseling, 98(5), 669–673. https://doi.org/10.1016/j.pec.2015.02.007
Published
2024-03-25
How to Cite
Widyakusuma, N. N., Suryawati, S., Probosuseno, & Wiedyaningsih, C. (2024). Predicting the Intention to Adhere to Hypertensive Medication among Seniors: A Cross-Sectional Survey. Indonesian Journal of Pharmacy, 35(1), 185-193. https://doi.org/10.22146/ijp.10213
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Research Article
