Factors associated with non-adherence to three hypertension self-management behaviors: Preliminary data for a new instrument

Journal Article

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. © 2012 Society of General Internal Medicine.

Full Text

Duke Authors

Cited Authors

  • Crowley, MJ; Grubber, JM; Olsen, MK; Bosworth, HB

Published Date

  • 2013

Published In

Volume / Issue

  • 28 / 1

Start / End Page

  • 99 - 106

International Standard Serial Number (ISSN)

  • 0884-8734

Digital Object Identifier (DOI)

  • 10.1007/s11606-012-2195-1