Study On The Status Of The Influencing Factors Of Medication Adherence In Community Patients With Hypertension And The Nursing Strategy

ObjectiveTo investigate the status of knowledge and attitude of medication, self-efficacy,family function, social supports and medication adherence of hypertension patients in3urban communities in Guangzhou; To analysis the relationships among knowledge ofmedication, attitude of medication, self-efficacy, family function, social supports andmedication adherence, and to filtrate the influence factors of medication adherence; Toexplore the predictors of medication adherence and to develop nursing interventions forimproving medication adherence of patients with hypertension.MethodsThis study was a cross-sectional study which was conducted in3urban communityhealth service centers selected by randomly sampling. During Nov,2010and May,2011,total samples of576hypertension patients from the outpatients and follow-upmanagement patients of the three health service centers were investigated. Theknowledge and attitude of medication, self-efficacy, family function, the status of social support and medication adherence were assessed by a self-made questionnaire abouthypertension, self-efficacy scale, Family APGAR index questionnaire, social supportrating scale and Morisky questionnaire. Data analysis were conducted by using SPSS16.0Statistical Software, the statistical methods included descriptive analysis, chi-squaretest, t-test, Analysis of Variance analysis, Spearman correlation analysis, Pearsoncorrelation analysis, Binary logistic regression.Results(1) The rates of patients with good, general and poor level of medication knowledgewere41.5%,47.9%, and10.6%, respectively; The rates of patients with good, general,and poor level of medication attitude were54.3%,33.7%, and12%, respectively;Univariate analysis showed that the factors affecting medication knowledge ofhypertensive patients included age, marital status, education level, family per capitaincome, course of hypertension and payment model of medical fee. The influence factorsof medication attitude included marital status, education level, family per capita income,course of hypertension and payment model of medical fee.(2) The rates of patients with good, general, and poor level of self-efficacy were74%,22.4%, and3.6%, respectively. Univariate analysis showed that there were nosignificant association between demographic factors and self-efficacy.(3) The rates of patients with good, moderate and poor level of family function were74.3%,21.7%, and4%, respectively. Univariate analysis showed that the influencingfactors of family function included marital status, education level, family per capitaincome.(4) Compared with norms of the whole nation, the total scores of social support inour survey was significant lower (39.03±0.34v.s44.34±8.38, p<0.01); Multivariateregression analysis showed that age, sex, occupation, marital status, payment model inmedical fee were the influencing factors to social support.(5) The rates of good and poor medication adherence in patients with hypertensionwere38.7%and61.3%, respectively. Univariate analysis show that the factors affecting medication adherence of hypertension patients in community included education level,family per capita income, whether have a sphygmomanometer or not, how many types ofantihypertensive drugs were taken, asymptomatic, medication knowledge, attitude ofmedication, self-efficacy, family function.(6) The Pearson correlation analysis found negative correlations betweenmedication knowledge scores or medication attitude scores and medication adherencescores(r=-0.192，-0.362, p<0.01); Negative correlations were also found betweenmedication adherence scores and self-efficacy scores (r=-0.662，-0.627，-0.540,P<0.001); A negative correlation was found between family function scores andmedication adherence scores(0.141,0.117,0.134,0.140,0.152,0.148, p<0.01).(7) Unconditional Logistic Regression found that the influencing factors ofmedication adherence of hypertension patients included self-efficacy promote andobstacle factors in the self-efficacy scale.Conclusions(1) The influencial factors of medication adherence of hypertensive patients incommunity included patients’ education, different per capita-month incomes of family,Sphygmomanometer or not, taking several antihypertensive drugs, asymptomatic,medication knowledge, medication attitude, self-efficacy, family function.(2) To improve medication adherence of hypertensive patients in community mayfrom improve the level of medication knowledge, medication attitude, self-efficacy,family function to start.(3) Self-efficacy entered the forecasting model, it was an important influence factor,and can be to predict medication adherence good or bad degree, the obstacle factor wasgreat danger.(4) The research established a credible model for forecasting hypertensive patients’smedication adherence by applying optimal statistiacal methods to control confoundingfactors. (5) Preliminary established community nursing intervention strategies, andcontribute to community nurses work on hypertension management.