Medication Adherence, Blood Pressure Control, Knowledge, Self-care and Self-efficacy among Tunisian Hypertensive Patients

The aim of this study was to investigate the associated factors with adherence to antihypertensive therapy and to explore the association between medication adherence, blood pressure control, knowledge about hypertension (HTN), self-care, and self-efficacy in hypertensive patients.

A cross-sectional study was conducted among 750 hypertensive patients in Tunisia. The data collection tool was a 5-section questionnaire including an information sheet, the Girerd medication adherence scale, the HTN Knowledge Level Scale (HK-LS), the Self-care of HTN Inventory (SC-HI), and the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S).

A low and moderate level of medication adherence has been observed in 83.2% of the participants. Uncontrolled blood pressure was detected in 73.1% of cases. Only 11.5% have a good level of knowledge about HTN. Concerning Self-care practices, 48.8% of patients have inadequate practices of maintenance, 48.8% have inadequate practices of monitoring, and 83.9% have inadequate practices of management. The self-efficacy for managing HTN was weak in 42.1% of the participants.

In multivariate analysis, low medication adherence was associated with the number of antihypertensive pills/day (OR_a=2.668; CI_95%= (1.447- 4.918) if ≥ 4 pills/day), side effects (OR_a=1.834; CI_95%= (1.263- 2.665); p=0.001), uncontrolled hypertension (OR_a=2.74; CI_95%= (1.798- 4.18); p<0.0001), insufficient self-efficacy for managing HTN (OR_a=1.773; CI_95%=(1.252- 2.512); p<0.0001), and insufficient self-care maintenance (OR_a=2.220; CI_95%=(1.562- 3.1570); p<0.0001).

Low medication adherence was associated with uncontrolled blood pressure, more anti-hypertensive pills, side effects, lower self-efficacy, and lower self-care maintenance. Nursing interventions improving the management skills of hypertensive patients may be beneficial in controlling the disease and its subsequent consequences.