Factors affecting treatment compliance among hypertension patients in three district hospitals - Dar es Salaam

Abstract

Background: Hypertension is one of the most important cardiovascular risk factor but its control is still a challenge all around the world. Control of blood pressure can reduce cardiovascular morbidity and mortality, so the compliance to antihypertensive drugs and life style modification play an important role for the control of hypertension. With the guide of the Health Belief Model (HBM) conceptual framework, the study investigated factors affecting treatment compliance with antihypertensive therapy among patients attended three District hospitals in Dar es Salam. Objectives: The study was guided by seven objectives, (1) To determine the proportion of treatment compliance among hypertensive study participants 2) To identify social demographic factors that affect treatment compliance among hypertensive study participants. 3) To determine how perceived susceptibility to hypertension complications affect treatment compliance among hypertensive study participants 4) To determine how perceived severity of hypertension affect treatment compliance among hypertensive study participants 5)To identify perceived barriers to treatment compliance among hypertensive study participants. 6)To identify how perceived benefits affect treatment compliance among hypertensive study participants and 7) To identify how cues to action affect treatment compliance among hypertensive study participants Methodology: The study was descriptive cross- sectional design, which was conducted in three District hospitals in Dar es Salaam Region namely Amana, Mwananyamala and Temeke which are located in Ilala, Kinondoni and Temeke Municipalities respectively. The study population was hypertensive patients who are using antihypertensive treatment that attended the hypertensive clinics. A total of 135 patients were included in the study; the study used simple random sampling. In this study data were collected using structured questionnaires. Data were analysed using SPSS software programme, Frequency distribution, Bivariate analysis using chi-square and Pearson correlation to compare proportions while Multivariate analysis was done using Linear Multiple Regression to identify variables which are vii strongest predictor among variables of HBM.Where as, P value of equal and less than 0.05 was considered statistical significant. Results: In this study the proportion of participants with treatment compliance was 56%, the mean age (SD) of participants was 56.3 (±13.1) years. While Participants who were equal and below 64years of age (56.8%) had high level of treatment compliance compared to participants with equal or above 65 years of age (53.2%).The study also revealed that female were more compliant (63.2% ) compared to male ( 36.8% ) statistically significant. Married participants (61.0%) were more compliant than single participants and employed patients were more compliant compared to non married participants. With the use of Bivariate analysis (Pearson correlation and Chi-square) the HBM variables (perceived susceptibility, perceived benefit, perceived barrier and cues to action) were statistically significant, the perceived severity did not show statistical significance. With multivariate analysis the strongest predictor was perceived barrier to hypertensive treatment. Conclusion and Recommendation: Hypertensive patients participated in this study showed low compliance to antihypertensive treatment, the most significant factors with demographic characteristic was sex (female being compliant) and with the guide of HBM the strongest predictor was perceived barrier to antihypertensive treatment. In order for the patients to be compliant with medication, Nurses/Doctors should give heath education to patients to every clinic visit on the importance of complying with medication, patients should be educated that antihypertensive drugs is for life use, the policy of cost sharing should be reviewed, strategies should be on the possibilities of giving antihypertensive drugs free of charge like BT and ARV drugs.