title: Factors associated with non-adherence to three hypertension self-management behaviors: preliminary data for a new instrument.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional analysis of randomized trial data.
  
  
  METHODS
  Six hundred and thirty-six primary care patients with hypertension.
  
  
  METHODS
  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.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, HSR&D (152), 508 Fulton Street, Durham, NC 27705, USA. matthew.crowley@dm.duke.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Crowley
authors.forename: Janet M
authors.initials: JM
authors.lastname: Grubber
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009657:North Carolina; D010349:Patient Compliance; D011320:Primary Health Care / Q000379:methods; D011594:Psychometrics; D012307:Risk Factors; D012648:Self Care / Q000379:methods*; D012959:Socioeconomic Factors
chemical_list: D000959:Antihypertensive Agents