Determinants of adherence to treatment in hypertensive patients of African descent and the role of culturally appropriate education.
BACKGROUND
In Western countries, better knowledge about patient-related determinants of treatment adherence (medication and lifestyle) is needed to improve treatment adherence and outcomes among hypertensive ethnic minority patients of African descent.


OBJECTIVE
To identify patient-related determinants of adherence to lifestyle and medication recommendations among hypertensive African Surinamese and Ghanaian patients with suboptimal treatment results (SBP≥140) living in the Netherlands and how culturally appropriate hypertension education (CAHE) influenced those determinants.


METHODS
This study analysed data of 139 patients who participated in the CAHE trial. Univariate logistic regression analysis was used to measure the association between patient-related determinants (medication self-efficacy, beliefs about medication and hypertension, social support, and satisfaction with care) and treatment adherence. We also tested whether CAHE influenced the determinants.


RESULTS
Medication self-efficacy and social support were associated with medication adherence at baseline. At six months, more medication self-efficacy and fewer concerns about medication use were associated with improved medication adherence. Self-efficacy was also associated with adherence to lifestyle recommendations at baseline. CAHE influenced patients' illness perceptions by creating more understanding of hypertension, its chronic character, and more concerns about the associated risks.


CONCLUSIONS
In this high-risk population, health care providers can support medication adherence by paying attention to patients' medication self-efficacy, the concerns they may have about medication use and patients' perceptions on hypertension. The CAHE intervention improved patients' perception on hypertension.
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Jennita G
JG
Meinema
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Nynke
N
van Dijk
Department of Social Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Erik J A J
EJ
Beune
Department of Evidence-based medical education, University Medical Center of Groningen, Groningen, the Netherlands.
Debbie A D C
DA
Jaarsma
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Henk C P M
HC
van Weert
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Joke A
JA
Haafkens
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044383:Black People / Q000523:psychology*; D003469:Culture; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology*; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000208:ethnology; D020377:Self Efficacy; D016896:Treatment Outcome
D000959:Antihypertensive Agents