title: Factors related to intentional and unintentional medication nonadherence in elderly patients with hypertension in rural community.
abstract: OBJECTIVE
  We assessed medication nonadherence, categorized as intentional or unintentional, and related factors in elderly patients with hypertension, correlating the data with measurement of blood pressure as the final target of medication adherence and other possible influencing factors, such as lifestyle.
  
  
  METHODS
  Subjects were aged ≥65 years, resided in a rural area, and were taking antihypertensive drugs. The survey was conducted in July 2014. Participants were divided into the following three groups: "Adherence", "Unintentional nonadherence", and "Intentional nonadherence". Individual cognitive components, such as necessity and concern as well as self-efficacy and other related factors, were compared according to adherence groups. The interrelationships between those factors and nonadherence were tested using structural equation modeling analysis.
  
  
  RESULTS
  Of the 401 subjects, 182 (45.6%) were in the adherence group, 107 (26.7%) in the unintentional nonadherence group, and 112 (27.9%) in the intentional nonadherence group. Necessity and self-efficacy were found to have a significant direct influence on unintentional nonadherence behaviors (necessity β=-0.171,P=0.019; self-efficacy β=-0.433,P<0.001); concern was not statistically significant (β=-0.009,P=0.909). Necessity was found to have significant direct and indirect impact on intentional nonadherence (direct β=-0.275,P=0.002; indirect β=-0.113,P=0.036). Self-efficacy had no significant direct effect on intentional nonadherence though it had the only significant indirect effect on intentional nonadherence (direct β=-0.055,P=0.515; indirect β=-0.286,P<0.001). Concern had no significant influence on intentional or on unintentional nonadherence (direct β=0.132 0.132,P=0.151; indirect β=-0.006,P=0.909).
  
  
  CONCLUSIONS
  Unintentional nonadherence should be regularly monitored and managed because of its potential prognostic significance. Interventions addressing cognitive factors, such as beliefs about medicine or self-efficacy, are relatively difficult to implement, but are essential to improve medication adherence.
authors.affiliation: Department of Preventive Medicine, Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital.
authors.forename: Sang Geun
authors.initials: SG
authors.lastname: Bae
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu.
authors.forename: Sin
authors.initials: S
authors.lastname: Kam
authors.affiliation: Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang National University School of Medicine; Department of Preventive Medicine, Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju.
authors.forename: Ki Soo
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu.
authors.forename: Keon-Yeop
authors.initials: KY
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu.
authors.forename: Nam-Soo
authors.initials: NS
authors.lastname: Hong
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu.
authors.forename: Ki-Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu.
authors.forename: Yu-Mi
authors.initials: YM
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu.
authors.forename: Won Kee
authors.initials: WK
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea.
authors.forename: Michael Sung Pil
authors.initials: MS
authors.lastname: Choe
keywords: aged; hypertension; medication adherence; self-control; self-efficacy