Factors affecting compliance and health-seeking behaviour of hypertensive patients: a mixed-method study

Bhavna Bharatkumar Baria; Mohmmedirfan Hanifbhai Momin

doi:10.18203/2394-6040.ijcmph20263209

Authors

Bhavna Bharatkumar Baria Department of Community Medicine, Government Medical College Surat, Gujarat, India
Mohmmedirfan Hanifbhai Momin Department of Community Medicine, Government Medical College Surat, Gujarat, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263209

Keywords:

Health-seeking behaviour, Hill-Bone compliance scale, Hypertension, Mixed-method, Surat, Treatment compliance

Abstract

Background: Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. Despite availability of effective pharmacological and lifestyle interventions, optimal blood pressure control remains suboptimal, largely due to poor treatment compliance and delayed or inappropriate health-seeking behaviour. Objectives were to assess the extent of treatment compliance among hypertensive patients; to identify determinants of antihypertensive treatment compliance; to explore factors affecting health-seeking behaviour; and to qualitatively explore accessibility, availability, challenges and opportunities influencing compliance.

Methods: A mixed-methods cross-sectional study was conducted at the non-communicable disease clinic of a tertiary care hospital in Surat, Gujarat, India from May to October 2023. The quantitative component included 300 adult hypertensive patients selected by convenient sampling. Data were collected using a semi-structured questionnaire capturing socio-demographic details, lifestyle practices, treatment characteristics, and the Hill-Bone compliance to high blood pressure therapy scale. The qualitative component comprised in-depth interviews with 10 hypertensive patients; thematic analysis was performed.

Results: The mean±SD age of 300 participants was 56.8±10.7 years. Overall mean±SD for Hill Bone compliance score was 17.49±3.83 while those of medication compliance, sodium use and appointment keeping subscales were 9.38±2.22, 3.62±1.05 and 4.49±1.68 respectively. Only 61 (20.33%) participants were perfectly adherent according to Hill Bone compliance therapeutic scale while 239 (79.66%) participants were not. Qualitative themes included perceived severity of hypertension, financial constraints, health literacy, access barriers and the enabling role of family and counselling.

Conclusions: Treatment compliance and health-seeking behaviour among hypertensive patients are influenced by an interplay of patient-related, therapy-related and system-level factors.

References

Momin MH, Desai VK, Kavishwar AB. Study of socio-demographic factors affecting prevalence of hypertension among bank employees of Surat City. Indian J Public Health. 56(1):44-8.

Musinguzi G, Anthierens S, Nuwaha F, Van Geertruyden JP, Wanyenze RK, Bastiaens H. Factors influencing compliance and health seeking behaviour for hypertension in Mukono and Buikwe in Uganda: a qualitative study. Int J Hypertens. 2018;2018.

Baharvand P, Malekshahi F, Babakhani A. Perception of hypertension and adherence to hypertension treatment among patients attending a hospital in western Iran: a cross-sectional study. Heal Sci Rep. 2023;6(8):1-8.

Liu T, Zhao X, Huang M, Yang Y, Chen Z, He X, et al. Hypertension doctors’ awareness and practice of medication adherence in hypertensive patients: a questionnaire-based survey. Peer J. 2023;11:1-21.

Ministry of Health and Family Welfare. India Fact Sheet, National Family Health Survey-5 2019-21. 2019. Available from; https://dhsprogram.com/ pubs/pdf/FR375/FR375.pdf. Accessed on 11 May 2026.

Schafhalter-Zoppoth I, Walther A, Flattery D. Exclusion of non-English speaking, recently released prisoners. Am J Public Health. 2013;103(6):6-7.

Prlic M, Hohl TM. INKTs foil fungi. Cell Host Microbe. 2011;10(5):421-2.

Schaa KL, Roter DL, Biesecker BB, Cooper LA, Erby LH. Genetic counselors’ implicit racial attitudes and their relationship to communication. Health Psychology. 2015;34(2):111.

Rao CR, Kamath VG, Shetty A, Kamath A. Treatment compliance among patients with hypertension and type 2 diabetes mellitus in a coastal population of southern India. Int J Prev Med. 2014;5(8):992-8.

Son PT. Hypertension in Vietnam: from community-based studies to a national targeted programme. Umeå universitet. 2012.

Shakya R, Shrestha R, Shrestha S, Sapkota P, Gautam R, Sapkota B, et al. Translation, cultural adaptation and validation of the Hill Bone compliance to high blood pressure therapy scale to Nepalese Language. Patient Prefer Adher. 2022:957-70.

Kshatri JS, Satpathy P, Sharma S, Bhoi T, Mishra SP, Sahoo SS. Health research in the state of Odisha, India: a decadal bibliometric analysis (2011‑2020). J Fam Med Prim Care. 2022;6(2):169-70.

Mutneja E, Yadav R, Ballav A, Gupta P. Frequency and predictors of compliance among patients taking antihypertensive medicines. Indian Heart J. 2020;72(2):136-9.

Nagamine Y, Shobugawa Y, Sasaki Y, Takagi D, Fujiwara T, Khin YP, et al. Associations between socioeconomic status and adherence to hypertension treatment among older adults in urban and rural areas in Myanmar: a cross-sectional study using baseline data from the JAGES in Myanmar prospective cohort study. BMJ Open. 2023;13(1):1-8.

Bhusal L, Deep Pathak B, Dhakal B, Simkhada N, Sharma N, Upadhaya Remi B, et al. Determination of level of self‐reported adherence of antihypertensive drug (s) and its associated factors among patient with hypertension at a tertiary care center. J Clin Hypertens. 2022;24(11):1444-50.

Nakwafila O, Mashamba-Thompson T, Godi A, Sartorius B. A cross-sectional study on hypertension medication adherence in a high-burden region in Namibia: exploring hypertension interventions and validation of the Namibia Hill-Bone Compliance Scale. Int J Environ Res Public Health. 2022;19(7):1-13.

Palabindela R, Nagamani PS, Choudary N. Assessing adherence to hypertension medications and its impact on blood pressure control: a community-based observational study. Asian J Med Sci. 2023;14(12):61-6.

Wang A, Wan J, Zhu L, Chang W, Wen L, Tao X, et al. Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model. Front Public Health. 2023;11:1283416.

Shakya R, Shrestha S, Gautam R, Rai L, Maharjan S, Satyal GK, et al. Perceived illness and treatment adherence to hypertension among patients attending a tertiary hospital in Kathmandu, Nepal. Patient Prefer Adher. 2020;14:2287-300.

Abdul Wahab NA, Makmor Bakry M, Ahmad M, Mohamad Noor Z, Mhd Ali A. Exploring culture, religiosity and spirituality influence on antihypertensive medication adherence among specialised population: a qualitative ethnographic approach. Patient Prefer Adher. 2021:2249-65.

Ojangba T, Boamah S, Miao Y, Guo X, Fen Y, Agboyibor C, et al. Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review. J Clin Hypertens. 2023;25(6):509-20.

Shi C, Cao P, Wang Y, Zhang Q, Zhang D, Wang Y, et al. PANoptosis: a cell death characterized by pyroptosis, apoptosis, and necroptosis. J Inflamm Res. 2023;16(April):1523-32.

Li M, Gorski M, Tin A, Wang L, Kirsten H, Ho K, et al. HHS Public Access. 2019;51(6):957–72.