A systematic review of interventions using health behavioral theories to improve medication adherence among patients with hypertension

Abstract

Medication adherence is a major problem in the treatment of hypertension. Approximately half of the patients who use antihypertensive medications are not adherent. Several interventions have endeavored to improve medication adherence among patients with hypertension, and some have used health behavioral models/theories. However, the quality and effectiveness of using health behavioral models/theories in improving medication adherence among patients with hypertension remain unknown. The main aim of this systematic review was to describe study characteristics and types of health behavioral models/theories used in interventions for improving medication adherence among adults with hypertension. PubMed, Scopus, Ovid MEDLINE, CINAHL, and PsycINFO databases were searched for randomized clinical trial interventions using any health behavioral models/theories published in English from 1979 to 2019. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent reviewers searched, screened abstracts and articles, extracted data, and assessed the risk of bias and the use of the model/theory using the Theory Coding Scheme. A total of 11 articles were included in this systematic review. Two studies reported significant improvement in medication adherence. The Self-Regulation Model and Social Cognitive Theory were the most common types of models/theories. Nine studies used a single model/theory, and four studies measured the constructs of a model/theory. Risk of bias was good (n = 4) and fair (n = 5) in interventions. Using health behavioral models/theories may be an efficient way for health care professionals to improve adherence to medications among patients with hypertension. More interventions with rigorous designs are needed that appropriately utilize health behavioral models/theories for improving medication adherence among adults with hypertension.

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

“…Medications of interest within the 80 reviews included in our umbrella review were: statins (n=10),25–34 antihypertensives (n=38),35–72 and statins and antihypertensives (n=34) 73–104. Nine of the reviews synthesised qualitative evidence,27 31 42 50 55 58 60 61 83 104 four of which also included quantitative evidence in a mixed evidence synthesis 42 50 58 61.…”

Determinants of Adherence to Treatment in Type 2 Diabetic Patients: A Directed Qualitative Content Analysis Based on Pender’s Health Promotion Model

“…Typically, interventions use simple methods, such as medication reminders to improve adherence to chronic disease treatment (Drabble et al, 2019). Considering that a wide range of individual, interpersonal, and situational factors (Hashimoto et al, 2019; Mannan et al, 2021; Pourhabibi et al, 2022) influence adherence to T2D treatment, we suggest that interventions become more specialized and be designed in light of theoretical frameworks (Nili et al, 2020). Including the factors mentioned in the interventions can facilitate patients’ increased motivation to follow the treatment; low costs will be imposed on the treatment of the complications of diabetes for the individuals and the medical system.…”

Comprehensive Approach for Improving Adherence to Prenatal Iron and Folic Acid Supplements Based on Intervention Studies in Bangladesh, Burkina Faso, Ethiopia, and India

“…To shape IFA adherence interventions for each level, we applied health systems strengthening 27 and social and behavioral science theories and frameworks proven to work in health promotion programs. 22,28,29 We tailored interventions to the national guidelines, national ANC program structures, and community contexts.…”

“…36,37 Theories on what drives individual behaviors deepened our understanding of how to structure interventions for behavior modification in individuals. 22,29 For example, intentions are highlighted as the immediate precursors of behavior, and intentions are a function of knowledge and attitudes toward the recommended behavior that develop from past experience or learned from influential persons, as well as perceptions of social norms and ability to perform the recommended action or self-efficacy. [38][39][40] Additionally, we reviewed approaches used for improving adherence to other drugs used for long-term adult chronic conditions, such as cardiovascular disease, hypertension, and diabetes.…”