Anthropological Approach to Adherence Factors for Antihypertensive Drug Therapy

Abstract

Objective: uncontrolled high blood pressure leads clinicians to wonder about adherence degree among hypertensive patients. In this context, our study aims to describe and analyze patients' experience of antihypertensive drugs in order to shed light on the multiple social and symbolic logics, forming part of the cultural factors shaping personal medication practices. Methods: The medical inductive and comprehensive anthropological approach implemented is based on an ethnographic survey (observations of consultations and interviews). Semi-structured interviews were conducted with 68 hypertensive patients (39 women and 29 men, between the ages of 40 and 95, of whom 52 were over 60) who had been receiving treatment for over a year. Results: Antihypertensive drugs are reinterpreted when filtered through the cultural model of physiopathology (the body as an engine). This symbolic dimension facilitates acceptance of therapy but leads to a hierarchization of other prescribed drugs and of certain therapeutic classes (diuretics). Prescription compliance does not solely depend on the patient' s perception of cardiovascular risk, but also on how the patient fully accepts the treatment and integrates it into his or her daily life; this requires identification with the product, building commitment and self-regulation of the treatment (experience, managing treatment and control of side effects, intake and treatment continuity). Following the prescription requires a relationship based on trust between the doctor and patient, which we have identified in three forms: reasoned trust, emotional trust and conceded trust. Conclusion: Consideration and understanding of these pragmatic and symbolic issues by the treating physician should aid practitioners in carrying out their role as medical educators in the management of hypertension. This paper was originally published in French, in the journal Pratiques et organisation des soins 39(1): 3-12. RésuméObjectif : Les hypertensions artérielles non contrôlées conduisent les cliniciens à s'interroger sur les niveaux d' observance des hypertendus traités. dans ce contexte, notre étude visait à décrire et à analyser l' expérience des hypotenseurs par les hypertendus, afin de mettre à jour les logiques plurielles, sociales et symboliques, permettant de comprendre ce qui construit culturellement les pratiques médicamenteuses des individus. Méthodes : La démarche anthropologique, inductive et compréhensive, mise en oeuvre reposait sur une enquête ethnographique (observations de consultations et entretiens). nous avons interviewé 68 hypertendus (39 femmes et 29 hommes, âgés de 40 à 95 ans, 52 d' entre eux ayant plus de 60 ans) traités depuis plus d'un an. HEALTHCARE POLICY Vol.5 No.4, 2010 [e159] Anthropological Approach of Adherence Factors for Antihypertensive DrugsRésultats : Le médicament hypotenseur était réinterprété au travers du filtre des représentations populaires de la physiopathologie (corps machine). Cette dimension symbolique facilitait l' adhésion thérapeutique, mais cond...

Uncontrolled hypertension among patients managed in primary healthcare facilities in Kinshasa, Democratic Republic of the Congo

“…In many studies, non-compliance with antihypertensive therapy was responsible for two-thirds of the cases of uncontrolled hypertension 33,34. Krousel-Woods et al33 found that non-compliance was associated with a nearly two-fold greater risk (OR 1.68; 95% CI 1.01–2.88) of uncontrolled BP.…”

“…In many studies, non-compliance with antihypertensive therapy was responsible for two-thirds of the cases of uncontrolled hypertension. 33 , 34 Krousel-Woods et al33 found that non-compliance was associated with a nearly two-fold greater risk (OR 1.68; 95% CI 1.01–2.88) of uncontrolled BP. Yaméogo et al25 in Burkina Faso found that non-compliance with both diet and antihypertensive therapy was associated with an eightfold (OR 8.40; 95% CI 1.11–4.17; p = 0.04) and nearly three-fold greater risk of uncontrolled hypertension, respectively.…”

Home blood pressure monitoring and adherence in patients with hypertension on primary prevention treatment: a survey of 1026 patients in general medicine in the Auvergne region

“…The practice of HBPM has to be accompanied by professional, and be performed rigorously for a better adherence and so a better control of hypertension. Adherence is influenced by sociocultural and psycho-behavioral factors specific to patients, and the quality of the doctor-patient relationship [29,30]. It is likely that participants in our survey who used the HBPM correctly received better information from their GP, thus developing self-care competencies [31].…”

Communicative and Discursive Perspectives on the Medication Experience

“…More generally, the attraction and even loyalty and closeness sometimes felt to a drug [ 29 ] may rest in part on the name. Brand loyalty in general is central to marketing, although ultimately, in the words of Rotfeld [ 62 ], ‘so little is known about how or why advertising works’.…”

“…Or, more likely, there is an interaction of sorts going on, part of what Halliday [ 15 ] terms a social semiotic but constantly morphing as the interaction progresses. By contrast, adherence to a medicine has been found expressed in terms of fear (the invisible disease), self-preservation (‘taking care of oneself’), and variations on a theme of trust: trust in the drug and trust in one’s physician [ 29 ].…”