Factors Affecting Medication Adherence among Nepalese Hypertensives in a Rural Area

Abstract

Maintaining drug adherence has become a challenge for both the hypertensives and the health system for a variety of reasons. There is a lack of understanding about the several factors that may lead to medication non-adherence, especially among rural hypertensives. The purpose of this study was to assess the status of medication adherence and to identify the factors influencing medication adherence among Nepalese rural hypertensives. This community-based cross-sectional study was conducted among 405 rural hypertensives from Lamahi Municipality, Dang District of Nepal through a simple random sampling. The sample size for this study was determined using the formula: Z2pq/d2. The standard 9-items Hill-Bone medication scale (HB-MAS) questionnaire was used to assess the status of medication adherence. The questionnaires used in this study are based on rigorous literature review and were tested for the validity and reliability. Data was collected using a face-to-face interview and was analyzed using descriptive (frequency and proportion), bivariate (chi-square) and multiple logistic regression. Study indicated that only 56.5% hypertensives are adherent to antihypertensive medication. Ethnicity [adjusted odds ratio (AOR) = 0.24; 95% CI: 0.09 - 0.65, p 0.005], knowledge [AOR = 13.80; 95% CI: 4.95 – 38.48, p <0.001], attitude [AOR = 15.08; 95% CI: 5.21 – 43.63, p <0.001], availability of medication and services [AOR = 2.84; 95% CI: 1.24 - 6.49, p <0.013], and accommodation of hypertension-related services [AOR = 14.15; 95% CI: 2.21 – 90.57, p 0.005] are the factors associated with medication adherence. Targeting tailored interventions for specific ethnic groups, enhancing knowledge, and building trust among the hypertensives regarding the medication, ensuring availability of the antihypertensive medication, and strengthening current health service provision for antihypertensive medication and services closer to the communities might improve medication adherence among the rural hypertensives in Nepal.