Author(s)

Aina Olufemi Odusola^1,2*, Heleen Nelissen¹, Marleen Hendriks¹, Constance Schultsz¹, Ferdinand Wit¹, Oladimeji Akeem Bolarinwa³, Tanimola Akande³, Charles Agyemang², Gbenga Ogedegbe⁴, Kayode Agbede⁵, Peju Adenusi⁶, Akin Osibogun⁷, Karien Stronks², Joke Haafkens⁸

¹Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.
²Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
³Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
⁴Division of Health and Behavior, Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, USA.
⁵Ogo Oluwa Hospital, Bacita, Nigeria.
⁶Hygeia Community Health Care, Hygeia HMO, Lagos, Nigeria.
⁷Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria.
⁸Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.

In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational interventions may reverse this trend. Using a pre-test/post-test design, in this study we investigated the effects of a structured cardiovascular health education program (CHEP) on treatment adherence, blood pressure (BP) control and body mass index (BMI) among Nigerian hypertensive patients who received guideline-based care in a rural primary care facility, in the context of a community based health insurance program. Study participants included 149 insured patients with uncontrolled BP and/or poor self-reported medication adherence after 12 months of guideline-based care. All patients received three group-based educational sessions and usual primary care over 6 months. We evaluated changes in self-reported adherence to prescribed medications and behavioral advice (primary outcomes); systolic BP (SBP) and/or diastolic BP (DBP) and BMI (secondary outcomes); and beliefs about hypertension and medications (explora- tory outcomes). Outcomes were analyzed with descriptive statistics and regression analysis. 140 patients completed the study (94%). At 6 months, more participants reported high adherence to medications and behavioral advice than at baseline: respectively, 101 (72%) versus 70 (50%), (p < 0.001) and 126 (90%) versus 106 (76%), (p < 0.001). Participants with controlled BP doubled from 34 (24%) to 65 (46%), (p = 0.001). The median SBP and DBP decreased from 129.0 to 122.0 mmHg, (p = 0.002) and from 80.0 to 73.5 mmHg, (p < 0.001), respectively. BMI did not change (p = 0.444). Improved medication adherence was associated with a decrease in medication concerns (p = 0.045) and improved medication self-efficacy (p < 0.001). By positively influencing patient perceptions of medications, CHEP strengthened medication adherence and, consequently, BP reduction among insured hypertensive Nigerians. This educational approach can support cardiovascular disease prevention programs for Africa’s growing hypertensive population.

BP-Control, Education, Adherence, Self-Efficacy, Insurance, Nigeria

Odusola, A. , Nelissen, H. , Hendriks, M. , Schultsz, C. , Wit, F. , Bolarinwa, O. , Akande, T. , Agyemang, C. , Ogedegbe, G. , Agbede, K. , Adenusi, P. , Osibogun, A. , Stronks, K. and Haafkens, J. (2015) How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study. World Journal of Cardiovascular Diseases, 5, 181-198. doi: 10.4236/wjcd.2015.57021.