How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study
Aina Olufemi Odusola1,2*, 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.
 DOI: 10.4236/wjcd.2015.57021   PDF   HTML   XML   3,582 Downloads   5,187 Views   Citations

Abstract

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.

Share and Cite:

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.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] WHO (2011) Global Atlas on Cardiovascular Disease Prevention and Control.
http://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/
[2] Alwan, A. and WHO (2011) Global Status Report on Non-Communicable Diseases 2010.
http://whqlibdoc.who.int/publications/2011/9789240
[3] WHO and Others (2007) Prevention of Cardiovascular Disease: Pocket Guidelines for Assessment and Management of Cardiovascular Risk (WHO/ISH Cardiovascular Risk Prediction Charts for the European Region).
[4] Mendis, S., Lindholm, L.H., Mancia, G., Whitworth, J., Alderman, M., Lim, S., et al. (2007) World Health Organization (WHO) and International Society of Hypertension (ISH) Risk Prediction Charts: Assessment of Cardiovascular Risk for Prevention and Control of Cardiovascular Disease in Low and Middle-Income Countries. Journal of Hypertension, 25, 1578-1582.
http://dx.doi.org/10.1097/HJH.0b013e3282861fd3
[5] Lewington, S., Clarke, R., Qizilbash, N., Peto, R. and Collins, R. (2002) Prospective Studies Collaboration: Age-Specific Relevance of Usual Blood Pressure to Vascular Mortality: A Meta-Analysis of Individual Data for One Million Adults in 61 Prospective Studies. Lancet, 360, 1903-1913.
http://dx.doi.org/10.1016/S0140-6736(02)11911-8
[6] Kayima, J., Wanyenze, R.K., Katamba, A., Leontsini, E. and Nuwaha, F. (2013) Hypertension Awareness, Treatment and Control in Africa: A Systematic Review. BMC Cardiovascular Disorders, 13, 1-11.
http://dx.doi.org/10.1186/1471-2261-13-54
[7] Ogah, O.S., Okpechi, I., Chukwuonye, I.I., Akinyemi, J.O., Onwubere, B.J., Falase, A.O., et al. (2012) Blood Pressure, Prevalence of Hypertension and Hypertension Related Complications in Nigerian Africans: A Review. World Journal of Cardiology, 4, 327-340.
http://dx.doi.org/10.4330/wjc.v4.i12.327
[8] Beaglehole, R., Epping-Jordan, J., Patel, V., Chopra, M., Ebrahim, S., Kidd, M., et al. (2008) Improving the Prevention and Management of Chronic Disease in Low-Income and Middle-Income Countries: A Priority for Primary Health Care. The Lancet, 372, 940-949.
http://dx.doi.org/10.1016/S0140-6736(08)61404-X
[9] Mendis, S., Abegunde, D., Oladapo, O., Celletti, F. and Nordet, P. (2004) Barriers to Management of Cardiovascular Risk in a Low-Resource Setting Using Hypertension as an Entry Point. Journal of Hypertension, 22, 59-64.
http://dx.doi.org/10.1097/00004872-200401000-00013
[10] Maimaris, W., Paty, J., Perel, P., Legido-Quigley, H., Balabanova, D., Nieuwlaat, R., et al. (2013) The Influence of Health Systems on Hypertension Awareness, Treatment, and Control: A Systematic Literature Review. PLoS Medicine, 10, e1001490.
http://dx.doi.org/10.1371/journal.pmed.1001490
[11] Adebisi, O.O. and Samali, A. (2013) Poverty and Hypertension in Nigerian Adults: A Barrier to Its Control and Treatment: A Review. Unique Research Journals, 1, 013-014.
[12] Mwaura, J.W. and Pongpanich, S. (2012) Access to Health Care: The Role of a Community Based Health Insurance in Kenya. The Pan African Medical Journal, 12, 35.
[13] Onoka, C., Onwujekwe, O., Uzochukwu, B. and Ezumah, N. (2013) Promoting Universal Financial Protection: Constraints and Enabling Factors in Scaling-Up Coverage with Social Health Insurance in Nigeria. Health Research Policy and Systems, 11, 20.
http://dx.doi.org/10.1186/1478-4505-11-20
[14] Hendriks, M.E., Wit, F.W., Akande, T.M., Kramer, B., Osagbemi, G.K., Tanovi?, Z., et al. (2014) Effect of Health Insurance and Facility Quality Improvement on Blood Pressure in Adults With Hypertension in Nigeria A Population-Based Study. JAMA Internal Medicine, 174, 555-563.
http://dx.doi.org/10.1001/jamainternmed.2013.14458
[15] Krousel-Wood, M., Thomas, S., Muntner, P. and Morisky, D. (2004) Medication Adherence: A Key Factor in Achieving Blood Pressure Control and Good Clinical Outcomes in Hypertensive Patients. Current Opinion in Cardiology, 19, 357-362.
http://dx.doi.org/10.1097/01.hco.0000126978.03828.9e
[16] Bowry, A.D., Shrank, W.H., Lee, J.L., Stedman, M. and Choudhry, N.K. (2011) A Systematic Review of Adherence to Cardiovascular Medications in Resource-Limited Settings. Journal of General Internal Medicine, 26, 1479-1491.
http://dx.doi.org/10.1007/s11606-011-1825-3
[17] AlGurair, S., Hughes, C., Simpson, S. and Guirguis, L. (2012) A Systematic Review of Patient Self-Reported Barriers of Adherence to Antihypertensive Medication Using the World Health Organization Multidimensional Adherence Model. The Journal of Clinical Hypertension, 14, 877-886.
http://dx.doi.org/10.1111/j.1751-7176.2012.00699.x
[18] De Geest, S. and Sabate, E. (2003) Adherence to Long-Term Therapies: Evidence for Action. European Journal of Cardiovascular Nursing, 2, 323.
http://dx.doi.org/10.1016/S1474-5151(03)00091-4
[19] Kleinman, A., Eisenberg, L. and Good, B. (2006) Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research. FOCS, 4, 140-149.
http://dx.doi.org/10.1176/foc.4.1.140
[20] Leventhal, H., Brissette, I. and Leventhal, E.A. (2003) The Common-Sense Model of Self-Regulation of Health and Illness. The Self-Regulation of Health and Illness Behaviour, 1, 42-65.
[21] Marshall, I.J., Wolfe, C.D. and McKevitt, C. (2012) Lay Perspectives on Hypertension and Drug Adherence: Systematic Review of Qualitative Research. BMJ, 345, e3953-e3953.
http://dx.doi.org/10.1136/bmj.e3953
[22] Houston, T.K., Allison, J.J., Sussman, M., Horn, W., Holt, C.L., Trobaugh, J., et al. (2011) Culturally Appropriate Storytelling to Improve Blood Pressure: A Randomized Trial. Annals of Internal Medicine, 154, 77-84.
http://dx.doi.org/10.7326/0003-4819-154-2-201101180-00004
[23] Beune, E.J., van Charante, E.P.M., Beem, L., Mohrs, J., Agyemang, C.O., Ogedegbe, G., et al. (2014) Culturally Adapted Hypertension Education (CAHE) to Improve Blood Pressure Control and Treatment Adherence in Patients of African Origin with Uncontrolled Hypertension: Cluster-Randomized Trial. PloS ONE, 9, e90103.
http://dx.doi.org/10.1371/journal.pone.0090103
[24] González-fernández, R.A., Rivera, M., Torres, D., Quiles, J. and Jackson, A. (1990) Usefulness of a Systemic Hypertension In-Hospital Educational Program. American Journal of Cardiology, 65, 1384-1386.
http://dx.doi.org/10.1016/0002-9149(90)91332-Z
[25] Warsi, A., Wang, P.S., LaValley, M.P., Avorn, J. and Solomon, D.H. (2004) Self-management Education Programs in Chronic Disease: A Systematic Review and Methodological Critique of the Literature. Archives of Internal Medicine, 164, 1641-1649.
http://dx.doi.org/10.1001/archinte.164.15.1641
[26] Walsh, J.M., Sundaram, V., McDonald, K., Owens, D.K. and Goldstein, M.K. (2008) Implementing Effective Hypertension Quality Improvement Strategies: Barriers and Potential Solutions. The Journal of Clinical Hypertension, 10, 311-316.
http://dx.doi.org/10.1111/j.1751-7176.2008.07425.x
[27] Mendis, S., Johnston, S.C., Fan, W., Oladapo, O., Cameron, A. and Faramawi, M.F. (2010) Cardiovascular Risk Management and Its Impact on Hypertension Control in Primary Care in Low-Resource Settings: A Cluster-Randomized Trial. Bulletin of the World Health Organization, 88, 412-419.
http://dx.doi.org/10.2471/BLT.08.062364
[28] Hendriks, M.E., Bolarinwa, O.A., Wit, F.W., Brewster, L.M., Odusola, A.O., Rosendaal, N.T., et al. (2014) Feasibility and Quality of Cardiovascular Disease Prevention within a Community-Based Health Insurance Program in Rural Nigeria: An Operational Cohort Study. Journal of Hypertension, 33, 366-375.
[29] Odusola, A.O., Hendriks, M., Schultsz, C., Bolarinwa, O.A., Akande, T., Osibogun, A., et al. (2014) Perceptions of Inhibitors and Facilitators for Adhering to Hypertension Treatment among Insured Patients in Rural Nigeria: A Qualitative Study. BMC Health Services Research, 14, 624.
http://dx.doi.org/10.1186/s12913-014-0624-z
[30] Odusola, A.O., Hendriks, M., Schultsz, C., Stronks, K., Lange, J., Osibogun, A., et al. (2011) Development and Evaluation of a Patient Centered Cardiovascular Health Education Program for Insured Patients in Rural Nigeria (QUICK-II). BMC Public Health, 11, 171.
http://dx.doi.org/10.1186/1471-2458-11-171
[31] Health Insurance Fund.
http://www.hifund.org/
[32] American Diabetes Association (2010) Standards of Medical Care in Diabetes—2010. Diabetes Care, 33, S11-S61.
http://dx.doi.org/10.2337/dc10-S011
[33] Mancia, G., Fagard, R., Narkiewicz, K., Redon, J., Zanchetti, A., Bohm, M., et al. (2013) 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal, 34, 2159-2219.
http://dx.doi.org/10.1093/eurheartj/eht151
[34] Hendriks, M., Brewster, L., Wit, F., Bolarinwa, O.A., Odusola, A.O., Redekop, W., et al. (2011) Cardiovascular Disease Prevention in Rural Nigeria in the Context of a Community Based Health Insurance Scheme: Quality Improvement Cardiovascular Care Kwara-I (QUICK-I). BMC Public Health, 11, 186.
http://dx.doi.org/10.1186/1471-2458-11-186
[35] Morisky, D.E., Green, L.W. and Levine, D.M. (1986) Concurrent and Predictive Validity of a Self-Reported Measure of Medication Adherence. Medical Care, 24, 67-74.
http://dx.doi.org/10.1097/00005650-198601000-00007
[36] Morisky, D.E., Ang, A., Krousel-Wood, M. and Ward, H.J. (2008) Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. The Journal of Clinical Hypertension, 10, 348-354.
http://dx.doi.org/10.1111/j.1751-7176.2008.07572.x
[37] Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L. and Buick, D. (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychology & Health, 17, 1-16.
http://dx.doi.org/10.1080/08870440290001494
[38] Horne, R., Weinman, J. and Hankins, M. (1999) The Beliefs about Medicines Questionnaire: The Development and Evaluation of a New Method for Assessing the Cognitive Representation of Medication. Psychology & Health, 14, 1- 24.
http://dx.doi.org/10.1080/08870449908407311
[39] Ogedegbe, G., Mancuso, C.A., Allegrante, J.P. and Charlson, M.E. (2003) Development and Evaluation of a Medication Adherence Self-Efficacy Scale in Hypertensive African-American Patients. Journal of Clinical Epidemiology, 56, 520-529.
http://dx.doi.org/10.1016/S0895-4356(03)00053-2
[40] Fernandez, S., Chaplin, W., Schoenthaler, A. and Ogedegbe, G. (2008) Revision and Validation of the Medication Adherence Self-Efficacy Scale (MASES) in Hypertensive African Americans. Journal of Behavioral Medicine, 31, 453-462.
http://dx.doi.org/10.1007/s10865-008-9170-7
[41] Ogedegbe, G., Tobin, J.N., Fernandez, S., Cassells, A., Diaz-Gloster, M., Khalida, C., et al. (2014) Counseling African Americans to Control Hypertension: Cluster-Randomized Clinical Trial Main Effects. Circulation, 129, 2044-2051.
http://dx.doi.org/10.1161/CIRCULATIONAHA.113.006650
[42] Sweileh, W.M., Zyoud, S.H., Abu Nab’a, R.J., Deleq, M.I., Enaia, M.I., Nassar, S.M., et al. (2014) Influence of Patients’ Disease Knowledge and Beliefs about Medicines on Medication Adherence: Findings from a Cross-Sectional Survey among Patients with Type 2 Diabetes Mellitus in Palestine. BMC Public Health, 14, 94.
http://dx.doi.org/10.1186/1471-2458-14-94
[43] AlHewiti, A. (2014) Adherence to Long-Term Therapies and Beliefs about Medications. International Journal of Family Medicine, 2014, Article ID: 479596.
[44] Ruppar, T.M., Dobbels, F. and De Geest, S. (2012) Medication Beliefs and Antihypertensive Adherence among Older Adults: A Pilot Study. Geriatric Nursing, 33, 89-95.
http://dx.doi.org/10.1016/j.gerinurse.2012.01.006
[45] Schoenthaler, A., Ogedegbe, G. and Allegrante, J.P. (2009) Self-Efficacy Mediates the Relationship Between Depressive Symptoms and Medication Adherence Among Hypertensive African Americans. Health Education & Behavior, 36, 127-137.
http://dx.doi.org/10.1177/1090198107309459
[46] Gatti, M.E., Jacobson, K.L., Gazmararian, J.A., Schmotzer, B. and Kripalani, S. (2009) Relationships between Beliefs about Medications and Adherence. American Journal of Health-System Pharmacy, 66, 657-664.
http://dx.doi.org/10.2146/ajhp080064
[47] Chen, S.-L., Tsai, J.-C. and Lee, W.-L. (2009) The Impact of Illness Perception on Adherence to Therapeutic Regimens of Patients with Hypertension in Taiwan. Journal of Clinical Nursing, 18, 2234-2244.
http://dx.doi.org/10.1111/j.1365-2702.2008.02706.x
[48] Ross, S., Walker, A. and MacLeod, M.J. (2004) Patient Compliance in Hypertension: Role of Illness Perceptions and Treatment Beliefs. Journal of Human Hypertension, 18, 607-613.
http://dx.doi.org/10.1038/sj.jhh.1001721
[49] Rajpura, J.R. and Nayak, R. (2014) Role of Illness Perceptions and Medication Beliefs on Medication Compliance of Elderly Hypertensive Cohorts. Journal of Pharmacy Practice, 27, 19-24.
http://dx.doi.org/10.1177/0897190013493806
[50] Helman, C.G. (2014) Culture, Health and Illness: An Introduction for Health Professionals. Butterworth-Heinemann, Boston.
[51] Campbell, M.K., DeVellis, B.M., Strecher, V.J., Ammerman, A.S., DeVellis, R.F. and Sandler, R.S. (1994) Improving Dietary Behavior: The Effectiveness of Tailored Messages in Primary Care Settings. American Journal of Public Health, 84, 783-787.
http://dx.doi.org/10.2105/AJPH.84.5.783
[52] Campbell, M.K., Honess-Morreale, L., Farrell, D., Carbone, E. and Brasure, M. (1999) A Tailored Multimedia Nutrition Education Pilot Program for Low-Income Women Receiving Food Assistance. Health Education Research, 14, 257-267.
http://dx.doi.org/10.1093/her/14.2.257
[53] Abbott, P., Davison, J., Moore, L. and Rubinstein, R. (2010) Barriers and Enhancers to Dietary Behaviour Change for Aboriginal People Attending a Diabetes Cooking Course. Health Promotion Journal of Australia, 21, 33-38.
[54] Staessen, J.A., Wang, J.G. and Thijs, L. (2001) Cardiovascular Protection and Blood Pressure Reduction: A Meta-Analysis. Lancet, 358, 1305-1315.
http://dx.doi.org/10.1016/S0140-6736(01)06411-X
[55] Korb-Savoldelli, V., Gillaizeau, F., Pouchot, J., Lenain, E., Postel-Vinay, N., Plouin, P.-F., et al. (2012) Validation of a French Version of the 8-Item Morisky Medication Adherence Scale in Hypertensive Adults. Journal of Clinical Hypertension, 14, 429-434.
http://dx.doi.org/10.1111/j.1751-7176.2012.00634.x
[56] Oliveira-Filho, A.D., Barreto-Filho, J.A., Neves, S.J.F. and Lyra Jr., D.P. (2012) Association between the 8-Item Morisky Medication Adherence Scale (MMAS-8) and Blood Pressure Control. Arquivos Brasileiros De Cardiologia, 99, 649-658.
http://dx.doi.org/10.1590/S0066-782X2012005000053
[57] Holt, E., Joyce, C., Dornelles, A., Morisky, D., Webber, L.S., Muntner, P., et al. (2013) Sex Differences in Barriers to Antihypertensive Medication Adherence: Findings from the Cohort Study of Medication Adherence among Older Adults. Journal of the American Geriatrics Society, 61, 558-564.
http://dx.doi.org/10.1111/jgs.12171
[58] Lee, G.K.Y., Wang, H.H.X., Liu, K.Q.L., Cheung, Y., Morisky, D.E. and Wong, M.C.S. (2013) Determinants of Medication Adherence to Antihypertensive Medications among a Chinese Population Using Morisky Medication Adherence Scale. PloS ONE, 8, e62775.
http://dx.doi.org/10.1371/journal.pone.0062775
[59] Sa’ed, H., Al-Jabi, S.W., Sweileh, W.M. and Morisky, D.E. (2013) Relationship of Treatment Satisfaction to Medication Adherence: Findings from a Cross-Sectional Survey among Hypertensive Patients in Palestine. Health and Quality of Life Outcomes, 11, 191.
http://dx.doi.org/10.1186/1477-7525-11-191
[60] Akintunde, A.A. and Akintunde, T.S. (2015) Antihypertensive Medications Adherence among Nigerian Hypertensive Subjects in a Specialist Clinic Compared to a General Outpatient Clinic. Annals of Medical and Health Sciences Research, 5, 173-178.
http://dx.doi.org/10.4103/2141-9248.157492

Journals Menu
Follow SCIRP
Contact us
customer@scirp.org
WhatsApp +86 18163351462(WhatsApp)
Click here to send a message to me 1655362766
Paper Publishing WeChat

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.