Medication adherence for resistant hypertension: treatment-related beliefs, experiential feedback, and habit strength

Abstract

Background: Medication non-adherence is a considerable problem that contributes to poor patient health and high healthcare costs. Basic and applied research has tended to focus on behaviour initiation factors, such as illness- and treatment-related beliefs. More recently, processes that occur after behaviour initiation have been proposed to predict long-term adherence. This paper aims to examine two such processes, i.e. coherence of patients’ beliefs from treatment experiences and habit development, among patients taking multiple medications for a chronic asymptomatic condition. Methods: The sample consisted of the first 100 participants recruited to an on-going cross-sectional cohort study of apparent treatment-resistant hypertension in primary care (M age = 69.18, SD = 11.39; 42.4% female). Patients reported their medication adherence, treatment-related beliefs, experiences related to treatment efficacy and medication-taking habit strength via self-report questionnaire. Findings: Preliminary analyses revealed patients’ medication habit strength was the strongest predictor of adherence, explaining 9% incremental variance in adherence to that explained by patients’ treatment-related beliefs. Patients’ beliefs and experiences did not predict overall adherence, even for patients with lower scores on the medication habit measure. Neither treatment-related beliefs nor habit strength predicted intentional non-adherence; whereas only habit strength was found to predict unintentional non-adherence. Discussion: Healthcare practitioners may examine patients’ medication-taking habits to get an initial view of their likely adherence to long-term medications. However more research is needed to elucidate the mechanisms of intentional non-adherence specifically. Future research should assess the current theoretical predictions using objective measures of non-adherence and in populations with symptomatic conditions.