INTRODUCTION:

Hypertension is the medical term for high blood pressure. It is considered to be present when a person’s systolic blood pressure is consistently 140 or more and their diastolic BP is consistently 90 mmHg or more. It is one of the most common worldwide disease affecting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge.¹ Uncontrolled and prolonged elevation of BP can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart. These changes in turn can lead to the development of left ventricular hypertrophy (LVH), coronary artery disease (CAD), various conduction system diseases, and systolic and diastolic dysfunction of the myocardium, complications that manifest clinically as angina or myocardial infarction, cardiac arrhythmias (especially atrial fibrillation) and congestive heart failure (CHF).²

Hypertensive heart disease was estimated to be responsible for 1.0 million deaths worldwide in 2004 (or approximately 1.7% of all deaths globally), and was ranked 13th in the leading global causes of death for all ages. It is a common chronic disease amenable to control by appropriate medication or adopting relevant lifestyle modifications. Adherence to therapeutic lifestyle measures reduces the risk of cardiovascular problems. Non-compliance can worsen the quality of life and add to the cost of medical care.³

NEED FOR THE STUDY:

Hypertension or high blood pressure affects at least 1 billion people worldwide. It is a widespread health problem affecting nearly 20% of the population in most countries. But its control is still a challenge for physicians all around the world. Control of blood pressure can reduce cardio vascular morbidity and mortality. So the compliance to antihypertensive drugs and life style modification play an important role for the control of hypertension.⁴

Thomas Dennis, (2006) found that half of the Indian patients were not adherent to their antihypertensive regimen and this might result in poor blood pressure control. Non-adherence to hypertension management remains a major limiting factor among Indians in the effective control of hypertension and in the prevention of cardiovascular diseases.⁵

Kaplan, et.al., (2006) identified the multiple reasons for the poor blood pressure (BP) control rates such as age, gender, low socioeconomic status and severity of disease, class of drug prescribed, number of pills per day, side effects of medication, patient’s inadequate understanding of the disease and importance of the treatment, co-morbid medical conditions, lack of social support, poor patient- care provider relationship, cost, forgetfulness, and presence of psychological problems especially depression had all been shown to affect adherence in various populations.⁶

According to NCD camps analysis, (2011) found that one in every five persons in Chennai is hypertensive. A majority are unaware of it. And even though undergoing treatment, they do not have their condition under control.⁷ Hence the investigator felt that if the factors influencing compliance to treatment regimen has been found out, the health care workers could help to rectify those problems.

STATEMENT OF THE PROBLEM:

A study to assess the factors influencing compliance and degree of compliance to treatment regimen among Hypertensive Patients in a Selected Tertiary Hospital, Tamilnadu, India.

OBJECTIVES:

· To assess the factors influencing compliance to treatment regimen among hypertensive patients.

· To assess the degree of compliance to treatment regimen among hypertensive patients.

· To associate the degree of compliance to treatment regimen with selected demographic variables of hypertensive patients.

OPERATIONAL DEFINITION:

Assess:

· It refers to the exploration of the factors influencing compliance and degree of compliance to treatment among hypertensive patients who are attending medical OPD with the structured questionnaire.

Factors Influencing Compliance:

· It refers to the factors such as socio economic factors, motivational factors, treatment related factors and cognitive factors, which are making the patients as non-adherent to treatment regimen.

Degree of Compliance:

· It refers to how for the patients are adherent to treatment regimen.

Treatment Regimen:

· It refers to regular drug, regular exercise (at least 30 minutes thrice per week), eating salt and fat free diets and regular checkup.

Hypertensive Patients:

· It refers to the Patients who were diagnosed as having baseline hypertension (>140/90 mmHg) minimum one year before.

Hypotheses:

H1: There will be a significant difference between the factors influencing compliance to treatment regimen among hypertensive patients.

H2: There will be a significant association between the degree of compliance to treatment regimen and selected demographic variables of hypertensive patients.

MATERIALS AND METHODS:

Research Approach:

A quantitative research approach was considered appropriate for the present study.

Research Design:

A non-experimental descriptive research design was adopted for this study.

Setting of the study:

The study was conducted in Chettinad hospital and research institute, medical OPD, Kelambakkam, Tamilnadu.

Population:

In the present study, the target population was Hypertensive Patients.

Sample:

Hypertensive patients who were attending medical OPD at CHRI and fulfilling the sampling criteria.

Sample size:

The present study comprised of 60 hypertensive Patients.

Sampling technique:

Non-probability purposive sampling technique was used for selecting samples for this study.

Criteria for Sample Selection:

a) Inclusion criteria:

o The patients who were placed on anti hypertensive treatment for at least one year prior to data collection.

o The patients whose age was between 20 and 80 years.

o The patients who were mentally sound.

o The patients who were attending medical OPD in CHRI.

o The patients who were willing to participate in the study.

b) Exclusion criteria:

o The patients who were too sick.

o The patients who could not give informed consent.

o The patients who had complications of hypertension.

Description of the tool:

The tool consisted of two sections.

Section-A:

It consisted of 10 items of demographic variables like age, sex, education, occupation, income, marital status, type of family, area of residence, duration of hypertension, present BP.

Section-B:

Questionnaire-I:

The structured questionnaire-I consisted of 36questions, to assess the factors influencing compliance. These 36 questions were classified under 4 parts. Socio economic factors consisted of 7 questions. Motivational factors consisted of 20 questions. Treatment related factors consisted of 4 questions. Cognitive factors consisted of 4 questions. Each part consisted of aspects like drug, diet, exercise and regular checkup. The first 31 questions had two options Yes/ No. The next 4 questions were choose the correct answer type.

Questionnaire-II:

The tool was a five point Likert scale consisted of 5 options namely always, sometimes, once in a while, rarely, and never to assess the degree of compliance to treatment regimen. It consisted of 15 items.

Data analysis:

The data analysis included both descriptive and inferential statistics. The collected data was organized, tabulated and analyzed based on the objectives of the study by using descriptive statistics (Percentage, mean, standard deviation) and inferential statistics (Chi-square test and f test).

Ethical consideration:

The research proposal was approved by the ethical committee of Chettinad University prior to conduct the pilot study and main study. The written permission obtained from the Dean and medical superintendent of CHRI. Written consent was obtained from each participant before data collection.

RESULTS:

Ø There was significant difference between the means of socio economic factors (p=0.02), motivational factors (p=0.03) and treatment related factors (0.03) with respect to medication.

Ø There was significant difference between the means of socio economic factors (p=0.001) and motivational factors (p=0.001) with respect to diet.

Ø There was a significant difference between the means of socio economic factors (p=0.001), motivational factors (p=0.001) and cognitive factors (p=0.001) with respect to exercise.

Ø There was a significant difference between the means of socio economic factors (p=0.001) cognitive factors (p=0.001) with respect to regular checkup.

Ø Among 60 samples 41 (68.3%) patients were non-compliant to treatment regimen and 19 (31.7%) patients were compliant to treatment regimen.

Ø There was significant association between the degree of compliance and the demographic variables of age (p=0.003), education (p=0.004) and income (p=0.003).

Fig 1: Percentage distribution of degree of compliance

DISCUSSION:

· First objective of the study to assess the factors influencing compliance to treatment regimen among hypertensive patients.

H1: There will be a significant difference between the factors influencing compliance to treatment regimen among hypertensive patients.

The result has shown that there is significant difference between the means of socio economic factors, motivational factors and treatment related factors with respect to Medication. There is no significant difference with respect to cognitive factors. There is significant difference between the means of socio economic factors and motivational factors. There is no significant difference with respect to cognitive factors with respect to diet. There is a significant difference between the means of socio economic factors, motivational factors and cognitive factors with respect to exercise. There is a significant difference between the means of socio economic factors cognitive factors with respect to regular checkup. But there is no significant difference with respect to motivational factors. Hence the researcher accepted the research hypothesis. Findings are supported by the research conducted by Kabir, et al. in Murtala Mohammed Specialist Hospital in Kano, Nigeria.⁸

· Second objective of the study to assess the degree of compliance to treatment regimen among hypertensive patients.

H2: There will be a significant association between the degrees of compliance to treatment regimen with selected demographic variables of hypertensive patients.

There is a significant association between the degree of compliance and the demographic variables of age, education and income. Hence the researcher accepted the research hypothesis.

CONCLUSION:

Based on the findings of the study Socio economic Factors, Motivational Factors, Treatment Related Factors, were the major contributors for non-compliance with medication. Socio economic Factors and Motivational Factors were the contributors for non-compliance with diet. Socio economic Factors, Motivational Factors and cognitive Factors were the contributors for non-compliance with exercise. Socio economic Factors and cognitive Factors were the contributors for non-compliance with regular checkup.

RECOMMENDATIONS:

· Additional research is needed to further explain the mechanism through which the factors and hypertension are related.

· An experimental study to determine the effectiveness of the structured information booklet on patients with hypertension.

NURSING IMPLICATIONS:

· Lack of motivation is one among the major factors why the patients are non-compliance. Therefore attempts must be made to motivate the patients as well as their relatives in adhering to treatment regimen.

· Nurses must educate the hypertensive patients regarding the complications of uncontrolled hypertension.

ACKNOWLEDGEMENT:

I wish to express my heartfelt gratitude and sincere thanks to our respected Dr. Ms. Rajalakshmi, MBBS., DPM. I profusely thank her for valuable suggestions and guidance from the beginning to the end of the study.

REFERENCES:

1. Brounwald. E, 1984. A Text Book of Cardiovascular Medicine. W.B Saunders Company. Philadelphia.

2. Lewis, et. al., 2000. Medical Surgical Nursing. 7^thedit. Mosby publication. Philadelphia.

3. Indian twin epidemic study, 2012. Prevalence of non communicable diseases. Indian Journal of Chest Diseases and Allied Sciences.Vol.1.(Retrieved from http//www.pubmed.com)

4. Maleka Sarour, 2006.Barriers associated with adherence to life style modification. Journal of Health and Social Behavior.Vol.1.

5. Dennis, 2006. Medication adherence in hypertensive patients. (Retrieved May 8, 2006 from http//www.bupa.com)

6. Kaplan, et. al., 2007. Factors influencing compliance with adherent to life style modification. National Medical Journal of India.Vol.2.

7. NCD, 2012.Prevalence of hypertension. Times of India. (Retrieved from http//www.pubmed.com )

8. Kabir, et. al., 2005. Factors influencing compliance and degree of compliance to anti hypertensive treatment. Niger Post Graduate Medical Journal.Vol.1.

Received on 12.02.2015 Modified on 11.04.2015

Int. J. Nur. Edu. and Research 3(2): April-June, 2015; Page 163-166