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It's all a matter of necessity and concern: A structural equation model of adherence to antihypertensive medication

Marcel Wilhelm1, Winfried Rief1, Bettina K Doering1

  • 1Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.

Patient Education and Counseling
|October 2, 2017
PubMed

Insights

Poor adherence to hypertension medication is common. The necessity-concern framework (NCF) mediates adherence by influencing beliefs about medication, with personalized communication improving outcomes.

Area of Science:

  • Cardiology
  • Psychology
  • Health Services Research

Background:

  • Hypertension pharmacotherapy adherence is suboptimal.
  • Patient beliefs about medication, specifically the necessity-concern framework (NCF), are crucial for adherence.
  • Previous models explaining adherence in hypercholesterolemia were adapted for hypertension.

Purpose of the Study:

  • To validate a structural equation model (SEM) for hypertension medication adherence.
  • To investigate the mediating role of the necessity-concern framework (NCF) in hypertension treatment.
  • To identify factors influencing necessity and concern beliefs about antihypertensive medication.

Main Methods:

  • Online survey of 273 hypertension patients.
  • Collected data on demographics, health factors, and medication beliefs (necessity, concern).
  • Structural equation modeling (SEM) was used for data analysis.

Main Results:

  • Necessity beliefs positively correlated with adherence (β=0.26, p=0.009).
  • Concern beliefs negatively correlated with adherence (β=-0.51, p=0.020).
  • The NCF model explained 23% of adherence variance, outperforming previous models.

Conclusions:

  • The necessity-concern framework (NCF) effectively mediates adherence in hypertension.
  • Factors like comorbidity, treatment duration, doctor-patient communication, side effects, and control beliefs influence NCF components.
  • Personalized, supportive doctor-patient communication may enhance medication adherence.
Abstract

Keywords:
Antihypertensive medicationBeliefs about medicineDoctor-patient communicationDrug adherenceStructural equation modeling

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