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A Nurse-Led Metamemory-Based Intervention to Improve Medication Adherence in Older Adults With H-Type Hypertension: A
Gang Wu1, Sixuan Li, Qiansheng Jin
1Gang Wu, MSN, RN, Nurse, Department of Cardiac Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China. Sixuan Li, MSN, RN, Nurse, Department of Thoracic Surgery, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China. Qiansheng Jin, MSN, RN, Nurse, Department of Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China. Jiang Nan, MSN, RN, Master's Student, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China. Xuehua Liu, MSN, RN, Nurse, Department of Cardiac Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China. Lingxiang Guo, MSN, RN, Head Nurse, Department of Cardiac Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China.
Background:
H-type hypertension substantially increases cardiovascular and cerebrovascular risk in older adults, yet long-term medication adherence remains suboptimal. Beyond regimen complexity, age-related cognitive vulnerability and limited self-monitoring capacity may undermine adherence. However, few nurse-led interventions explicitly target memory-related mechanisms underlying medication-taking behavior.
Objective:
To evaluate the effectiveness of a nurse-led, metamemory-based intervention in improving medication adherence and related cognitive and psychosocial outcomes in older adults with H-type hypertension.
Methods:
In this 12-week, randomized controlled trial, 76 older adults with H-type hypertension were randomly assigned (1:1) to a nurse-led metamemory-based intervention or usual care. The intervention combined face-to-face sessions and remote follow-up to enhance memory strategy use, self-monitoring, and medication adherence. Primary outcomes were metamemory and medication adherence. Secondary outcomes included cognitive function, anxiety, depression, quality of life, and self-management.
Results:
Seventy-one participants completed the trial (intervention n = 35; control n = 36). Compared with usual care, the intervention group demonstrated significantly greater improvements in metamemory (mean change: 36.7 vs. 1.7; P < .001) and medication adherence (mean change: 2.1 vs. 0.5; P < .001). Significant between-group improvements were also observed in cognitive function, anxiety, quality of life, and self-management (all P < .05). Changes in depressive symptoms were modest and not statistically significant.
Conclusions:
A nurse-led metamemory-based intervention significantly improved medication adherence in older adults with H-type hypertension by strengthening memory self-monitoring and strategy use. These findings support metamemory as a clinically meaningful mechanism through which nursing interventions can enhance adherence in cognitively vulnerable cardiovascular populations.
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