Effects of a health belief model-based educational programme on medication adherence among older adults with coronary artery disease: a randomised controlled trial
M Q Xu, S H S Lo, L Y Zhu, X L HuangAbstract
Background
Coronary artery disease (CAD) is the leading cause of death worldwide. Medication management is the priority for CAD secondary prevention. However, medication adherence (MA) was sub-optimal among older adults with CAD. They had greater challenges than younger adults in medication management, such as more concerns about the side-effects, forgetfulness and polypharmacy. Comprehensive and rigorously designed educational programmes are needed to improve MA among them.
Purpose
This study was aimed at evaluating the effects of a Health Belief Model-based educational programme on MA and related psychosocial outcomes among older adults with CAD.
Methods
This is a two-armed randomised controlled trial conducted in a tertiary hospital during May to December 2025. In addition to usual care, the educational programme consisted of four sessions (two in-hospital sessions and two discharge sessions) with the duration of four weeks. The programme was underpinned with Health Belief Model, including information provision, psychological support, consultation, problem solving and peer modelling. Under the intention to treat principle, Generalised Estimating Equation model and Linear Mixed Model were used in analysing the between groups differences over time of subjective outcomes and physiological outcomes, respectively.
Results
A total of 160 older adults with CAD were involved with 80 older adults in the intervention and control group, respectively. The intervention group demonstrated significantly improved MA immediate (P<0.001) and three months post-intervention (P=0.004). The intervention group also had significant improvements in perceived benefits of medications (P<0.001), medication self-management capacity (P<0.001) and self-efficacy (P<0.001), and reducing concerns about medications (P=0.002) immediate post-intervention, but the effects on concerns and self-efficacy were not sustained at three months. Nonsignificant effects were observed in most dimensions of health-related quality of life, except the disease perception dimension (P=0.016). There was also no significant effect on physiological outcomes (including systolic blood pressure, diastolic blood pressure, heart rate, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol). The interviews indicated that the older adults started to engage in disease management actively and had increasing control over medication management. They also had difficulties in understanding the information due to information load and maintaining MA.
Conclusion
The Health Belief Model-based educational programme was effective in improving MA and related psychosocial outcomes among the older adults with CAD. The programme could be integrated into clinical nursing practice to improve medication management in future.Comparisons of subjective outcomesComparisons of objective outcomes