Perception of self-efficacy improves adherence in hypertensive patients
A D Farcas, M A Stoia, F P Anton, L E NastasaAbstract
Background
Non-adherence to treatment is one of the causes of the weak control in hypertension, which affects health and causes increased personal and social/societal costs. Self-efficacy is the belief in the personal ability to successfully manage situations, to execute behaviours and to achieve specific objectives. It determines the way a person thinks, feels and behaves, influencing their motivation, perseverence and resilience when faced with challenges.
Aims/ Purpose
Our objective is to study the relationship between perceived self-efficacy and adherence to treatment (including lifestyle changes) in hypertensive patients.
Methods
154 hypertensive patients were identified as non-adherent to treatment using the Morisky Medication Adherence Scale (MMAS-8) that was administered before the consult. After signing the informed consent, the patients were randomly assigned to two groups. Those in group A (76 patients) participated in an educational program (including lifestyle changes, medication, adverse reactions etc.) delivered by a physician and customized to address individual causes of non-adherence, while those in group B (78 patients) only received a brochure with general information. All patiens completed MMAS-8 and Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD) at baseline, 1 month and 6 months. Statistical analysis was performed using SPSS 23. The study was approved by the ethics committee.
Results
Adherence to treatment and lifestyle changes was not significantly different at baseline (4.52 ± 1.3 vs 4.21 ± 1.2, p=ns), but significantly improved at 1 months (6.12 ± 1.1 vs 5.17 ± 2.1, p < 0.001) and 6 month (7.42 ± 1.3 vs 5.88 ± 1.7, p < 0.001) for patients in group A compared to group B. SEMCD score significantly increased in all patients in group A, both at 1 month and at 6 months after the initial consult (8.9 ± 1.1 vs 7.7 ± 1.4 vs 5.8 ± 2.2, p < 0.001), while patients in group B had a non-significant increase. Univariate analysis showed that perceived self-efficacy was responsible for a 20.5% decrease in intentional non-adherence and a 10.6% decrease of non-intentional non-adherence. Moreover, as the perceived self-efficacy level increased we found an increase of patients’ trust in their ability to make changes in their lifestyle, as shown by items 5 and 6 in SEMCD.
Conclusions
Perceived self-efficacy appears to be a limiting factor for increasing the adherence to treatment in hypertensive patients. It is therefore the physicians’ responsibility during consultation to provide the patient with reccomendations adapted to the (beliefs and) causes of non-adherence and to increase the patients’ locus of control regarding this disease and its medical and non-medical treatment.