A qualitative comparison of high and low adherers with apparent treatment-resistant hypertension

ABSTRACT

Poor adherence is a leading cause of apparent resistance to antihypertensive treatment. Recent empirical research has investigated predictors of adherence for primary care patients who are apparently resistant to treatment; however, questions remain regarding the variability in adherence behaviour among this group. This study aimed to investigate factors that may elucidate medication adherence among patients with apparent treatment-resistant hypertension (aTRH) using qualitative methods. Fourteen semi-structured interviews were conducted with patients undergoing treatment for aTRH in primary care in the West of Ireland. Patients who self-reported both high and low adherence in a previous quantitative study were purposively sampled. Data were analysed using thematic analysis. A public and patient involvement research group were active partners in developing the study protocol and interview topic guide. Three major themes were identified: beliefs about treatment, habits and routine, and health and health systems. High adherers reported favourable beliefs about antihypertensive treatment that had been validated by experience with taking the treatment over time, described strong medication-taking habits and stable routines, and positive relations with their GP. Low adherers expressed less coherence in their beliefs and used less effective strategies to support their medication-taking in daily life. The current findings are consistent with qualitative studies of adherence in other chronic conditions. Results reflect the difficulty for healthcare practitioners in identifying adherent versus non-adherent patients via conversation, and highlight the importance of accurate adherence assessment. Inception studies may provide an opportunity to better understand adherence behaviour across the illness trajectory.

KEYWORDS:

• Treatment adherence and compliance
• medication adherence
• hypertension
• primary health care
• qualitative research
• Public and Patient Involvement (PPI)

Acknowledgments

The authors are indebted to the patients who participated in the study, and the GPs and practice staff who supported recruitment of patients into the study. We are also grateful to the Health Research Board Primary Care Clinical Trials Network Ireland Public and Patient Partnership in Research Group for their role in developing the study, and Edel Murphy and Edel Tierney for their expert facilitation.

Data Availability

The data that support the findings of this study are available on reasonable request from the corresponding author, HD. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Declarations

Ethical approval was obtained from the Clinical Research Ethics Committee at Merlin Park University Hospital, Galway (Ref: C.A. 1386 Amendment 1, 12 October 2017). This research is supported by the Health Research Board Patient-Oriented Research Award (Ref: HRA-POR-2014-615). The authors have no conflicts of interest to declare.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This research is supported by the Health Research Board Patient-Oriented Research Award (Ref: HRA-POR-2014-615).