Impact of multimodal interventions on medication nonadherence among elderly hypertensives: a randomized controlled study

Figures & data

Figure 1 Consort flow chart of subjects recruited for the study.

Table 1. Baseline sociodemographic characteristics of the sample as frequency and percentage (N=124)

Variable	Experimental group (n=64)		Control group (n=60)		p-value
	f	%	f	%
Age in years					0.662
≥60–70	45	42.1	40	38.8
>70	19	17.8	20	19.4
Gender					0.214
Male	27	42.2	32	53.3
Female	37	57.8	28	46.7
Education					0.533
Illiterate	10	9.3	11	10.7
≤7th standard	16	15	16	15.5
>7th standard-PUC	30	28	30	29.1
Degree	8	7.5	3	2.9
Occupation					0.197
Professional	5	4.7	4	3.9
Nonprofessional	6	5.6	9	8.7
Business	2	1.9	7	6.8
Retired	12	11.2	5	4.9
Cooli	13	12.1	8	7.8
Not working	26	24.3	27	26.2
Living with spouse					0.887
Yes	56	52.3	53	51.5
No	8	7.5	7	6.8
Annual income of the family					0.938
<12,000	34	31.8	34	33
12,000–1 lakh	20	18.7	18	17.5
>1–2.5 lakhs	5	4.7	5	4.9
>2.5 lakh	5	4.7	3	2.9
Finance for the treatment					0.413
Children	29	27.1	32	31.1
Own	25	23.4	23	22.3
Spouse	10	9.3	5	4.9

Note: N=124, p<0.05.

Abbreviation: PUC, Pre University College.

Table 2. Baseline clinical characteristics of the sample as frequency and percentage (N=124)

Variable	Experimental group (n=64)		Control group (n=60)		p-value
	f	%	f	%
Duration of treatment					0.864
<6 months	13	12.1	11	10.7
6–12 months	1	0.9	2	1.9
>1 year	50	46.7	47	45.6
Body mass index (kg/m^2)					0.170
Underweight (<18.5)	3	2.8	4	3.9
Normal (18.5–24.9)	42	39.3	28	27.2
Overweight (25–29.9)	18	16.8	25	14.3
Obese (>30)	1	9	3	2.9
Comorbidities					0.113
Diabetes mellitus	26	24.3	39	37.9
Chronic ischemic heart disease	9	8.4	3	2.9
Dyslipidemia	1	0.9	0	0
Chronic rheumatism	0	0	0	0
No comorbidities	28	26.2	18	17.5
More than one comorbidity	0	0	0	0
Number of medications					0.681
1–4	44	68.7	44	73.3
5–8	18	28.1	15	25
9–12	2	3.1	1	1.6
Class of antihypertensives					0.742
ACE inhibitors	13	20.3	14	23.3
Angiotensin II antagonists	6	9.3	6	10
ACE inhibitors + diuretics	2	3.1	2	3.3
Beta blockers	12	18.7	8	13.3
Angiotensin II antagonists + calcium antagonists	9	14.1	8	1.6
Beta blockers + ACE inhibitors	1	1.5	1
Beta blockers + calcium antagonists	14	21.8	8	13.3
Calcium antagonists	7	10.9	13	21.6

Note: p<0.05.

Abbreviation: ACE, angiotensin converting enzyme.

Table 3. Friedman 2-way ANOVA on effectiveness of the multimodal intervention on nonadherence of the elderly on antihypertensives (N=124)

Variable	Group	Baseline	At 3 months	At 6 months		F	df	p-value	ƞp^2
		Mean (SD)	Mean (SD)	Mean (SD)
Medication adherence	Experimental (n=64)	5.59 (0.49)	7.93 (0.35)	8.00 (0.00)	Time	774.18	1.75, 214.30	<0.001	0.86
	Control (n=60)	5.93 (0.44)	7.60 (0.86)	7.70 (0.72)	Group	3.31	1, 122	0.071	0.02
					Time ×group	4.24	1.75, 214.30	0.020	0.03

Notes: Score range 0–8: low adherence (<6), medium adherence (6–8) and high adherence (=8). Time refers to within group effects, group refers to between group effects, and time×group refers to interaction effects. SD=F-ratio. p<0.05.

Abbreviations: df, degrees of freedom; ƞ_p², partial eta squared (effect size).

Table 4. Friedman 2-way ANOVA on effectiveness of the multimodal intervention on QOL of the elderly on antihypertensives (N=124)

Variable	Group	Baseline	At 3 months	At 6 months		F	df	p-value	ƞp^2
		Mean (SD)	Mean (SD)	Mean (SD)
Overall QOL	Experimental (n=64)	50.54 (11.14)	50.04 (9.30)	51.85 (8.75)	Time	1.34	2,244	0.26	0.011
	Control (n=60)	50.65 (7.96)	48.75 (10.53)	50.58 (9.45)	Group	1.06	1,122	0.30	0.009
					Time×group	0.18	2,244	0.82	0.002
Physical domain-QOL	Experimental (n=64)	12.64 (2.72)	12.51 (2.13)	13.01 (2.01)	Time	2.17	2,244	0.11	0.018
	Control (n=60)	12.63 (2.08)	12.35 (2.21)	12.73 (2.08)	Group	2.17	1,122	0.14	0.01
					Time×group	0.01	2,244	0.98	<0.001
Psychological domain-QOL	Experimental (n=64)	12.34 (2.64)	12.39 (2.56)	13.01 (2.10)	Time	2.49	2,244	0.08	0.02
	Control (n=60)	12.20 (1.97)	12.01 (2.88)	12.53 (2.32)	Group	2.83	1,122	<0.001	<0.999
					Time×group	0.21	2,244	0.80	0.002
Social relationships domain-QOL	Experimental (n=64)	11.92 (4.20)	11.71 (3.76)	12.12 (3.69)	Time	0.92	2,244	0.39	0.008
	Control (n=60)	12.20 (3.28)	11.18 (4.19)	11.80 (3.99)	Group	3.64	1,122	<0.001	<0.999
					Time×group	0.18	2,244	0.83	0.002
Environmental domain-QOL	Experimental (n=64)	13.64 (2.39)	13.42 (2.15)	13.70 (2.06)	Time	0.50	2,244	0.60	0.004
	Control (n=60)	13.61 (1.91)	13.20 (2.23)	13.51 (2.26)	Group	0.68	1,122	0.41	0.006
					Time×group	0.02	2,244	0.97	<0.001

Notes: Score range 26–130. A high score represents a better functioning in that particular domain of QoL. Overall QoL is a sum of physical domain, psychological domain, social relationships domain, and environmental domain. Time refers to within group effects, group refers to between group effects, and time×group refers to interaction effects. SD=F-ratio.p<0.05.

Abbreviations: df, degrees of freedom; ƞ_p², partial eta squared (effect size); QoL, quality of life.

Table 5. Friedman 2-way ANOVA on effectiveness of the multimodal intervention on knowledge on HTN of the elderly on antihypertensives (N=124)

Variable	Group	Baseline	At 3 months	At 6 months		F	df	p-value	ƞp^2
		Mean (SD)	Mean (SD)	Mean (SD)
Knowledge on HTN	Experimental (n=64)	9.68 (3.24)	10.35 (2.72)	11.96 (3.06)	Time	43.83	2,244	<0.001	0.26
	Control (n=60)	8.21 (1.88)	8.15 (1.72)	9.71 (3.21)	Group	1.91	1,122	<0.001	1.00
					Time×group	6.67	2,244	0.002	0.052

Note: Score range 0–20: poor knowledge (0–6), average knowledge (7–13), and good knowledge (14–20). Time refers to within group effects, group refers to between group effects, and time×group refers to interaction effects. SD=F-ratio.p<0.05.

Abbreviations: df, degrees of freedom; HTN, hypertension; ƞ_p², partial eta squared (effect size).

Table 6. Repeated-measures ANOVA on effectiveness of the multimodal intervention on self-efficacy of the elderly on antihypertensives (N=124)

Variable	Group	Baseline	At 3 months	At 6 months		F	df	p-value	ƞp^2
		Mean (SD)	Mean (SD)	Mean (SD)
Self-efficacy	Experimental (n=64)	37.25 (2.58)	37.28 (2.56)	37.37 (2.43)	Time	0.73	2,244	0.48	0.006
	Control (n=60)	38.03 (1.82)	37.30 (2.49)	37.83 (2.10)	Group	3.99	1,122	0.04	0.032
					Time×group	0.72	2,244	0.48	0.006

Notes: Score range 13–39. Time refers to within group effects, group refers to between group effects, and time×group refers to interaction effects. SD=F-ratio.p<0.05.

Abbreviations: df, degrees of freedom; ƞ_p², partial eta squared (effect size).

Table 7. Repeated-measures ANOVA on effectiveness of the multimodal intervention on clinical outcome (BP) of the elderly on antihypertensives (N=124)

Variable	Group	Baseline	At 3 months	At 6 months		F	df	p-value	ƞp^2
		Mean (SD)	Mean (SD)	Mean (SD)
Systolic BP	Experimental (n=64)	154.34 (10.34)	153.96 (12.37)	153.28 (12.85)	Time	0.29	2,244	0.74	0.002
	Control (n=60)	154.66 (11.26)	156.13 (10.59)	154.83 (11.57)	Group	1.06	1,122	0.30	0.009
					Time×group	0.18	2,244	0.83	0.001
Diastolic BP	Experimental (n=64)	86.28 (7.01)	86.25 (6.28)	84.96 (6.89)	Time	0.55	2,244	0.57	0.005
	Control (n=60)	85.73 (6.58)	87.43 (6.57)	87.30 (7.99)	Group	1.94	1,122	0.16	0.01
					Time×group	1.31	2,244	0.27	0.011

Notes: Time refers to within group effects, group refers to between group effects, and time×group refers to interaction effects. SD=F-ratio.p<0.05.

Abbreviations: BP, blood pressure; df, degrees of freedom; ƞ_p², partial eta squared (effect size).

Table 8. Percentage change for the outcome variables (N=124)

Variable	Group	N	Baseline	Post Test II	Improvement	PI
Medication adherence	Experimental Control	64 60	5.59 5.93	8.00 7.70	2.41 1.77	43.11 29.84
Overall QOL	Experimental Control	64 60	50.54 50.65	51.85 50.58	1.31 −0.07	2.59 −0.13
Physical domain-QOL	Experimental Control	64 60	12.64 12.63	13.01 12.73	0.37 0.1	2.92 0.79
Psychological domain-QOL	Experimental Control	64 60	12.34 12.20	13.01 12.53	0.67 0.33	5.42 2.70
Social relationships domain-QOL	Experimental Control	64 60	11.92 12.20	12.12 11.80	0.2 –0.4	1.67 –3.27
Environmental domain-QOL	Experimental Control	64 60	13.64 13.61	13.70 13.51	0.06 –0.1	0.43 –0.73
Knowledge on HTN	Experimental Control	64 60	9.68 8.21	11.96 9.71	2.28 1.5	23.55 18.27
Self-efficacy	Experimental Control	64 60	37.25 38.03	37.37 37.83	0.12 –0.2	0.32 –0.52
Variable	Group	N	Baseline	Post Test II	Reduction	PR
SBP	Experimental Control	64 60	154.34 154.66	153.28 154.83	1.06 –0.17	0.68 –0.10
DBP	Experimental Control	64 60	86.28 85.73	84.96 87.30	1.32 –1.57	1.52 –1.83

Abbreviations: DBP, diastolic blood pressure; HTN, hypertension; PI, percentage improvement; PR, percentage reduction; QOL, quality of life; SBP, systolic blood pressure.

Data availability

The patient information leaflet on adherence prepared both in English as well as Kannada is available with the corresponding author. Also, the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.