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Positive patient education boosted medication adherence in black patients with hypertension
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Among black patients with hypertension, patient education with positive-affect induction and self-affirmation led to higher medication adherence compared with patient education alone, according to results from a recent study.
Poor medication adherence among blacks with hypertension could explain poor BP control, Gbenga O. Ogedegbe, MD, of the Center for Healthful Behavior Change at New York University School of Medicine, and colleagues wrote. To reduce the racial gap in hypertension-related outcomes, interventions that improve medication adherence are needed.
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“Evidence suggests that successful interventions designed to improve medication adherence in patients with chronic diseases use a combined strategy, with the behavioral education combination being the one most frequently used,” the researchers wrote.
Researchers randomly assigned 256 black patients (mean age, 58 years) who were using at least one antihypertensive medication to receive patient education only or an intervention designed to educate and enhance positive feelings. Both groups received culturally tailored hypertension self-management workbooks, a behavioral contract and bimonthly telephone calls to help patients overcome barriers to medication adherences. However, to foster self-affirmation, the intervention group also received small gifts and bimonthly telephone calls to incorporate positive thoughts into their daily routine.
Among both groups, mean baseline BP was 137 mm Hg/82 mm Hg. Additionally, 36% of patients had diabetes, 11% had stroke and 3% had chronic kidney disease. Two-thirds of patients had uncontrolled hypertension.
At 12 months, study results showed that medication adherence was higher in the intervention group (42%) vs. the control group (35%; P=.049). The intention-to-treat analysis also revealed that approximately one in 16 patients would benefit from the intervention. Changes in BP were not statistically significant, with the intervention group experiencing a 2.14-mm Hg within-group reduction in systolic BP and the control group experiencing a 2.18-mm Hg within-group reduction (P=.98), according to study results. Similarly, decreases in diastolic BP were 1.59 mm Hg in the intervention group and 0.78 mm Hg in the control group (P=.45).
In an accompanying editorial, Geoffrey C. Williams, MD, PhD, and Christopher P. Niemiec, PhD, both of the department of clinical and social sciences in psychology at the University of Rochester, said maintenance of health-change behavior occurs through autonomous self-regulation and perceived competence.
“We recommend that future research target positive affect and self-affirmation in a context of support for satisfaction of the basic psychological needs for autonomy, competence and relatedness,” Williams and Niemiec concluded.
For more information:
- Ogedegbe GO. Arch Intern Med. 2012;doi:10.1001/archinternmed.2011.1307.
- Williams GC. Arch Intern Med. 2012;doi:10.1001/archinternmed.2011.1830.
Disclosure: Drs. Ogedegbe, Niemiec and Williams report no relevant financial disclosures.
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