Assessing adherence to antihypertensive therapy in primary health care in Namibia: findings and implications

M. M. Nashilongo, B. Singu, F. Kalemeera, M. Mubita, E. Naikaku, A. Baker, A. Ferrario, B. Godman, L. Achieng, D. Kibuule

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Introduction: Namibia has the highest burden and incidence of hypertension in sub-Sahara Africa. Though non-adherence to antihypertensive therapy is an important cardiovascular risk factor, little is known about potential ways to improve adherence in Namibia following universal access. The objective of this study is to validate the Hill-Bone compliance scale and determine the level and predictors of adherence to antihypertensive treatment in primary health care (PHC) settings in suburban townships of Windhoek, Namibia. Methods: Reliability was determined by Cronbach's alpha. Principal component analysis (PCA) was used to assess construct analysis. Results: The PCA was consistent with the three-factors with 12 items, explaining 24.1%, 16.7% and 10.8% of the variance. Cronbach’s alpha was 0.695. None of the 120 patients had perfect adherence to antihypertensive therapy, and less than half had acceptable levels of adherence (≥80%). The mean adherence level was 76.7± 8.1 %. Three quarters of patients ever missed their scheduled clinic appointment. Having a family support system (OR = 5.4, 95%CI: 1.687 – 27.6, p = 0.045) and attendance of follow-up visits (OR = 3.1, 95%CI: 1.1 – 8.7, p < 0.030) were significant predictors of adherence. Having HIV/ AIDs did not lower adherence. Conclusions: The modified Namibian version of the Hill-Bone scale is reliable and valid for assessing adherence in Namibia. There is sub-optimal adherence to antihypertensive therapy among PHCs in Namibia. This needs standardized systems to strengthen adherence monitoring as well as investigation of other factors including transport to take full advantage of universal access.
LanguageEnglish
Pages565–578
Number of pages14
JournalCardiovascular Drugs and Therapy
Volume31
Issue number5-6
Early online date14 Oct 2017
DOIs
Publication statusPublished - 18 Dec 2017

Fingerprint

Namibia
Antihypertensive Agents
Primary Health Care
Principal Component Analysis
Therapeutics
Bone and Bones
Northern Africa
Compliance
Appointments and Schedules
HIV
Hypertension
Incidence

Keywords

  • adherence
  • hypertension
  • Namibia
  • primary health care
  • universal access

Cite this

Nashilongo, M. M. ; Singu, B. ; Kalemeera, F. ; Mubita, M. ; Naikaku, E. ; Baker, A. ; Ferrario, A. ; Godman, B. ; Achieng, L. ; Kibuule, D. / Assessing adherence to antihypertensive therapy in primary health care in Namibia : findings and implications. In: Cardiovascular Drugs and Therapy. 2017 ; Vol. 31, No. 5-6. pp. 565–578.
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abstract = "Introduction: Namibia has the highest burden and incidence of hypertension in sub-Sahara Africa. Though non-adherence to antihypertensive therapy is an important cardiovascular risk factor, little is known about potential ways to improve adherence in Namibia following universal access. The objective of this study is to validate the Hill-Bone compliance scale and determine the level and predictors of adherence to antihypertensive treatment in primary health care (PHC) settings in suburban townships of Windhoek, Namibia. Methods: Reliability was determined by Cronbach's alpha. Principal component analysis (PCA) was used to assess construct analysis. Results: The PCA was consistent with the three-factors with 12 items, explaining 24.1{\%}, 16.7{\%} and 10.8{\%} of the variance. Cronbach’s alpha was 0.695. None of the 120 patients had perfect adherence to antihypertensive therapy, and less than half had acceptable levels of adherence (≥80{\%}). The mean adherence level was 76.7± 8.1 {\%}. Three quarters of patients ever missed their scheduled clinic appointment. Having a family support system (OR = 5.4, 95{\%}CI: 1.687 – 27.6, p = 0.045) and attendance of follow-up visits (OR = 3.1, 95{\%}CI: 1.1 – 8.7, p < 0.030) were significant predictors of adherence. Having HIV/ AIDs did not lower adherence. Conclusions: The modified Namibian version of the Hill-Bone scale is reliable and valid for assessing adherence in Namibia. There is sub-optimal adherence to antihypertensive therapy among PHCs in Namibia. This needs standardized systems to strengthen adherence monitoring as well as investigation of other factors including transport to take full advantage of universal access.",
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Nashilongo, MM, Singu, B, Kalemeera, F, Mubita, M, Naikaku, E, Baker, A, Ferrario, A, Godman, B, Achieng, L & Kibuule, D 2017, 'Assessing adherence to antihypertensive therapy in primary health care in Namibia: findings and implications' Cardiovascular Drugs and Therapy, vol. 31, no. 5-6, pp. 565–578. https://doi.org/10.1007/s10557-017-6756-8

Assessing adherence to antihypertensive therapy in primary health care in Namibia : findings and implications. / Nashilongo, M. M.; Singu, B.; Kalemeera, F.; Mubita, M.; Naikaku, E.; Baker, A.; Ferrario, A.; Godman, B.; Achieng, L.; Kibuule, D.

In: Cardiovascular Drugs and Therapy, Vol. 31, No. 5-6, 18.12.2017, p. 565–578.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Assessing adherence to antihypertensive therapy in primary health care in Namibia

T2 - Cardiovascular Drugs and Therapy

AU - Nashilongo, M. M.

AU - Singu, B.

AU - Kalemeera, F.

AU - Mubita, M.

AU - Naikaku, E.

AU - Baker, A.

AU - Ferrario, A.

AU - Godman, B.

AU - Achieng, L.

AU - Kibuule, D.

PY - 2017/12/18

Y1 - 2017/12/18

N2 - Introduction: Namibia has the highest burden and incidence of hypertension in sub-Sahara Africa. Though non-adherence to antihypertensive therapy is an important cardiovascular risk factor, little is known about potential ways to improve adherence in Namibia following universal access. The objective of this study is to validate the Hill-Bone compliance scale and determine the level and predictors of adherence to antihypertensive treatment in primary health care (PHC) settings in suburban townships of Windhoek, Namibia. Methods: Reliability was determined by Cronbach's alpha. Principal component analysis (PCA) was used to assess construct analysis. Results: The PCA was consistent with the three-factors with 12 items, explaining 24.1%, 16.7% and 10.8% of the variance. Cronbach’s alpha was 0.695. None of the 120 patients had perfect adherence to antihypertensive therapy, and less than half had acceptable levels of adherence (≥80%). The mean adherence level was 76.7± 8.1 %. Three quarters of patients ever missed their scheduled clinic appointment. Having a family support system (OR = 5.4, 95%CI: 1.687 – 27.6, p = 0.045) and attendance of follow-up visits (OR = 3.1, 95%CI: 1.1 – 8.7, p < 0.030) were significant predictors of adherence. Having HIV/ AIDs did not lower adherence. Conclusions: The modified Namibian version of the Hill-Bone scale is reliable and valid for assessing adherence in Namibia. There is sub-optimal adherence to antihypertensive therapy among PHCs in Namibia. This needs standardized systems to strengthen adherence monitoring as well as investigation of other factors including transport to take full advantage of universal access.

AB - Introduction: Namibia has the highest burden and incidence of hypertension in sub-Sahara Africa. Though non-adherence to antihypertensive therapy is an important cardiovascular risk factor, little is known about potential ways to improve adherence in Namibia following universal access. The objective of this study is to validate the Hill-Bone compliance scale and determine the level and predictors of adherence to antihypertensive treatment in primary health care (PHC) settings in suburban townships of Windhoek, Namibia. Methods: Reliability was determined by Cronbach's alpha. Principal component analysis (PCA) was used to assess construct analysis. Results: The PCA was consistent with the three-factors with 12 items, explaining 24.1%, 16.7% and 10.8% of the variance. Cronbach’s alpha was 0.695. None of the 120 patients had perfect adherence to antihypertensive therapy, and less than half had acceptable levels of adherence (≥80%). The mean adherence level was 76.7± 8.1 %. Three quarters of patients ever missed their scheduled clinic appointment. Having a family support system (OR = 5.4, 95%CI: 1.687 – 27.6, p = 0.045) and attendance of follow-up visits (OR = 3.1, 95%CI: 1.1 – 8.7, p < 0.030) were significant predictors of adherence. Having HIV/ AIDs did not lower adherence. Conclusions: The modified Namibian version of the Hill-Bone scale is reliable and valid for assessing adherence in Namibia. There is sub-optimal adherence to antihypertensive therapy among PHCs in Namibia. This needs standardized systems to strengthen adherence monitoring as well as investigation of other factors including transport to take full advantage of universal access.

KW - adherence

KW - hypertension

KW - Namibia

KW - primary health care

KW - universal access

UR - https://link.springer.com/journal/10557

U2 - 10.1007/s10557-017-6756-8

DO - 10.1007/s10557-017-6756-8

M3 - Article

VL - 31

SP - 565

EP - 578

JO - Cardiovascular Drugs and Therapy

JF - Cardiovascular Drugs and Therapy

SN - 0920-3206

IS - 5-6

ER -