Health Beliefs and Medication Adherence Among Omani Patients With Hypertension

Thursday, 27 July 2017: 2:50 PM

Huda Al Noumani, PhD, RN, CNS1
Jia-Rong Wu, PhD2
Debra Barksdale, PhD, RN, FNP-BC, CNE, FAANP, FAAN3
George Knafl, PhD4
Gwen Sherwood, PhD, RN, FAAN5
Esra Al-Khasawneh, DNSc, MSN, RN, FAAN1
(1)College of Nursing, Sultan Qaboos University, Muscat, Oman
(2)School of Nursing, University of North Carolina, chapel Hill, chapel hill, NC, USA
(3)School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
(4)School of Nursing, University of North Carolina, Chapel Hill, chapel hill, NC, USA
(5)School of Nursing, University of North Carolina, Chapel Hill, Chapel hill, NC, USA

Hypertension (HTN) is a public health concern around the globe, which if not treated will lead to serious cardio and cerebrovascular complications. Antihypertensive medication is central in controlling BP and preventing HTN-related complications. Despite the effectiveness of medications, adherence to antihypertensive medications remains a challenge and less than 50% (WHO, 2013). Plenty of literature has reported different factors contributing to better or worse medication adherence in patients with HTN (AlGhurair, Hughes, Simpson, & Guirguis, 2012). Health beliefs about HTN and its medications are among patient-related factors that significantly related to antihypertensive medication adherence (AlGhurair et al., 2012). For example, stronger beliefs about HTN severity and susceptibility to its consequences, stronger beliefs about necessity of antihypertensive medications, higher self-efficacy, and fewer concerns about medication were associated with higher medication adherence (Kamran, Ahari, Biria, Malpour, & Heydari, 2015). These studies are consistent with the health beliefs model. In Oman, a high-income developing country, HTN prevalence is high and many studies have examined HTN prevalence and risk factors (Al-Maqbali, Temple-Smith, Ferler, & Blackberry, 2013; Al-Mawali, 2015). However, studies examining medication adherence and patients’ beliefs and medication adherence are lacking. It is essential that clinicians assess patients’ beliefs when aiming to improve medication adherence to plan effective and personalized plan of care.


The aim of this study is to examine Omani patients adherence with antihypertensive medications and their beliefs regarding HTN severity, necessity of and concerns about medications, and medication adherence self-efficacy. The study also aims to examine the relationship between 1) patients’ beliefs and medication adherence and 2) medication adherence and blood pressure (BP) control in Oman.


This cross-sectional study used descriptive correlation design and was conducted in Oman using 25 primary health care settings in 6 Omani governorates. Participants completed 4 questionnaires in Arabic version to measure medication adherence (Morisky medication adherence scale), beliefs about HTN severity (Brief illness perception questionnaire), beliefs about medication necessity and concerns (Beliefs about medicine questionnaire), and self-efficacy (Medication adherence self-efficacy scale). In this study, high medication adherence is defined as a Morisky scale of ≥ 6.BP values of the day of the study were taken from patients’ electronic medical records. Descriptive and Bivariate and multivariate logistic regression were used to conduct the analyses.


The study included a total of 215 participants with HTN with a mean age of 54 years (SD=13.1). Study findings showed 68% of participants reported high adherence and 63% have uncontrolled BP. Majority of participants reported stronger beliefs about necessity of medication (mean score = 3.7, SD = 0.9), higher self-efficacy regarding their ability to adhere to medications (mean score = 3.4, SD = 0.7), fewer concerns about medication (mean score = 2.4, SD = 0.8), and believed that HTN is not a severe condition (mean score=25.8, SD = 12.2). Logistic regression analysis showed that higher self-efficacy (OR=2.59; 95% CI 1.54-4.37), stronger beliefs about medication necessity (OR=1.98; 95% CI 1.21-3.23), increased age (OR=1.06; 95% CI 1.03-1.10), and fewer medication concerns (OR=0.34; 95% CI 0.20-0.57) were significantly related to high medication adherence and explained 37% of variation in medication adherence. Furthermore, participants with high medication adherence were less likely to have their BP uncontrolled (OR=0.47; 95% CI 0.24-0.93) and explained 3% in BP control variation.


Findings regarding the relationship between medication adherence and beliefs about the necessity of and concerns about medication and self-efficacy are consistent with studies among patients with HTN and other chronic conditions. Although we did not find a significant relationship between medication adherence and beliefs about severity of HTN, the direction of the relationship was negative, which is inconsistent with majority of studies that reported a positive relationship. This inconsistency in findings could be related to cultural variation and the influence of unique Islamic beliefs on disease and treatment. Therefore, clinicians and researchers should be aware that beliefs might vary across cultures and/or within cultures.

Results of this study indicated that patients beliefs play significant role in medication adherence, which highlight the significance of assessing and incorporating patients’ health beliefs in clinical practice by the clinicians (e.g., physicians, nurses). Moreover, strategies to improve medication adherence should incorporate beliefs as key component for effective and personalized plan of care for patients with HTN generally and Omani patients specifically.