Patient perception about reasons for non-adherence to antihypertensive medication in Windhoek District
Background: Adherence is the extent to which a person takes medication as prescribed by health-care providers. It includes both dosing regularity and timing of intake. Antihypertensive medication reduces high blood pressure effectively and reduces the risk of heart failure, renal failure and stroke. Hypertension is considered a public health problem due to its impact of high mortality and morbidity. According to the Namibia Ministry of Health and Social Services a total of 34,826 people, aged 18 years and older in the Windhoek District, were diagnosed with hypertension in 2006-2007; the premature death toll due to uncontrolled hypertension increased from 88 deaths per 1,000 cases in 2006 (MOHSS, 2006) to 301 deaths per 1,000 cases in 2007 (MOHSS, 2007). Despite the availability, accessibility and affordability of medication at clinics and health centers, non-adherence is increasing, especially among the young productive population. The purpose of this study was to gain an understanding into the perceptions of non-adherent hypertension patients in Katutura Township in the Windhoek District about their treatment regimens. The research provided information that can be used by policy-makers in the development of a hypertension policy to improve interventions. Aim: The study aimed to explore the perceptions of non-adherent hypertensive patients in Katutura Township by looking at what they considered to be the factors influencing their non-adherence to antihypertensive medication. Methodology: An explorative qualitative study was conducted, using individual in-depth interviews among eight non-adherent hypertension patients, aged 35 years and older. The eligible respondents were purposively selected. A thematic content analysis of transcribed data was conducted where themes were related to patients‟ perceptions for non–adherence. Results: The results showed that the respondents were not adhering to medication. There were several reasons given for this. An important factor was their limited knowledge about the hypertension disease and medication, in part due to ineffective health education. Other factors included the side effects of the medication as well as the belief that antihypertensive medications are poisonous and addictive. Cultural and religious beliefs were also found to be contributing factors to non-adherence. The findings also revealed that the doctors appeared not to have time to examine patients. The attitudes of the nurses were identified as factors that influence non-adherence. It is reported that they do not listen to patients‟ complaints and patients do not feel respected by them. Additional factors included the cost of traveling to the health center which was considered to be prohibitive, long distances to get to the health center as well as 3-5 hours waiting time at the health center influenced non-adherence. Some respondents claimed that they do not want to mix medication with alcohol so that when they are drinking alcohol, they skip their medications. Lastly, some of the patients earn low income and as they are paid per hour, they cannot afford to take time off from work and this further results in non-adherence to medication. Conclusion: The findings concurred with findings of other research done in developing and developed countries. These included poor interpersonal relationships between health-care providers and patients, a lack of knowledge about hypertension and its treatment; cultural beliefs and traditions, and standards of health care provision. Improvement in communication between health-workers and hypertensive patients may promote better adherence. The study indicates an urgent need to design intervention measures to enhance adherence among hypertension patients.