Influencing adherence among hypertensives

Authors

  • Mary Ann Swain,

    1. Dr. Mary Ann Swain is a professor and chairperson of nursing research in the School of Nursing, University of Michigan, Ann Arbor; and Dr. Susan B. Steckel is an associate professor in the School of Nursing, University of Michigan, Ann Arbor, and director of nursing research, St. Joseph Mercy Hospital, Pontiac, Michigan.
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  • Susan B. Steckel

    1. Dr. Mary Ann Swain is a professor and chairperson of nursing research in the School of Nursing, University of Michigan, Ann Arbor; and Dr. Susan B. Steckel is an associate professor in the School of Nursing, University of Michigan, Ann Arbor, and director of nursing research, St. Joseph Mercy Hospital, Pontiac, Michigan.
    Search for more papers by this author

Abstract

In the treatment of hypertension, problems of nonadherence and consequent poor blood pressure control are particularly severe. Alternative intervention strategies were compared to explore means of improving adherence and lowering blood pressures. In a 3 × 4 repeated measures analysis of variance design, 115 patients were randomly selected and randomly assigned to one of three treatment modalities (routine clinic care, patient education, and contingency contracting) and were followed over four clinic visits. Subjects' knowledge about hypertension and its management, adherence to requests for regular medical follow-up, and blood pressure levels were measured. Patient education was not effective in lowering blood pressures; it produced an untoward outcome, a dropout rate higher than that for patients receiving only routine clinic care. However, contingency contracting was an effective intervention strategy for improving patient knowledge, F (1,59) = 51.32, p<.0001; adherence to requests for regular medical care, Max L (2) = 25.9, p<.0001; and decreasing diastolic blood pressures, F (2,49) = 3.39, p<.05.

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