Psychosocial Predictors of Self-Efficacy Related to Self-Reported Adherence in Older Chronic Patients Dealing with Hypertension: A European Study

PURPOSE: Non-adherence to clinical prescriptions is widely recognized as the most common cause of uncontrolled hypertension, contributing to develop acute and chronic cardiovascular diseases. Specifically, patients’ unintentional non-adherence is related to psychosocial factors as beliefs about medications, perceived physician’s communication effectiveness and medication-specific social support. The aim of this study was to observe the impact of these factors on self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence among older chronic patients with hypertension. PATIENTS AND METHODS: This research had a cross-sectional, observational and multicentre study design. Italian inpatients under rehabilitation, and Polish inpatients/outpatients were recruited. Following a cognitive screening, socio-demographic and clinical characteristics were obtained. Data on clinical and behavioral adherence (i.e., pharmacological adherence, adherence to refill medicines, intentional non-adherence) and psychosocial factors related to treatment adherence (i.e., beliefs about medicines, physician’s communication skills, medication-specific social support, psychological antecedents and self-efficacy) were collected with self-report questionnaires. RESULTS: A total of 458 patients were recruited. Fischer’s LSD post hoc test revealed significant differences between Italian and Polish samples in all measures (p<0.001). Multiple linear regression analysis showed low self-reported intentional non-adherence (β = −.02, p=0.031), high self-reported adherence to refill medications (β=−.05, p=0.017), high levels of perceived physician’s communication effectiveness (β=0.11, p<0.001), positive beliefs about medications (β=0.13, p<0.001), and high perceived medication-specific social support (β=0.05, p<0.001) to predict significantly high patients’ self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence. CONCLUSION: The observed psychosocial and behavioral factors revealed to positively impact on self-efficacy in relation to treatment adherence among older chronic patients dealing with hypertension. In a prevention framework, future studies and clinical practice may consider these factors in order to improve assessment and intervention on adherence in this population.