Determinants of MedicationAdherence in Hypertensive Patients: Clinical Evidence from Indonesian Primary Healthcare Settings
-
Ronald Pratama Adiwinoto
,
Saptono Putro
,
Tamam Jauhar
,
Kellyn Tricia Zenjaya
,
Dinnara Nelya Rindayu
,
Lidya Prillyarista Herlambang
,
I Made Dwi Mertha Adnyana
Abstract
Introduction: Adherence to hypertension medication remains a critical challenge in healthcare management, particularly
in resource-limited settings. This study investigated the determinants of medication adherence among patients with
hypertension in Indonesian primary healthcare settings.
Methods: A cross-sectional study involving 96 hypertensive patients selected through systematic random sampling was
conducted at the Public Health Center of Tenggilis, Surabaya. Data were collected via validated questionnaires, including the
Morisky Medication Adherence Scale-8 (MMAS-8), and analyzed via multivariate logistic regression.
Results: Among the 96 hypertensive patients included in this study, the majority were aged 40–49 years (30.2%), with a
male predominance (67.7%). Most participants had a senior high school education (57.3%) and were employed as civil
servants (30.2%). Only 52.1% of patients reported consistent medication adherence, with financial barriers and knowledge
gaps identified as the primary challenges. Multivariate logistic regression analysis revealed that regular medical control
(odds ratio [OR] = 1.963, 95% CI 1.214-3.181; p = 0.006) and alternative diagnostic methods (OR = 2.326, 95% CI 1.532-
3.538, p<0.001) were significantly associated with better medication adherence. Adherence to doctors' advice (OR = 1.699,
95% CI 1.128–2.559, p = 0.012), the ability to manage medication costs (OR = 1.518, 95% CI 1.012–2.278, p = 0.044), and
routine treatment management (OR = 1.825, 95% CI 1.219–2.736, p = 0.004) were identified as key predictors of positive
medication adherence.
Conclusion: Medication adherence in patients with hypertension is influenced by multiple factors, including diagnostic
approach, healthcare access, cost management, and routine treatment compliance. These findings emphasize the need for
comprehensive interventions that address both clinical and socioeconomic barriers to improve hypertension management
in primary healthcare settings.
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in Indonesia. Indian J Forensic Med Toxicol. 2021;15(4):1065–71.
7. Sudiartawan IP, Adnyana IMDM. Efficacy of hydrotherapy soak feet in lowering blood pressure
of hypertension sufferers in Dauhwaru Village, Jembrana. Sci Midwifery. 2022;10(4):2954–62.
8. Amatullah ZR, Yogananda AA, Faizah N. Relationship between adherence to antihypertensive
therapy and blood pressure in patients of Kotagede I Health Center Yogyakarta. J Kefarmasian
Akfarindo. 2023;63–9.
9. Gede IB, Baskara A, Ayu G, Widowati R, Arimbawa E. Knowledge, attitude, and compliance of
hypertension patients at Kediri I Tabanan Health Center. Lumbung Farmasi J Ilmu Kefarmasian.
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knowledge on hypertension treatment adherence and efficacy: A single-center study in Poland. Int
J Med Sci. 2021;18(3):852–60.
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control, accessibility, and adherence to antihypertensive medications: patients seeking care in two
hospitals in the Ashanti Region of Ghana. Int J Hypertens. 2021;2021:1–9.
12. Mathavan J, Pinatih GNI. An overview of the level of knowledge of hypertension and adherence
to taking medication in patients with hypertension in the Kintamani I Health Center working area.
Intisari Sains Med. 2017;8(3):176–80.
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Hypertens. 2017;2017:1–6.
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hypertension. Medicina. 2019;55(11):715.
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knowledge and medication adherence among patients with hypertension. Patient Prefer Adherence.
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patients with hypertension. J Ilmu Keperawatan Kebidanan. 2021;12(2):327–33.
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patients at Mekarsari Health Center and lebubg Bandung Health Center, Ogan Ilir District in May-
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learning theory. Front Pharmacol. 2023;14:1184701.
21. Hamrahian SM, Maarouf OH, Fülöp T. A critical review of medication adherence in hypertension:
barriers and facilitators clinicians should consider. Patient Prefer Adherence. 2022;16:2749–57.
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hypertension knowledge, medication adherence, and blood pressure control: A feasibility study. J
Clin Nurs. 2021 Oct 19;30(19–20):2960–7.
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trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a
pooled analysis of 1201 population-representative studies with 104 million participants. The
Lancet. 2021;398(10304):957–80.
25. Darwin M, Mamondol MR, Sormin SA, Nurhayati Y, Tambunan H, Sylvia D, et al. Quantitative
approach research method. 1st ed. Tambunan TS, editor. Bandung: CV Media Sains Indonesia;
2021. 192 p.
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1st ed. Akbar H, editor. Bandung: CV. Media Sains Indonesia; 2023. 208 p.
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drivers of misinformation belief and its resistance to correction. Nature Reviews Psychology.
2022;1(1):13–29.
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appointments among patients with hypertension at public health facilities in Punjab, India. J Clin
Hypertens. 2021;23(4):713–9.
31. Wolde M, Azale T, Debalkie Demissie G, Addis B. Knowledge about hypertension and associated
factors among patients with hypertension in public health facilities of Gondar city, Northwest
Ethiopia: Ordinal logistic regression analysis. Akash MSH, editor. PLoS One. 2022;17(6):e0270030.
32. Kurnia AD, Melizza N, Ruhyanudin F, Masruroh NL, Prasetyo YB, Setyowati CI, et al. The effect
of educational program on hypertension management toward knowledge and attitude among
uncontrolled hypertension patients in rural area of Indonesia. Community Health Equity Res
Policy. 2022;42(2):181–8.
33. Anyanti J, Akuiyibo SM, Fajemisin O, Idogho O, Amoo B. Assessment of the level of knowledge,
awareness and management of hypertension and diabetes among adults in Imo and Kaduna states,
Nigeria: a cross-sectional study. BMJ Open. 2021;11(3):e043951.
34. Pathak A, Poulter NR, Kavanagh M, Kreutz R, Burnier M. Improving the management of
hypertension by tackling awareness, adherence, and clinical inertia: a symposium report. American
J Cardio Drugs. 2022;22(3):251–61.
35. Cangussú LR, Sartori Alho EA, Silva AL, Fonsêca DV, Lopes JM, Barbosa RH de A, et al. Low
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incidence of mortality among hypertensive subjects from Northeast Rural China. Front Public
Health. 2022;10:951930.
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care and services in primary health-care settings in Vietnam: a systematic narrative review of
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lifestyle modifications among hypertensive patients: An integrative review. Int J Environ Res
Public Health. 2020;17(7):2513.
39. Sun K, Lin D, Li M, Mu Y, Zhao J, Liu C, et al. Association of education levels with the risk of
hypertension and hypertension control: a nationwide cohort study in Chinese adults. J Epidemiol
Community Health (1978). 2022;76(5):451–7.
40. Martin LR, Williams SL, Haskard KB, Dimatteo MR. The challenge of patient adherence. Ther
Clin Risk Manag. 2005;1(3):189–99.
41. Poulter NR, Borghi C, Parati G, Pathak A, Toli D, Williams B, et al. Medication adherence in
hypertension. J Hypertens. 2020;38(4):579–87.
42. Paraidathathu T, Azuana, Nur Sufiza A. Medication adherence among hypertensive patients of
primary health clinics in Malaysia. Patient Prefer Adherence. 2012;6:613.
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sample of Portuguese hypertensive patients’ knowledge about hypertension and its influence on
their beliefs and adherence to therapy. Revista Portuguesa de Cardiologia. 2022;41(5):361–7.
44. Ojo O, Malomo S, Sogunle P. Blood pressure (BP) control and perceived family support in patients
with essential hypertension seen at a primary care clinic in Western Nigeria. J Family Med Prim
Care. 2016;5(3):569.
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individuals with hypertension: results from a cross-sectional study in Kollam District, Kerala.
Wellcome Open Res. 2020;5:180.
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control of hypertension: A randomized controlled trial in Zunyi, China. Glob Health Sci Pract.
2021;9(4):890–904.
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to change: The antidotal effect of organizational justice, support and leader-member exchange.
Front Psychol. 2021;12:678952.
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nurse‒patient interactions: barriers, facilitators, and the way forward. BMC Nurs. 2021;20(1):158.
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prevalence of hypertension in older adults from southeastern Poland: an observational study. Sci
Rep. 2024;14(1):1450.
50. Bhandari B, Narasimhan P, Vaidya A, Subedi M, Jayasuriya R. Barriers and facilitators for treatment
and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative
study informed by COM-B model of behavior change. BMC Public Health. 2021;21(1):1524.
51. Abaynew Y, Hussien M. A Qualitative study on barriers to treatment and control of hypertension
among patients at dessie referral hospital, Northeast Ethiopia, Ethiopia: healthcare workers’
perspective. Integr Blood Press Control. 2021;14:173–8.
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and barriers to hypertension management in urban Nepal: findings from a qualitative study. Open
Heart. 2023;10(2):e002394.
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1. WHO. Hypertension [Internet]. Geneva: World Health Organization; 2023 [cited 2023 Jul 30].
Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension.
2. Gaziano TA. Reducing The growing burden of cardiovascular disease in the developing world.
Health Aff. 2007;26(1):13–24.
3. Mboi N, Syailendrawati R, Ostroff SM, Elyazar IR, Glenn SD, Rachmawati T, et al. The state of
health in Indonesia’s provinces, 1990–2019: a systematic analysis for the global burden of disease
study 2019. Lancet Glob Health. 2022 Nov;10(11):e1632–45.
4. WHO. Global action plan for the prevention and control of noncommunicable diseases 2013-
2020. World Health Organization [Internet]. 2013;102. Available from: http://apps.who.int/iris/
bitstream/10665/94384/1/9789241506236_eng.pdf.
5. Brathwaite R, Hutchinson E, McKee M, Palafox B, Balabanova D. The long and winding road: a
systematic literature review conceptualizing pathways for hypertension care and control in low-
and middle-income countries. Int J Health Policy Manag. 2022;11(3):257–68.
6. Dwimawati E, Sari FDN, Sinuraya E, Purwaningsih. Prevalence and determinants of hypertension
in Indonesia. Indian J Forensic Med Toxicol. 2021;15(4):1065–71.
7. Sudiartawan IP, Adnyana IMDM. Efficacy of hydrotherapy soak feet in lowering blood pressure
of hypertension sufferers in Dauhwaru Village, Jembrana. Sci Midwifery. 2022;10(4):2954–62.
8. Amatullah ZR, Yogananda AA, Faizah N. Relationship between adherence to antihypertensive
therapy and blood pressure in patients of Kotagede I Health Center Yogyakarta. J Kefarmasian
Akfarindo. 2023;63–9.
9. Gede IB, Baskara A, Ayu G, Widowati R, Arimbawa E. Knowledge, attitude, and compliance of
hypertension patients at Kediri I Tabanan Health Center. Lumbung Farmasi J Ilmu Kefarmasian.
2023;4(1):178–85.
10. Paczkowska A, Hoffmann K, Kus K, Kopciuch D, Zaprutko T, Ratajczak P, et al. Impact of patient
knowledge on hypertension treatment adherence and efficacy: A single-center study in Poland. Int
J Med Sci. 2021;18(3):852–60.
11. Adomako NO, Marfo AFA, Opare-Addo MNA, Nyamekye N, Owusu-Daaku FT. Blood pressure
control, accessibility, and adherence to antihypertensive medications: patients seeking care in two
hospitals in the Ashanti Region of Ghana. Int J Hypertens. 2021;2021:1–9.
12. Mathavan J, Pinatih GNI. An overview of the level of knowledge of hypertension and adherence
to taking medication in patients with hypertension in the Kintamani I Health Center working area.
Intisari Sains Med. 2017;8(3):176–80.
13. Pirasath S, Kumanan T, Guruparan M. A Study on Knowledge, awareness, and medication
adherence in patients with hypertension from a tertiary care center from Northern Sri Lanka. Int J
Hypertens. 2017;2017:1–6.
14. Ghembaza MA, Senoussaoui Y, Tani M, Meguenni K. Impact of Patient knowledge of hypertension
complications on adherence to antihypertensive therapy. Curr Hypertens Rev. 2014;10(1):41–8.
15. Gavrilova A, Bandere D, Rutkovska I, Šmits D, Mauriņa B, Poplavska E, et al. Knowledge
about disease, medication therapy, and related medication adherence levels among patients with
hypertension. Medicina. 2019;55(11):715.
16. Jankowska-Polańska B, Uchmanowicz I, Dudek K, Mazur G. Relationship between patients’
knowledge and medication adherence among patients with hypertension. Patient Prefer Adherence.
2016;10:2437–47.
17. Machaalani M, Seifeddine H, Ali A, Bitar H, Briman O, Chahine MN. Knowledge, attitude, and
practice toward hypertension among hypertensive patients residing in Lebanon. Vasc Health Risk
Manag. 2022;18:541–53.
18. Wirakhmi IN, Purnawan I. Relationship between medication adherence and blood pressure in
patients with hypertension. J Ilmu Keperawatan Kebidanan. 2021;12(2):327–33.
19. Rifandani Z, Yogananda AA, Faizah N. Rationality of drug use and compliance of hypertensive
patients at Mekarsari Health Center and lebubg Bandung Health Center, Ogan Ilir District in May-
July 2016. J Ilmiah Bakti Farmasi. 2018;3(2).
20. Lu T, Yang Z, Chen P, Li J, Zheng C, Kong L, et al. Influencing factors of medication literacy
among community-dwelling older adult patients with hypertension: a study based on social
learning theory. Front Pharmacol. 2023;14:1184701.
21. Hamrahian SM, Maarouf OH, Fülöp T. A critical review of medication adherence in hypertension:
barriers and facilitators clinicians should consider. Patient Prefer Adherence. 2022;16:2749–57.
22. Marseille BR, Commodore‐Mensah Y, Davidson PM, Baker D, D’Aoust R, Baptiste D. Improving
hypertension knowledge, medication adherence, and blood pressure control: A feasibility study. J
Clin Nurs. 2021 Oct 19;30(19–20):2960–7.
23. Adeloye D, Owolabi EO, Ojji DB, Auta A, Dewan MT, Olanrewaju TO, et al. Prevalence,
awareness, treatment, and control of hypertension in Nigeria in 1995 and 2020: A systematic
analysis of current evidence. J Clin Hypertens. 2021;23(5):963–77.
24. Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, et al. Worldwide
trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a
pooled analysis of 1201 population-representative studies with 104 million participants. The
Lancet. 2021;398(10304):957–80.
25. Darwin M, Mamondol MR, Sormin SA, Nurhayati Y, Tambunan H, Sylvia D, et al. Quantitative
approach research method. 1st ed. Tambunan TS, editor. Bandung: CV Media Sains Indonesia;
2021. 192 p.
26. Paulus AY, Sulaeman, Mayasari AC, Ayu JD, Musniati N, Sari MP, et al. Biostatistika Epidemiologi.
1st ed. Akbar H, editor. Bandung: CV. Media Sains Indonesia; 2023. 208 p.
27. Adnyana IMDM. Populasi dan Sampel. In: Darwin M, editor. Metode Penelitian Pendekatan
Kuantitatif. 1st ed. Bandung: CV. Media Sains Indonesia; 2021. p. 103–16.
28. Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al.
Resistant hypertension: Detection, evaluation, and management: a scientific statement from the
american heart association. Hypertension. 2018;72(5):e53–e90.
29. Ecker UKH, Lewandowsky S, Cook J, Schmid P, Fazio LK, Brashier N, et al. The psychological
drivers of misinformation belief and its resistance to correction. Nature Reviews Psychology.
2022;1(1):13–29.
30. Das B, Neupane D, Singh Gill S, Bir Singh G. Factors affecting non‐adherence to medical
appointments among patients with hypertension at public health facilities in Punjab, India. J Clin
Hypertens. 2021;23(4):713–9.
31. Wolde M, Azale T, Debalkie Demissie G, Addis B. Knowledge about hypertension and associated
factors among patients with hypertension in public health facilities of Gondar city, Northwest
Ethiopia: Ordinal logistic regression analysis. Akash MSH, editor. PLoS One. 2022;17(6):e0270030.
32. Kurnia AD, Melizza N, Ruhyanudin F, Masruroh NL, Prasetyo YB, Setyowati CI, et al. The effect
of educational program on hypertension management toward knowledge and attitude among
uncontrolled hypertension patients in rural area of Indonesia. Community Health Equity Res
Policy. 2022;42(2):181–8.
33. Anyanti J, Akuiyibo SM, Fajemisin O, Idogho O, Amoo B. Assessment of the level of knowledge,
awareness and management of hypertension and diabetes among adults in Imo and Kaduna states,
Nigeria: a cross-sectional study. BMJ Open. 2021;11(3):e043951.
34. Pathak A, Poulter NR, Kavanagh M, Kreutz R, Burnier M. Improving the management of
hypertension by tackling awareness, adherence, and clinical inertia: a symposium report. American
J Cardio Drugs. 2022;22(3):251–61.
35. Cangussú LR, Sartori Alho EA, Silva AL, Fonsêca DV, Lopes JM, Barbosa RH de A, et al. Low
health literacy and quality of life in patients with systemic arterial hypertension. Dialogs in Health.
2022;1:100036.
36. Yu S, Guo X, Li G, Yang H, Zheng L, Sun Y. Low educational status correlates with a high
incidence of mortality among hypertensive subjects from Northeast Rural China. Front Public
Health. 2022;10:951930.
37. Meiqari L, Nguyen TPL, Essink D, Zweekhorst M, Wright P, Scheele F. Access to hypertension
care and services in primary health-care settings in Vietnam: a systematic narrative review of
literature. Glob Health Action. 2019 Jan 1;12(1):1610253.
38. Tam HL, Wong EML, Cheung K. Effectiveness of educational interventions on adherence to
lifestyle modifications among hypertensive patients: An integrative review. Int J Environ Res
Public Health. 2020;17(7):2513.
39. Sun K, Lin D, Li M, Mu Y, Zhao J, Liu C, et al. Association of education levels with the risk of
hypertension and hypertension control: a nationwide cohort study in Chinese adults. J Epidemiol
Community Health (1978). 2022;76(5):451–7.
40. Martin LR, Williams SL, Haskard KB, Dimatteo MR. The challenge of patient adherence. Ther
Clin Risk Manag. 2005;1(3):189–99.
41. Poulter NR, Borghi C, Parati G, Pathak A, Toli D, Williams B, et al. Medication adherence in
hypertension. J Hypertens. 2020;38(4):579–87.
42. Paraidathathu T, Azuana, Nur Sufiza A. Medication adherence among hypertensive patients of
primary health clinics in Malaysia. Patient Prefer Adherence. 2012;6:613.
43. Cabral AC, Lavrador M, Fernandez-Llimos F, Castel-Branco M, Figueiredo IV. Evaluation of a
sample of Portuguese hypertensive patients’ knowledge about hypertension and its influence on
their beliefs and adherence to therapy. Revista Portuguesa de Cardiologia. 2022;41(5):361–7.
44. Ojo O, Malomo S, Sogunle P. Blood pressure (BP) control and perceived family support in patients
with essential hypertension seen at a primary care clinic in Western Nigeria. J Family Med Prim
Care. 2016;5(3):569.
45. Chacko S, Jeemon P. Role of family support and self-care practices in blood pressure control in
individuals with hypertension: results from a cross-sectional study in Kollam District, Kerala.
Wellcome Open Res. 2020;5:180.
46. Li Y, Liu G, Liu C, Wang X, Chu Y, Li X, et al. Effects of pharmacist intervention on community
control of hypertension: A randomized controlled trial in Zunyi, China. Glob Health Sci Pract.
2021;9(4):890–904.
47. Rehman N, Mahmood A, Ibtasam M, Murtaza SA, Iqbal N, Molnár E. The psychology of resistance
to change: The antidotal effect of organizational justice, support and leader-member exchange.
Front Psychol. 2021;12:678952.
48. Kwame A, Petrucka PM. A literature-based study of patient-centered care and communication in
nurse‒patient interactions: barriers, facilitators, and the way forward. BMC Nurs. 2021;20(1):158.
49. Leszczak J, Czenczek-Lewandowska E, Asif M, Baran J, Mazur A, Wyszyńska J. Risk factors and
prevalence of hypertension in older adults from southeastern Poland: an observational study. Sci
Rep. 2024;14(1):1450.
50. Bhandari B, Narasimhan P, Vaidya A, Subedi M, Jayasuriya R. Barriers and facilitators for treatment
and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative
study informed by COM-B model of behavior change. BMC Public Health. 2021;21(1):1524.
51. Abaynew Y, Hussien M. A Qualitative study on barriers to treatment and control of hypertension
among patients at dessie referral hospital, Northeast Ethiopia, Ethiopia: healthcare workers’
perspective. Integr Blood Press Control. 2021;14:173–8.
52. Bhattarai S, Bajracharya S, Shrestha A, Skovlund E, Åsvold BO, Mjolstad BP, et al. Facilitators
and barriers to hypertension management in urban Nepal: findings from a qualitative study. Open
Heart. 2023;10(2):e002394.
53. Brettler JW, Arcila GPG, Aumala T, Best A, Campbell NR, Cyr S, et al. Drivers and scorecards to
improve hypertension control in primary care practice: Recommendations from the HEARTS in
the Americas Innovation Group. The Lancet Regional Health - Americas. 2022;9:100223.
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| Files | ||
| Issue | Vol 11 No 3 (2025): . | |
| Section | Articles | |
| Keywords | ||
| Medication Adherence Hypertension Health Knowledge Attitudes Practice Patient Compliance Health Services Accessibility | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Adiwinoto RP, Putro S, Jauhar T, Zenjaya KT, Rindayu DN, Herlambang LP, Adnyana IMDM. Determinants of MedicationAdherence in Hypertensive Patients: Clinical Evidence from Indonesian Primary Healthcare Settings. JBE. 2026;11(3):290-307.
