CHAPTER FOUR

RESULTS

Socio-demographic Profile

Table 4.1 below shows that 88 (42.7%) representing the highest proportion of the 206 respondents were between the age of 61-65years, while 59 (28.6%) representing a lowest proportion were between 56-60years and 66years and above respectively.

Also, more than half the total number of the respondents; 117 (56.8%) were married, 57 (27.7%) were widowed, 30 (14.6%) were divorced/separated, 2 (1.0%) were cohabiting while none was single.

Considering their educational level, 84 (40.8%) being the majority had had secondary school education, 63 (30.6%) had had primary school education, 59 (28.6%) had had tertiary education whereas none had no formal education.

A majority of the 206 respondents; 147 (71.4%) were Christians, 59 (28.6%) were Muslims, while none was a traditionalist nor belonged to other religious affiliations.

In addition, 89 (43.2%) representing the highest percentage had two children, 45 (21.8%) had four children, 30 (14.6%) had three children, 25 (12.1%) had five children, 13 (6.3%) had five children or more and 4 (1.9%) representing the lowest percentage had one child.

Furthermore, 147 (71.4%) being the majority had none of their children being dependent, 36 (17.5%) had one dependent child, 20 (9.7%) had two dependent children whereas the minority; 3 (1.5%) had three or more dependent children.

Lastly, more than half of the respondents; 163 (79.1%) had 1 supportive child, 31 (15.0%) had two supportive children, 12 (5.8%) had three or more supportive children whereas none of the respondents had none of their children being unsupportive.

Considering the socioeconomic characteristics of the respondents as represented in Table 4.2 below, more than half of the 206 respondents; 111 (53.9%) were retired, 59 (28.6%) were businesspersons, 26 (12.7%) were professionals, 6 (2.9%) were traders/shop attendants, 4 (1.9%) were farmers/fishermen. However, none of them was unemployed, tradesman, unskilled labourer, clerical worker nor student.

In view of their average monthly income in Ghana cedis, 117 (56.8%) being the majority made 601- 1000, 42 (20.4%) made more than 2000, 30 (14.6%) had 200-600 while 17 (8.3%) being the minority made 1001-2000.

Again, a majority; 147 (71.4%) paid for their hypertensive drug with NHIS, 42 (21.1.%) paid with private insurance whereas 18 (7.6%) paid out of their pocket. None of them paid for their drugs through other means.

Out of the 186 NHIS and private insured respondents, more than half; 106 (57.0%) answered in the negative while 80 (43.0%) answered in the positive to getting all their drugs from their health insurance.

Out of the 106 respondents who answered no to getting all their drugs from the health insurance, half of them; 53 (50.0%) spent less than 100 Ghana cedis for the drugs not gotten from health insurance, 36 (34.0%) spent 100-200 cedis, 12 (11.3%) spent 300-400 cedis whereas 5 (4.7%); the lowest percentage spent more than 400 cedis monthly.

Table 1 Socio-demographic Profile

Item	Frequency (N=206)	Percent (%)
Age Ranges
56- 60years	59	28.6
61-65 years	88	42.7
66 years and above	59	28.6
Marital Status
Single	0	0.0
Married	117	56.8
Divorced/Separated	30	14.6
Widowed	57	27.7
Cohabiting	2	1.0
Educational Level
No Formal Education	0	0.0
Primary	63	30.6
Secondary	84	40.8
Tertiary	59	28.6
Religion
Christian	147	71.4
Muslim	59	28.6
How many children do you have?
1 Child	4	1.9
2 Children	89	43.2
3 Children	30	14.6
4 Children	45	21.8
5 Children	25	12.1
More than 5 Children	13	6.2
How many children are dependent?
None	147	71.4
1 Child	36	17.5
2 Children	20	9.7
3 or more	3	1.5
How many children are supportive?
None	0	0.0
1 Child	163	79.1
2 Children	31	15.0
3 or more	12	5.8
What is your occupation?
Businessperson	59	28.6
Farmer/Fisherman	4	1.9
Professional	26	12.7
Trader/Shop Attendant	6	2.9
Retired	111	53.9
What is your average monthly income?
GHS 200-GHS 600	30	14.6
GHS 601-GHS 1000	117	56.8
GHS 1001- GHS 2000	17	8.3
More than GHS 2000	42	20.4
How do you pay for your hypertensive drug?
NHIS	147	71.4
Private Insurance	18	8.5
Out of pocket	42	21.1
Others	0	0.0
If out of pocket, how much do you spend on drug monthly?
100-200	13	65.0
300-400	6	30.0
More than 400	1	5.0
If insured, do you get all your drugs from the Health Insurance?
Yes	80	43.0
No	106	57.0
If no to Q1 2, how much do you spend monthly on your drugs that are not gotten from Health Insurance?
Less than 100	53	50.0
100-200	36	34.0
300-400	12	11.3
More than 400	5	4.7

Source: Field Data (2024)

4.2 Knowledge Level on Hypertension and Antihypertensive

Assessing the respondents’ level of knowledge on hypertension as represented in Table 4.3 below, a majority 147 (71.4%) answered yes while the minority; 59 (28.6%) answered no with a significant p value of 0.001 to the assertion that a blood pressure of above 130/90 is considered high.

Correspondingly, with a significant p value of 0.002, a greater percentage of the respondents; 176 (85.4%) replied yes whereas a lower percentage; 30 (14.6%) replied no to the statement that a blood pressure of less than 118/70 is considered to be normal.

Also, all the 206 (100.0%) respondents answered yes to the statement that smoking cigarettes has a negative effect on persons with hypertension.

Displaying a statistically significant p value of 0.023, a majority; 188 (91.3%) affirmed that drinking alcohol has a negative effect on persons with hypertension while the minority; 18 (8.7%) answered in the negative.

Additionally, all the respondents; 206 (100.0%) answered yes to the assertion that hypertension is a serious condition that can lead to complications.

Furthermore, to the claim that an individual with hypertension should go for periodic check-ups, close to the total number of the respondents; 199 (96.6%) answered yes whereas a minority; 7 (3.4%) answered no with a p value of 0.000.

Likewise, a majority; 110 (54.3%) replied yes while 96 (46.7%) being the minority replied no to the assertion that it is important for a patient with hypertension to have a reliable means of blood pressure monitoring between visits to their health care provider with a p value of 0.003.

Finally, the claim that increased physical exercise actually decreases the blood pressure of a person with hypertension had a higher proportion of the respondents; 147 (71.4%) replying yes while the lower proportion; 59 (28.6%) replied no with a statistically significant p value of 0.024.

Regarding the respondents’ level of knowledge on antihypertensives as represented in Table 4.4 below, all 206 (100.0%) of the respondents answered in the affirmative that blood pressure medication is taken to control high blood pressures.

Once more, a majority of the respondents; 196 (95.1%) confirmed that drugs for increased blood pressure must be taken every day while the minority; 10 (4.9%) replied in the negative; showing a significant p value of 0.000.

Also, to the claim that there is no need for treatment if individuals with increased blood pressure change their lifestyle, more than half of the respondents; 118 (57.3%) answered yes whereas 88 (42.7%) answered no displaying a p value of 0.043

Contrarily, 148 (71.8%) being the greater percentage answered in the negative that individuals with increased blood pressure must take their medication only when they feel ill while the lesser percentage 58 (28.2%) answered in the positive; displaying a p value of 0.021.

Moreover, showing a significant p value of 0.017, all the respondents; 206 (100.0%) replied in the negative to the assertion that individuals with increased blood pressure must take their medication in a manner that makes them feel good.

Lastly, to the statement that individuals with increased blood pressure must take their medication throughout their life, 150 (72.8%) being the greater proportion replied yes whereas 56 (27.2%) being the lower proportion replied no.

Table 2: Knowledge Level on Hypertension and Antihypertensive

Item	Responses (N=206)		Std. Dev.	p Value
	Yes N (%)	No N (%)
A blood pressure of above 130/90 is considered high.	147 (71.4)	59 (28.6)	0.453	0.001
A blood pressure of less than 118/70 is considered to be normal.	176 (85.4)	30 (14.6)	0.354	0.002
Smoking cigarettes has a negative effect on persons with hypertension.	206 (100.0)	0 (0.0)	0.000
Drinking alcohol has a negative effect on persons with hypertension.	188 (91.3)	18 (8.7)	0.283	0.023
Hypertension is a serious condition that can lead to complications.	206 (100.0)	0 (0.0)	0.000
An individual with hypertension should go for periodic check-ups.	199 (96.6)	7 (3.4)	0.182	0.000
It is important for a patient with hypertension to have a reliable means of blood pressure monitoring between visits to their health care provider.	110 (54.3)	96(46.7)	0.310	0.003
Increased physical exercise actually decreases the blood pressure of a person with hypertension.	147 (69.4)	59 (30.6)	0.453	0.024
Blood pressure medication are taken to control high blood pressures	206 (100.0)	0 (0.0)	0.000	0.000
Drugs for increased blood pressure must be taken every day.	196 (95.1)	10 (4.9)	0.070	0.000
If individuals with increased blood pressure change their lifestyle, there is no need for treatment.	118 (57.3)	88 (42.7)	0.496	0.043
Individuals with increased blood pressure must take their medication only when they feel ill.	58 (28.2)	148 (71.8)	0.451	0.021
Individuals with increased blood pressure must take their medication in a manner that makes them feel good	0 (0.0)	206 (100.0)	0.000	0.017
Individuals with increased blood pressure must take their medication throughout their life.	150 (72.8)	56 (27.2)	0.446	0.000

Source: Field Data (2024)

4.3 How Patient’s Knowledge on Hypertension Relates to the Practice

Table 3 indicated that there is a significant association between hypertensive patients who knew that BP of 130/90 is high (χ2 = 110.867, p= 0.001), the essences of periodic checkups (χ2 = 61.361, p= 0.000), how hypertension can lead to complication (χ2 = 61.361, p= 0.029) and the rate at which patient forget to take their medications. That is, majority, 85.4% of the patients who knew that BP of 130/90 is high were two times likely to sometimes forget to take their antihypertensives [COR=2.034(1.56, 2.63) 0.003], and the majority, 88.4% who knew the essence of periodic checkups are 11% more likely to sometimes fail taking their medications [0.116(0.079, 0.170)0.022] and majority 85.4% with knowledge that hypertension can lead to complications are 3% more likely to sometimes forget of taking their medications [2.034(1.56, 2.63)0.003].

Again, there was a significant statistical association between patient knowledge on BP of 130/90 being high (χ2 = 41.821, p= 0.001), periodic checkups (χ2 = 54.654, p= 0.000) and hypertension can lead to complications (χ2 = 61.660, p= 0.007) with the rate at which they default their BP medication when their BP is not control on it. Thus, majority, 71.4%, of those who knew that a BP of 130/90 is high are 70% more likely to default their medications when they felt worse on it [COR= 0.707(0.707-0.70)0.001]. Also, the majority, 83.5% of the respondents who knew the essence of periodic checkups, are 16% more likely to default their medications when they are not getting better on it [0.165(0.118, 0.230)0.000] and the majority of the respondents, 71.4%, who knew that hypertension could lead to complications are also 70% times more likely to default their antihypertensives when their BP readings are not improving on the medications.

Furthermore, there is a significant association between BP of 130/90 being high (χ2 = 147.394, p= 0.001), periodic checkups (χ2 = 111.542, p= 0.022), hypertension can lead to complications (χ2 = 114.569, p= 0.009) and the rate at which hypertensive patients always stick to their treatment plan. In another words, the assertion showed that the majority of the respondents, 147(100%), who have the knowledge of a target BP of 130/90mmHg being high, are 21% likely to always stick to their medications [0.218(0.16-0.286)0.003]. Nevertheless, 52(26.1%) of the patients who did not know the essence of periodic checkups were 26% likely to stick to their treatment plan constantly [0.261(0.207-0.330)0.027] and 28. % of the BP patient who did not know that Hypertension might cause complications are 70% less likely [0.707(1.707-0.70)0.001] to stick to the treatment plan of their antihypertensive.

More so, there is a statistically significant association between hypertensive patient knowledge of BP value of 130/90mmHg being high (χ2 = 107.611, p= 0.000), periodic checkups (χ2 = 135.190, p= 0.042), hypertension can lead to complications,(χ2 = 110.329, p= 0.001) and the rate at which patients have stop taken medication on uncontrolled BP. In actual fact, 88(59.9%) of those who knew that 130/90mmHg is a high BP are 40% more likely [0.401(0.329-0.489)0.000]to stop taking their antihypertensives medication when their BP readings are not less than the target of 130/90mmHg. Again close to half of the respondents, 88(44.2%), who knew the importance of period checkups are 55% more likely [0.558(.493-0.631)0.003] to stop taking their antihypertensives when the BP is under control, and 88(44.2%) of those knowing that hypertension has complications are also 51% more likely to default antihypertensive when their target BP is under control.

Table 3 how patient’s knowledge on hypertension relates to the practice

Knowledge on HPT Versus Adherence	BP of 130/90 is high				Periodic check-ups.					Hypertension can lead to complications.
	Yes		No	COR (95% CI) p-value	Yes	No			COR (95% CI) p-value	Yes	No	COR (95% CI) p-value
	N(%)		N(%)		N(%)	N(%)				N(%)	N(%)
Do you sometimes forget to take your medicines?	χ2 = 110.867, p= 0.001				χ2 = 61.361, p= 0.000					χ2 = 61.361, p= 0.029
Yes	176(85.4%)		30(14.6%)	2.034(1.56-2.63)0.003	176(88.4%)	23(11.6%)			0.116(0.079 -.170)0.022	176(85.4%)	30.0(14.6%)	2.034(1.56-2.63)0.003
No	29(49.2%)		30(50.8%)	Ref.	0(0.0%)	7(100.0%			Ref.	29(49.2%)	30(50.8%)	Ref.
Have you ever default medication because you felt worse when you took it?	χ2 = 41.821, p= 0.001				χ2 = 54.654, p= 0.000					χ2 = 61.660, p= 0.007
Yes	147(71.4%)		59(28.6%)	0.707(0.707-0.70)0.001	147(83.5%)			29(16.5%)	0.165(0.118 -0.230)	147(71.4%)	59(28.%)	0.707(0.707-0.70)0.001
No	0(0.0%)		59(100.0%)	Ref.	0(0.0%)			30(100.0%)	Ref.	0(0.0%)	59(100.0%)	Ref.
Do you always stick to your treatment plan?	χ2 = 147.394, p= 0.001				χ2 = 111.542, p= 0.022					χ2 = 114.569, p= 0.009
Yes	147(100.%)	0(0.0%)		0.218(0.16-0.286)0.003	147(73.9%)		52(26.1%)		0.261(0.207 -0.330)0.027	147(71.4%)	59(28. %)	0.707(1.707-0.70)0.001
No	0(0.0%)	59(100.0%)		Ref.	0(0.0%)		7(100.0%)		Ref.	/*0(0.0%)	59(100.0%)	Ref.
Have you stop taking medication on uncontrolled BP?	χ2 = 107.611, p= 0.000				χ2 = 135.190, p= 0.042					χ2 = 110.329, p= 0.001
Yes	88(59.9%)		59(40.1%)	0.401(0.329-0.489)0.000	88(44.2%)			111(55.8%)	0.558(.493-0.631)0.003	88(42.7%)	118(57.3%)	0.517(.493-0.631)0.003
No	0(0.0%)		59(100.0%)	Ref.	0(0.0%)			7(100.0%)	Ref.	0(0.0%)	7(100.0%)	Ref.

Source: Field Data (2024)

4.4 How patient’s knowledge on antihypertensive medication relates to the practice

Table 4 shows that there is a significant association between knowledge of hypertensive medications on if individuals with increased blood pressure change their lifestyle, there is no need for treatment (χ2 = 98.821, p= 0.000), drugs for increased blood pressure must be taken every day (χ2 = 14.321, p= 0.041), blood pressure medication is taken to control high blood pressures (χ2 = 11.851, p= 0.001) and the rate they have been taking their antihypertensive drugs. That is, 58 (65.9%) of the respondents were 1.5 times [1.517(1.306-1.763)0.011] more likely to forget to take their antihypertensives when they were aware that if people with high blood pressure changed their lifestyle, treatment was not necessary. Furthermore, the study indicated that 176(89.8%) of the BP patients who were knowledgeable about the need to take BP medications daily were 48% likely sometimes to forget their medications [0.480(0.341-0.571)0.033], and respondents 176(89.8%) who did not had the knowledge that blood pressure medication is taken to control high blood pressures were 3% likely sometimes to forget taking their medications [0.034(1.56-2.63)0.003]

Again the result in the table showed that there is a significant association between the variables; knowledge of individuals who change their lifestyle must stop taking BP treatment (Χ2 = 41.821, p= 0.001), drugs for increased blood pressure must be taken every day (χ2 = 41.821, p= 0.001), pressure medication are taken to control high blood pressures (χ2 = 151.311, p= 0.000) and the rate at which patient default their anti-hypertension medications when they are not getting better on them. That is the results showed that the majority, 176(85.4%), who knew that if individuals with increased blood pressure change their lifestyle, there is no need for treatment are 50% likely to default to medication when they felt worse on antihypertensives. Likewise, 147(71.4%) respondents who knew that drugs for increased blood pressure must be taken daily are 16.5% likely to default to medication whenever they feel worse on the drugs. Furthermore, the majority of 118(57.3%) who are knowledgeable on the assertion that blood pressure medications are taken to control high blood pressures are 70% likely to stop taking their medications when their BP gets worse.

Furthermore, there is statistical significance in the knowledge that If individuals with increased blood pressure change their lifestyle, there is no need for treatment (χ2 = 78.991, p= 0.009), drugs for increased blood pressure must be taken every day (χ2 = 11.321, p= 0.005) and blood pressure medication are taken to control high blood pressures (χ2 = 34.721, p= 0.001) with patients being always staking to treatment plan. Thus; the majority, 147(75.0%) of respondents who had the knowledge that if individuals with increased blood pressure change their lifestyle, there is no need for treatment are 25% less likely to stick to their treatment plan [0.250(0.196-0.319).0.003] Likewise, with the knowledge that drugs for increased blood pressure must be retaken every day, 147(71.4%) of those who do not had the knowledge that blood pressure medication is taken to control high blood pressures are 70% less likely to 0.707(1.707-0.70)0.001 to always stick to their treatment plan.

The results showed that there is a significant association between the litem whether to stop antihypertensive medications on uncontrolled BP among patients who knew that if individuals with increased blood pressure change their lifestyle, there is no need for treatment drugs for improving blood pressure must be taken every day (χ2 = 12.221, p= 0.000) and blood pressure medication are taken to control high blood pressures (χ2 = 821.521, p= 0.001). That is, the majority, 88(74.6%) who knew that If individuals with increased blood pressure change their lifestyle, there is no need for treatment are 25% likely to stop taking medication on uncontrolled BP [0.254(.187-.346)0.001]. The majority, 88(74.6%), knew that If individuals with increased blood pressure change their lifestyle, there is no need for treatment; are 3 times more likely to stop taking medication for uncontrolled BP. The results also showed that the majority, 108(55.1%) of the hypertensive patients with knowledge of blood pressure medication taken to control high blood pressures and are 55% more likely to stop taking hypertensive medication on uncontrolled BP [0.551(0.486-0.625)0.009].

Table 4 how patient’s knowledge on antihypertensive medication relates to the practice

Knowledge on HPT medications Versus Adherence	If individuals with increased blood pressure change their lifestyle, there is no need for treatment.			Drugs for increased blood pressure must be taken every day.			Blood pressure medication are taken to control high blood pressures
	Yes	No	COR (95% CI) p-value	Yes	No	COR (95% CI) p-value	Yes	No	COR (95% CI) p-value
	N(%)	N(%)		N(%)	N(%)		N(%)	N(%)
Do you sometimes forget to take your medicines?	χ2 = 98.821, p= 0.000			χ2 = 14.321, p= 0.041			χ2 = 11.851, p= 0.001
Yes	58(65.9%)	30(34.1%)	1.517(1.306-1.763)0.011	20(10.2%)	176(89.8%)	0.480(0.341-0.571)0.033	147(100%)	0(0.0%)	2.034(1.56-2.63)0.003
No	0(0.0%)	118(100.0%)	Ref.	0(0.0%)	10(100.0%)	Ref.	29(49.2%)	30(50.8%)	Ref.
Have you ever default medication because you felt worse when you took it?	Χ2 = 41.821, p= 0.001			χ2 = 41.821, p= 0.001			χ2 = 151.311, p= 0.000
Yes	176(85.4%)	30(14.6%)	0.501(0.307-0.10)0.001	147(71.4%)	59(28.6%)	0.165(0.118 -0.230)	118(57.3%)	88(42.7%)	0.707(0.707-0.70)0.001
No	0(0.0%)	16(100.0%)	Ref.	0(0.0%)	30(100.0%)	Ref.	0(0.0%)	22(100.0%)	Ref.
Do you always stick to your treatment plan?	χ2 = 78.991, p= 0.009			χ2 = 11.321, p= 0.005			χ2 = 34.721, p= 0.001
Yes	0(0.0%)	10(100.0%)	Ref.	0(0.0%)	10(100.0%)	Ref.	0(0.0%)	59(100.0%)	Ref.
No	147(75.0%)	49(25.0%)	0.250(0.196-0.319).0.003	147(75.0%)	49(25.0%)	0.250(0.196-0.319)0.003	59(28. %)	147(71.4%)	0.707(1.707-0.70)0.001
Have you stop taking medication on uncontrolled BP?	χ2 = 31.151, p= 0.000			χ2 = 12.221, p= 0.000			χ2 = 821.521, p= 0.001
Yes	88(74.6%)	30(25.4%)	0.254(.187 -.346)0.001	59(67.0%)	29(33.0%)	3.034(2.252-4.088)0.047	108(55.1%)	88(44.9%)	0.551(0.486-0.625)0.009
No	0(0.0%)	88(100.0%)	Ref.	0(0.0%)	118(100.0%)	Ref.	0(0.0%)	10(100.0%)	Ref.

Source: Field Data (2024)

4.5 Factors Affecting Medication Adherence

Table 5 below reveals that a majority of the respondents; 59 (28.6%) had been diagnosed of hypertension 15-20years ago, 45 (21.8%) were diagnosed 9-14years and 3-8years ago respectively, 42 (20.4%) had been diagnosed less than 3years while a minority; 15 (7.3%) had been diagnosed for more than 20years with a p value of 0.000.

Again, 95 (46.1%) representing the greatest proportion of the respondents were diagnosed of hypertension during routine medical assessment, 48 (23.3%) were diagnosed when they were rushed in for an emergency, 30 (14.6%) were diagnosed through a medical screening exercise, 22 (10.7%) were diagnosed during a pre-employment medical assessment while 11(5.3%) were diagnosed while reporting to the OPD for something else with a p value of 0.004. However, none of them was diagnosed via other means.

Moreover, displaying a significant p value of 0.032, a majority; 176 (85.4%) were not told whereas a minority; 30 (14.6%) were told they had developed complications already.

Additionally, almost all of the respondents; 190 (92.2%) had ever been admitted on account of very high blood pressure since diagnosis, whereas 16 (7.8%) had never been admitted since diagnosis with a significant p value of 0.021.

Out of the 190 respondents who had ever been admitted for very high blood pressure as represented in Table 4.6B, a majority of them; 169 (88.9%) answered yes while the minority; 21 (11.1%) answered no to been consistent with therapy at the time of admission with a p value of 0.000.

Considering the type of oral antihypertensive the respondents were taking at the time, 73 (35.4%) being the greatest proportion of the respondents were on calcium channel blockers, 59 (28.6%) were taking angiotensin II receptor blockers, 30 (14.6%) were taking diuretics, 29 (14.1%) were on angiotensin II converting enzyme inhibitors, and 15 (7.3%) were taking beta- adrenoceptor blockers while none was taking centrally acting drugs nor other types of oral antihypertensives displaying a p value of 0.006.

Besides, more than half of the respondents; 118 (57.3%) take one antihypertensive tablet daily while 88 (42.7%) take a total of two antihypertensive tablets daily displaying a p value of 0.043.

Similarly, exhibiting a p value of 0.043, a majority of the respondents; 118 (57.3%) take their medicines once in a day while the minority; 88 (42.7%) take their medicines twice in a day.

Furthermore, 147 (71.4%) being the greater percentage of the respondents answered yes whereas 59 (28.6%) being the lower percentage answered no with a p value of 0.010 to their medications ever been changed since the start of therapy.

Out of the 147 respondents who responded yes to their medications ever been changed, 59 (40.1%) being the highest proportion selected aid in adherence, 58 (39.5%) selected poor control and 30 (20.4%) being the lowest proportion selected side effects as the reasons for the change of their medications displaying a p value of 0.004.

However, a majority; 147 (71.4%) replied no while the minority; 59 (28.6%) replied yes to having ever experienced any side effect to any of their medications with a p value of 0.001.

Of the 59 respondents who had had a side effect from their medications, 29 (49.2%) being the highest percentage stopped/reduced the regular intake of the drug by themselves, 26 (44.1%) reported to the clinician at the OPD and it was withdrawn, 4 (6.8%) rushed to the hospital, were admitted and the medication withdrawn with a p value of 0.003. None of them was ignored upon reporting to the clinician at the OPD nor had the medication maintained on reporting at the OPD.

Also, a majority of the respondents; 147 (71.4%) answered yes to being managed for other chronic condition apart from hypertension while the minority; 59 (28.6%) answered no exhibiting a p value of 0.034 as represented in Table 4.6C.

Regarding the 147 who confirmed management for other chronic condition, and displaying a p value of 0.090, 59 (40.1%) being the highest proportion of the respondents were being managed for diabetes and high cholesterol respectively, 9 (6.1%) were being managed for arthritis, 6 (4.1%) were on management for heart attack and heart failure respectively, 5 (3.4%) were being managed for stroke while 3 (2.0%) were being managed for asthma. However, none of them was being managed for cancer.

Out of the 147 being managed for other chronic condition, 118 (80.3%) being the majority take one pill for the second chronic condition whereas 29 (19.7) being the minority take two pills in a day for the second condition with a p value 0.004.

Last but not least, 176 (85.4%) representing the greater proportion of the respondents replied yes while 30 (14.6%) representing the lower proportion of the respondents replied no to taking unprescribed medications/supplements/mixtures showing a p value of 0.000.

Lastly, more than half of the 176 who take unprescribed medications take orthodox, 30 (17.0%) take herbal whereas 29 (16.5%) take both orthodox and herbal unprescribed medications with a p value of 0.001.

Table 5 again indicated that a majority; 176 (85.4%) replied yes while a minority; 30 (14.6%) replied no to the facility being their regular health facility showing a p value of 0.000.

Almost half of the 176 who responded positively; 83 (47.2%) had been regular attendants of the facility for more than 10years, 51 (2.0%) had been regular for 3-6years, 27 (15.3%) had been regular for 7-10years whereas 15 (8.5%) had been regular attendants of the facility for less than 3years showing a p value of 0.030.

Also, more than half the total number of the respondents; 118 (57.3%) were not referred whereas 88 (42.7%) were referred to the facility exhibiting a p value of 0.043.

A majority of those who were referred to the facility; 30 (34.1%) selected poor control of hypertension, 29 (33.0%) chose personal request, 25 (28.4%) chose acute complications while a minority; 4 (4.5%) selected specialist care on account of complications as the reasons for their referral to the facility with a p value of 0.000.

Besides, showing a p value of 0.026, more than half of the total respondents; 147 (71.4%) lived more than 100 miles while 59 (28.6%) lived less than 100 miles away from the hospital.

Again, 111 (53.9%) being the highest proportion came to the facility by public transport, 60 (29.1%) by their own vehicles while 35 (17.0%) being the lowest proportion walked to the facility exhibiting a p value of 0.003.

In addition, 191 (92.7%) being the majority and 15 (7.3%) being the minority replied no and yes respectively to having difficulty reaching the facility with a p value of 0.000.

Finally, of the 15 who affirmed difficulty in reaching the facility, 10 (66.7%) selected distance with p value of 0.302, all the 15 (100.0%) selected transportation at certain times, 7 (46.7%) chose transportation fares with a p value of 1.000, and 4 (26.7%) selected availability of caregivers displaying a p value of 0.118 as the reasons they had difficulty reaching the facility.

More so, below, a majority of the respondents; 147 (71.4%) and a minority; 59 (28.6%) respectively replied no and yes to finding waiting time at the clinic acceptable whereas none did not know with a p value of 0.000.

To the question about doctors and other health professionals showing interest during consultations, more than half of the respondents; 117 (56.8%) replied yes, 59 (28.6%) replied no while a minority; 30 (14.6%) did not know exhibiting a p value of 0.021.

Again, all 206 (100%) respondents answered affirmatively to being given the chance to state their problems and ask questions about their disease.

Also, to the claim about being satisfied with the health information and advice provided by their doctors and other health professionals, 147 (71.4%) representing the highest percentage answered in the positive, 59 (28.6%) did not know whereas none replied in the negative with a p value of 0.004.

Additionally, 88 (42.7%) being the majority answered yes, 119 (46.7%) being the minority did not know and answered no to spending time with their doctor and other health professionals during consultations showing a p value of 0.017.

Finally, all the respondents; 206 (100.0%) replied affirmatively that they have confidence in their doctors and other health professionals.

In view of the challenges to adherence as represented in Table 5 below , a majority; 107 (51.9%) selected cost of therapy, 30 (14.6%) selected forgetfulness and side effects experienced respectively, 19 (9.2%) chose physical support to get to facility, 9 (4.4%) chose side effects feared, 8 (3.9%) chose complexity of drug therapy, 3 (1.5%) chose belief in alternative treatment modalities while none (0.0%) selected other nor poor knowledge about hypertension as the single most important challenge to adherence to their medications with a p value of 0.000.

Besides, with a p value of 0.028, 88 (42.7%) representing the majority of the respondents selected improvement of the NHIS as the assistance needed in helping with adherence, 59 (28.6%) selected financial aid, 29 (14.1%) selected fewer medication side effects, 25 (12.2%) chose fewer drugs and times of administration while 5 (2.4%) chose some form of reminder. However, none of them selected more education about hypertension and therapy nor improvement in health care provider attitudes.

Also, 176 (85.45%); a majority of the respondents did not have a care taker while 30 (14.6%); a minor percentage had a care giver exhibiting a p value of 0.006.

Further, a majority of the 30 respondents who had caregivers; 23 (76.7%) answered no to their caregivers forgetting to give them their medications while a minority; 7 (23.3%) answered yes.

Lastly, all the 30 (100.0%) respondents answered in the positive that their caregivers are sometimes stressed with taking care of them.

TABLE 5: Factors Contributing to Non-Adherence

Item	Frequency(N=206)	Percent	Std.	p Value
How long ago were you diagnosed as hypertensive?			1.258	0.000
More than 20yrs	15	7.3
15-20yrs	59	28.6
9-14yrs	45	21.8
3-8yrs	45	21.8
Less than 3yrs	42	20.4
How was it diagnosed?			1.292	0.004
Through a medical screening exercise	30	14.6
During pre-employment medical assessment	22	10.7
During routine medical assessment	95	46.1
Whilst reporting at the OPD	11	5.3
When I was rushed in for an emergency	48	23.3
Others	0	0.0
Were you told you had developed complications already?			0.354	0.032
Yes	30	14.6
No	176	85.4
Have you ever been admitted on account of very high blood pressures since diagnosis?			0.268	0.021
Yes	190	92.2
No	16	7.8
Were you consistent with therapy by then?			0.314	0.000
Yes	169	88.9
No	21	11.1
Which oral anti-hypertensive drug are you currently taking?			1.493	0.006
Diuretics	30	14.6
Calcium-channel blocker	73	35.4
Beta-Adrenoceptor blocker	15	7.3
Angiotensin-converting enzyme inhibitors	29	14.1
Angiotensin-II-receptor blockers	59	28.6
What is the total number of anti-hypertensive tablets you take daily?			0.496	0.043
One	118	57.3
Two	88	42.7
How many times in a day do you take your medicine?			0.496	0.043
Once	118	57.3
Twice	88	42.7
Have your medications been changed since you were started on therapy?			0.453	0.010
Yes	147	71.4
No	59	28.6
If yes, what was the reason? (n=147)			0.755	0.004
Side-effects	30	20.4
Poor control	58	39.5
To help adherence	59	40.1
Others	0	0.0
Have you ever experienced any side effect to any of your medications?			0.453	0.001
Yes	59	28.6
No	147	71.4
If Yes, what did you do? (n=59)			1.599	0.003
I rushed to the hospital and was admitted	4	6.8
Reported to the clinician at the OPD	26	44.1
I stopped/ reduced the regular intake of the drug	29	49.2
Apart from hypertension, are you being managed for any other chronic condition?			0.453	0.034
Yes	148	71.4
No	59	28.6
If yes, what condition? (n=148)			1.656	0.090
Diabetes	59	40.1
High cholesterol	6	4.2
Heart attack	6	4.2
Heart Failure	5	3.4
Stroke	3	2.0
Asthma	9	6.1
If yes to what are the total number of pills you take for that/ those condition(s) in a day? (n=148)			0.399	0.004
One	118	80.3
Two	29	19.7
Do you take unprescribed medications/Supplements/ Mixtures?			0.354	0.000
Yes	176	85.4
No	30	14.6
If yes, are they			0.763	0.001
Orthodox	117	66.5
Herbal	30	17.0
Both	29	16.5
Is this your regular health facility?			0.354	0.000
Yes	176	85.4
No	30	14.6
If yes, for how long? (n=176)			1.053	0.030
More than 10yrs	83	47.2
7-10yrs	51	2.0
3-6yrs	27	15
Less than 3yrs	15	8.5
Were you referred to this facility?			0.496	0.043
Yes	88	42.7
No	118	57.3
If yes, what was the reason for the referral?			1.261	0.000
Poor control of hypertension	30	34.1
Acute Complications of hypertension	25	28.4
For specialist care on account of complications	4	4.5
Personal request	29	33.0
How far is your house from the hospital?			0.453	0.026
<100m	59	28.6
>100m	147	71.4
What means of transportation do you come by?			0.670	0.003
Own vehicle	60	29.1
Public Transport	111	53.9
Walk	35	17.0

Health System factors	Yes N (%)	No N (%)
Any difficulty reaching facility?	15 (7.3)	191 (92.7)	0.260	0.000
If yes, what are some of the reasons (tick as many)
Distance	10 (66.7)	5 (33.3)	0.488	0.302
Transportation at certain times	15 (100.0)	0(0.0)	0.000
Transportation fares	7 (46.7)	8 (53.3)	0.516	1.000
Availability of caregivers (Aged/ other forms of dependence, like physical disabilities)	4 (26.7)	11 (73.3)	0.458	0.118
Other	0	0.0	0.000
Do you find waiting time at the clinic acceptable?	59 (28.6)	147 (71.4)	0.453	0.000
Do your doctors and other health professionals show interest during consultations?	147 (71.4)	59 (28.6)	0.733	0.021
Are you given the chance to state your problems and ask questions about your disease?	206 (100.0)	0 (0.0)	0.000
Are you satisfied with the health information and advice provided by your doctor and other health professionals?	88 (34.3)	118 (46.7)	0.906	0.004
Do you spend enough time with your doctor and other health professionals during consultation?	147 (71.3)	59 (28.6)	0.835	0.017
Do you have confidence in your doctor and other health professionals?	206 (100.0)	0 (0.0)	0.000

Patient Factors of Adherence
What is the most important challenge to adherence to your medications?			1.701	0.000
Forgetfulness	30	14.6
Side effects experienced	30	14.6
Side-effects feared	9	4.4
Cost of therapy	107	51.9
Complexity of drug therapy	8	3.9
Poor knowledge about hypertension	0	0.0
Physical support to get to facility	19	9.2
Belief in alternative treatment modalities	3	1.5
Other	0	0.0
What assistance do you think you need in helping with adherence?			1.558	0.028
Financial aid	59	28.6
Improvement of the NHIS	88	42.7
Fewer side effects	29	14.1
Some form of reminder	5	2.4
Fewer drugs and times of administration	25	12.2
Do you have a care giver?			0.354	0.006
Yes	30	14.6
No	176	85.4
If yes, does the care giver sometimes forget to give you your medication?			0.430	0.001
Yes	7	23.3
No	23	76.7
Is the care giver sometimes stressed with taking care of you?			0.000	0.001
Yes	30	100.0
No	0	0.0

Source: Field Data (2024)

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