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Systematic Review
- Theory-Based Interventions to Improve Medication Adherence Among Patients With Hypertension in Primary Healthcare and the Community: A Systematic Review
- Tri Yulianti, Anna Wahyuni Widayanti, Susi Ari Kristina, Nanang Munif Yasin
- J Prev Med Public Health. 2025;58(4):348-359. Published online February 17, 2025
- DOI: https://doi.org/10.3961/jpmph.24.651
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Abstract
Summary
PDF - Objectives
Numerous interventions have been implemented to enhance adherence to antihypertensive medications, yet only a few have utilized health behavioral theories. The research quality and efficacy of these theory-based studies remain undetermined. This systematic review aimed to provide a thorough description of research that employed health behavior theories to improve medication adherence in patients diagnosed with hypertension, particularly in primary healthcare and community settings.
Methods
PubMed and Scopus were searched for randomized clinical trials that employed health behavioral theories to improve medication adherence in patients with hypertension, published in English between 2013 and 2023. Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Joanna Briggs Institute critical appraisal tool was used to evaluate the risk of bias.
Results
Of the 446 studies initially identified, only 10 met the inclusion criteria and were included in this systematic review. Eight studies employed a single theory, and 2 applied a combination of theories, with Social Cognitive Theory and the Transtheoretical Model being the most predominant. Six trials demonstrated a notable enhancement in medication adherence, while 5 studies were assessed to have a high risk of bias.
Conclusions
Although not all studies employed a complete theoretical framework, the majority indicate that utilizing theory can enhance medication adherence. -
SummaryKey Message
Developing complex interventions to improve medication adherence in hypertensive patients requires a theoretical framework to increase efficacy. Theoretical frameworks utilized included the predisposing, reinforcing, and enabling constructs in educational diagnosis and evaluation (PRECEDE) model, social cognitive theory (SCT), the transtheoretical model (TTM), motivational interviewing (MI), and information-motivation-behavioral (IMB) skills models as single or combination theories. Research studies applying theoretical frameworks frequently neglect to elucidate the rationale for selecting a specific theory and its underlying mechanisms. Still, most studies that applied theories have successfully enhanced medication adherence. Additional research with a rigorous design and theory is needed to improve medication adherence.Citations
Citations to this article as recorded by
- A Systematic Literature Review: Effectiveness of Social Cognitive Therapy on Hypertension Treatment Adherence
Endang Triyanto, Dian Ramawati
The Journal for Nurse Practitioners.2026; 22(2): 105676. CrossRef
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