Determinants of adherence to antihypertensive medication among outpatients in a mountainous province of Vietnam: A cross-sectional study

Objective Many related scales have been developed and applied to measure patients’ medication adherence, but the research on the psychometric characteristics of the scale still requires further studies. This study aims to provide further validation of the GMAS scale by using Rasch analysis and to make targeted recommendations for scale improvement. Methods This is a cross-sectional study using secondary data. 312 Chinese adult patients were recruited from two tertiary hospitals and one community health service center in Tianjin to complete a questionnaire containing the GMAS, from January to June 2020. Participants included to have at least one chronic condition and also have been on medication for more than 3 months, but excluded patients with major life-threatening illnesses (e.g. heart failure, cancer), cognitive impairments preventing clear expression and significant communication difficulties. Rasch analysis was used to explore the psychometric properties of the GMAS scale. Key indicators including unidimensionality, validity and reliability, differential item functioning and degree of fit with Rasch model are validated. Results After fitting the Rasch model for the first time, 56 samples poorly fitting the model were deleted. The remaining 256 samples were used for Rasch analysis. The results show that GMAS can fit the Rasch model well, which proves that the scale has favourable psychometric characteristics. But some items had differential item functioning in whether patients have comorbidities. Conclusion The GMAS was found to be useful as a screening tool for patients’ medication adherence problems reported, except some issues to be addressed for further improvement of the scale.

Background: The Global Burden of Disease Study found that in 2017, asthma caused about 495 thousand deaths, affecting about 300 million people worldwide. Adherence increases the effectiveness of treatment. Studies on asthma in the world and in Vietnam show that the adherence rate fluctuates in various regions, ranging from 30 to 70%. Objectives: To determine the rate of treatment adherence and some associated factors in outpatients with asthma at Ba Ria Hospital in 2021-2022. Materials and methods: A cross-sectional study on 247 asthma patients from October 2021 to January 2022. Assessment of treatment adherence using Atta Abbas Naqvi's General Medication Adherence Scale (GMAS) scale. Results: The study showed that 77.7% of asthmatics had adherence with GMAS 30-33 points (GMAS=33 accounted for 48.6%, GMAS=30-32 points accounted for 29.1%). Multivariable logistic regression analysis showed that age, smoking, Covid- 19 epidemic statistically significantly affect treatment adherence of asthma patients. Conclusion: The study showed that treatment adherence in asthma outpatients at the hospital reached a high level compared with domestic and international studies.

ObjectiveThe aim was to validate the Urdu version of General Medication Adherence Scale (GMAS) in patients with rheumatoid arthritis disease.MethodsA 2-month (March–April 2019) cross-sectional study was conducted in randomly selected out-patients with rheumatoid arthritis. The sample size was calculated using item-subject ratio of 1:20. The scale was evaluated for factorial, concrete, concurrent, and known group validities. Concrete validity was established by correlating scores of EQ-5D quality of life scale and GMAS adherence score. Concurrent validity was established by correlating the GMAS adherence score with pill count. Analyses for sensitivity were also conducted. Cut-off value was determined through receiver operator curve (ROC), and test–retest method was used to analyze internal consistency and reliability. Data were analyzed through IBM SPSS, IBM AMOS, and MedCalc software. The Urdu version of EQ-5D quality of life questionnaire was used with permission from developers (#ID20884). The study was approved by an ethics committee (#NOV:15).ResultsA total of 351 responses were analyzed. The response rate was 98%. Reliability was in acceptable range, i.e., Cronbach α = 0.797. Factorial validity was established by calculation of satisfactory fit indices. Correlation coefficients for concrete and concurrent validities were ρ = 0.687, p < 0.01 and ρ = 0.779, p < 0.01, respectively. Known group validity was established as significant association of adherence score with insurance and illness duration (p < 0.05) that were reported. Sensitivity of the scale was 94%. Most patients had high adherence (N = 159, 45.3%).ConclusionThe Urdu version of GMAS demonstrated adequate internal consistency and was validated. These results indicate that it is an appropriate tool to measure medication adherence in Pakistani patients with rheumatoid arthritis.

Concurrent validity of the Arabic version of General Medication Adherence Scale using two validated indirect adherences measures in Saudi patients with non-communicable diseases

Introduction: Medication non-adherence is a significant problem, especially among geriatric patients. The General Medication Adherence Scale (GMAS) is a validated tool to assess patients’ behaviour, pill burden, comorbidity, and cost. Although this tool has been tested among patients with chronic illness, less is known about the usage of GMAS in assessing adherence among geriatric patients. Aim: This study aimed to assess the level of Medication adherence and determine the factors influencing medication adherence among geriatric patients in a primary health clinic in Malaysia. Methods: This cross-sectional study involved 250 geriatric patients on follow-up in a public primary health clinic. Adherence was measured using the GMAS, a validated 11-item structured questionnaire. Both descriptive and inferential statistics were performed. Results: Half of the respondents had a high adherence while one-quarter (26.8%) showed good adherence. Female patients were more likely to adhere to their medication regime. Most of the patients had at least three illnesses and needed an average of five medicines (25.2%). Good internal consistency of the GMAS (α =0.741) was reported. Conclusion: The medication adherence rate was good among primary care geriatric patients compared to other populations in Malaysia. To promote better adherence, patients must have a good understanding of their disease and strong beliefs about the medications prescribed.

Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48-3.87], treatment adherence [0.46; 0.21-0.97], salt consumption [28.35; 7.87-102.04], physical activity [0.22; 0.13-0.37], current alcohol use [2.10; 1.22-3.61], and current cigarette smoking [4.79; 1.88-12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure.

Background: Epilepsy is one of the most common neurological diseases, characterized by recurrent epileptic seizures. Adherence to antiepileptic drugs (AEDs) is vital in establishing seizure control. The adherence, in turn, impacts the quality of life (QoL) in epileptic patients. Methodology: This was a hospital-based cross-sectional study conducted at King Fahd Hospital of the University, Qatif Central Hospital, and Dammam Central Hospital in the Eastern region of Saudi Arabia during the period from January 2018 to April 2018. Epileptic patients from all age groups treated with at least single AED and who had follow-up in hospital for the past 6 months were included in the study. Patients with intellectual disabilities and those who received AEDs for other indications were excluded. The participants were interviewed in Arabic, and validated translated version of questionnaire was completed under the following sections: sociodemographic characteristics, adherence assessment using the General Medication Adherence Scale (GMAS), and QoL in epilepsy patients using EQ-5D-5L. Results: We report 48% of participants with high adherence, 34% with moderate adherence, while 19% exhibited low adherence toward AEDs. Of 80 participants, 25 (31%) reported perfect health status (11,111) and 2 (3%) reported extremely worst health status (55,555). Further, the study revealed a significant (P = 0.045 and 0.035) improvement of QOL in patients with moderate and high adherence compared to patients with low adherence. Conclusion: This study reports high health-related quality index (QoL) in participants with moderate–high adherence. The relationship between adherence and overall HRQoL was directly proportional.

ObjectiveThe study aimed to evaluate the association between disease knowledge and medication adherence in patients with type 2 diabetes mellitus.MethodsA cross-sectional study was conducted for three months, in patients with type 2 diabetes who visited three community pharmacies located in Khobar, Saudi Arabia. Patients’ disease knowledge and their adherence to medications were documented using Arabic versions of the Michigan Diabetes Knowledge Test and the General Medication Adherence Scale respectively. Data were analyzed through SPSS version 23. Chi-square test was used to report association of demographics with adherence. Spearman’s rank correlation was employed to report the relationship among HbA1c values, disease knowledge and adherence. Logistic regression model was utilized to report the determinants of medication adherence and their corresponding adjusted odds ratio. Study was approved by concerned ethical committee (IRB-UGS-2019-05-001).ResultsA total of 318 patients consented to participate in the study. Mean HbA1c value was 8.1%. A third of patients (N = 105, 33%) had high adherence and half of patients (N = 162, 50.9%) had disease knowledge between 51% - 75%. A significantly weak-to-moderate and positive correlation (ρ = 0.221, p < 0.01) between medication adherence and disease knowledge was reported. Patients with >50% correct answers in the diabetes knowledge test questionnaire were more likely to be adherent to their medications (AOR 4.46, p < 0.01).ConclusionDisease knowledge in most patients was average and half of patients had high-to-good adherence. Patients with better knowledge were 4 to 5 times more likely to have high adherence. This highlights the importance of patient education and awareness regarding medication adherence in managing diabetes.

Depression stands out as the predominant risk factor among Type 2 diabetes (T2DM) patients. Depression and its association with drug adherence in T2DM patients are lacking in Bahrain. The current study aimed to examine the association depression in relation to drug adherence in T2DM in primary care centers in the Kingdom of Bahrain. This was a cross-sectional study that enrolled 455 people with T2DM. Data on demographics, risk behavior, and diabetes details were noted. Measuring tools such as patient health questionnaire (PHQ-9) to measure depression severity, and General Medication Adherence Scale (GMAS) were used to assess medical adherence respectively. Categorical variables and continuous variables were presented in a frequency table and mean &amp;plusmn; SD/ Median (Min, Max) respectively. The data was analyzed using SPSS 24.0 software. The statistical significance threshold was set at p=0.05. The study involved participants with an average age of 54.5 &amp;plusmn; 11.5 (M&amp;plusmn;SD) years. The frequency of depression based on PHQ-9 and medical adherence as per GMAS among T2DM patients was 30.5% and 79.1% respectively. There was a significant association between the prevalence of depression and adherence (x2 =25.03; P=0.001). Age (r=-0.121; P= 0.010), education (r=-0.096; P=0.040), family income (r=-0.101; P=0.031), physical activity (r=-0.193; P=0.001), and self-rated diabetes control within the last visit (r=-0.200; P=0.001) were significantly negatively correlated with PHQ &amp;ndash; 9 scale. Likewise, age (r=-0.231; p=0.001), education (r=-0.123; p=0.008), nationality (r=-0.185; p=0.001), physical activity (r=-0.108; p=0.021), and self-rated diabetes control within the last visit (r=-0.139; p=0.003) were significantly negatively correlated with the GMAS scale. Our findings suggest that medical adherence is linked to depression. Age, height, education, family income, physical activity, and self-rated diabetes control in the previous visit are all important factors that are correlated to depression and drug adherence.

Adherence rates to adjuvant therapy for breast cancer are often suboptimal, which raises the risk of recurrence, lowers survival rates, and increases healthcare expenses. The present study aimed to assess the validity and reliability of the General Medication Adherence Scale (GMAS) in identifying adherence to adjuvant cancer therapy (ACT) in breast cancer patients. A prospective, cross-sectional study was conducted on breast cancer patients using the Urdu version of the GMAS. Reliability was assessed using Cronbach's alpha (α) and inter-item correlations. The instrument was subjected to principal component factor analysis (PCFA) with varimax rotation. Exploratory factor analysis (EFA) and PCFA were performed using IBM SPSS version 23, while confirmatory factor analysis (CFA) was carried out using IBM AMOS version 25. Cronbach's alpha of the GMAS was found to be 0.882, confirming that the scale has good reliability. The mean score was significantly different among items ensuring the significance of each item in the GMAS scale (Tukey's test p< 0.0001; Chi-square=38.825, p< 0.0001). A total of 204 female responses were recorded; the mean age was 41.2±9.5 years. It was observed that n=95 (46.5%) of patients showed partial adherence whereas n=76 (37.2%) patients were highly adherent to ACT. The probability of patients' adhering to their therapy was greater among those who were employed [OR = 1.95, 95% CI (1.27, 2.62)] and have higher level of education [OR = 2.93, 95% CI (1.39, 4.46)]. The potential reasons for non-adherence were the cost of treatment n=44 (21.5%), adverse effects n=33 (16.1%), depression and emotional stress n=32 (15.6%). The Urdu version of GMAS, validated with good internal reliability, proved to be a feasible and accurate tool for measuring adherence among breast cancer patients.

(1) Background: COVID-19 has significantly affected the quality of life and the medication adherence of patients with chronic diseases. Attitudes towards the disease and preventive measures are the things that need to be considered for patient adherence to medication during the COVID-19 pandemic. We aimed to evaluate the rate and compare the medication adherence and the impact of the COVID-19 pandemic on medication adherence in Vietnamese patients with cardiovascular and endocrine–metabolic diseases. (2) Methods: A cross-sectional study was conducted on outpatients having chronic diseases such as cardiovascular or/and endocrine–metabolic diseases in some southern provinces in Vietnam. In each group of patients, medication adherence was measured and assessed with the General Medication Adherence Scale (GMAS), adjusted and validated in Vietnam. In addition, the study also investigated attitudes and practices to prevent COVID-19. (3) Results: Out of 1444 patients in our study, the level of adherence was recorded in 867 cases, accounting for 61.1%. The group of patients with only cardiovascular disease and patients with only endocrine–metabolic disease had relatively similar compliance rates of 62 and 61.1%, respectively. The leading cause of non-adherence to treatment in all three groups of patients in the study, as assessed by the GMAS, was non-adherence due to financial constraints. Our study showed that 71.6% of patients felt anxious when going to the hospital for a medical examination. However, only 53.7% identified the COVID-19 pandemic as obstructing treatment follow-up visits. The research results showed that the COVID-19 epidemic influences the patient’s psychology with regard to re-examination and treatment adherence, with p coefficients of 0.003 and <0.001, respectively. (4) Conclusion: Medication adherence rates in two disease groups are close, and financial constraint is the fundamental reason for medication non-adherence. Regulatory agencies must take care of people’s welfare to improve adherence in the epidemic context.

Introduction: Medication adherence is crucial for effective management of chronic obstructive pulmonary disease (COPD). However, the medication adherence rates among patients with COPD is generally low due to various influencing factors. This study aimed to identify predictors of medication adherence among Vietnamese patients with COPD.Methods: A cross-sectional study was conducted at a tertiary hospital in Central Vietnam. A total of 104 patients diagnosed with COPD were conveniently recruited between March and June 2022. Data were collected using three structured questionnaires, including demographic and health-related characteristics form, the Beliefs about Medicines Questionnaire, and the General Medication Adherence Scale (GMAS). Descriptive statistics, independent t-test, Chi-square test, univariate logistic regression analysis, and multivariable logistic regression were used for data analysis. Results: Up to 41.3% of participants adhered to medication. Medication adherence was higher among younger individuals, those with education levels above high school, those with fewer medications, and those who held a stronger positive belief about the necessity of medication. Conclusion: The overall medication adherence rate was moderate. It was significantly influenced by age, educational level, number of medications, and beliefs about the necessity of medication. These findings suggest that healthcare providers should prioritize identifying and supporting patients who are at risk of non-adherence. Moreover, intervention programs should aim to enhance patients’ awareness of the necessity of medication in managing COPD.

ObjectiveThe aim of this study was to validate the Arabic version of General Medication Adherence Scale (GMAS) in Sudanese patients with type 2 diabetes mellitus (T2DM).MethodsA 3-month cross-sectional study was conducted among patients with T2DM at Al-Daraja Health Center, located in Wad Medani, Sudan. A convenient sample of patients was selected, and the study sample size was calculated using the item response ratio. Factorial, known group, and construct validities were determined. Internal consistency and reliability were also determined.ResultsResponses were provided by 500 patients. The average medication adherence score was 30 (median 31). The normed fit index (NFI) was 0.950, the comparative fit index (CFI) was 0.963, the incremental fit index (IFI) was 0.963, and the root-mean-square error of approximation (RMSEA) was 0.071. The results from these fit indices indicated a good model. Factorial, known group and construct validities were all established. A significant association was found between adherence score and age (P = 0.03) since a larger proportion of older patients were found to have high adherence compared to patients in other age groups. The reliability (α) of the questionnaire was 0.834.ConclusionThe Arabic version of GMAS was validated in Sudanese patients with T2DM making it a suitable scale to be used in this population.

Multimorbidity, the coexistence of two or more chronic conditions, is increasingly prevalent in Jordan, a middle-income country with a growing non-communicable disease (NCD) burden and limited data on medication adherence. This study examined adherence prevalence, predictors, and barriers among Jordanians with multimorbidity to inform interventions supporting Sustainable Development Goal 3. A cross-sectional, mixed-methods study was conducted from April to December 2024 in two tertiary Hospitals' outpatient clinics in Amman. Adults (≥18years) with ≥2 chronic conditions requiring ongoing medication (n = 405) were recruited via convenience sampling. Adherence was assessed using the General Medication Adherence Scale (GMAS, 0-33; high adherence defined as GMAS ≥27) alongside a Self-Administered Comorbidity Questionnaire (SCQ)-like checklist. Qualitative data were collected through an open-ended question and analyzed using thematic analysis. Descriptive statistics, correlation analysis, and logistic regression were used. Qualitative data were analysed using thematic analysis. Of 420 invited participants, 405 completed the survey (response rate: 96.4%). High adherence (GMAS ≥27) was observed in 54.3% of participants. Factors positively associated with medication adherence included older age, higher income, fewer medications, higher health literacy, and social support, while cost, polypharmacy, forgetfulness, rural residence, and low perceived medication necessity were key barriers. Six qualitative themes were identified: economic strain, access gaps, cultural beliefs, religious coping, caregiving burden, and symptom management issues. This first study of medication adherence in Jordanian multimorbidity highlights actionable barriers and facilitators, offering a scalable model for resource-limited settings. Subsidies, mobile pharmacies, and culturally tailored strategies could substantially reduce the non-adherence rates, advancing NCD control regionally and globally.

Background: Oral Anti-coagulant is widely used for the prevention and treatment of cardiac and thromboembolic diseases. As oral anticoagulant is a narrow therapeutic index medicine, it requires close monitoring to achieve effectiveness of anticoagulants therapy. Therefore, this study was conducted to assess adherence to anticoagulant therapy and its awareness among cardiac patients attending cardiac OPD of Chitwan Medical College Teaching Hospital, Chitwan. Methods: A descriptive cross-sectional study design was carried out among 91 cardiac patients attending cardiac OPD of Chitwan Medical College Teaching Hospital sample was selected by using Consecutive sampling technique. Data was collected using structured interview schedule. General medication adherence scale and self-prepared structured questionnaire of awareness of anticoagulant therapy was used. Data was analyzed in SPSS version 20 by using descriptive and inferential statistics. Results: Out of 91 respondents 42.9% of the respondents had partial adherence while 33.0% had good adherence. Only 6% of the respondents had high adherence, 7.7% and 9.9% of the respondents had poor and low respectively. Regarding awareness of anticoagulant therapy 63.7% of the respondents had inadequate level of awareness. There was statistically significant relationship between level of awareness with educational status (0.02), having insurance (0.05) and drug duration (0.05). Conclusions: Based on this finding respondent’s awareness was found to be low on the risk effects of alcohol intake, drugs and food interaction and self-limiting of injurious activities and most identified reason for non-adherence is discontinue due to feeling well, adverse effect and progression of disease. So, clinician and nurse should design an effective instructional program about anticoagulant therapy by highlighting those limited area thus to enhance adherence and prevent life threatening complications.