Home Care Providers Research Articles

Walking into a COVID Petri Dish: Home Care Providers' Experiences during a Pandemic.

As we approach the third anniversary of the COVID-19 pandemic, the long-term effects on the health and well-being of those caring for patients in their homes, where less control of the environment can be maintained, remain a concern. The purposes of this study were to describe home care providers' experiences caring for patients during the pandemic, barriers and facilitators to the provision of care, and lessons learned for practice during future healthcare crises. A qualitative descriptive study using semistructured interviews was conducted with 13 home care providers. Four themes emerged from the data: Riding an emotional roller coaster, Putting a fire out with a garden hose, Walking into a COVID petri dish, and I'm just trying to do my job. Support for frontline staff should be initiated early in a healthcare crisis or pandemic. Communication needs to be clear, consistent, and made available at regular intervals. Home care leaders need to be visible and transparent to reduce emotional uncertainties that can negatively influence staff and patient outcomes. Education and planning around emergency preparedness are essential in future crises to mitigate the negative consequences on staff and patients.

Is 911 The Answer? A Retrospective Review of Emergency Medical Services Use by Home Care Providers.

With the Ontario healthcare system under strain the use of resources-particularly emergency medical services (EMS) is an increasing focus. Recent work has identified long-term care facilities as high users of EMS despite access to health-related support outside of the hospital. However, such insights are not available for home care. A retrospective review of administrative records of EMS calls drawn from over 6 million visits by home care providers found relatively low call rates: 8.4 calls per 100 000 personal support visits, 4.1 calls per 100 000 for rehabilitation providers, and 0.9 calls per 100 000 for nurses. The majority (85%) of calls resulted in transport to the hospital; the notable exception was fall-related events, and of these falls, a third (32%) were treated at home. Classification of reported physical symptoms suggests opportunities for leveraging in-home clinical specialists to avoid hospital transport where possible and preserve EMS capacity to respond to the most urgent and severe events.

Educational material production and validity: educational instrument for home care for premature newborns.

to produce and validate a booklet, based on Jean Watson's Theory, on home care for premature newborns, based on caregivers' experiences. a methodological study, developed in the following stages: diagnosis of knowledge needs about home care; survey of scientific content; educational material production; and validity by judges/experts. the literature review resulted in 19 articles. The main themes (breastfeeding, bath care, bond building, infection prevention and support network) were listed for producing the booklet "Booklet for Premature Newborns: Demystifying Home Care". The booklet content and appearance received the overall Content Validity Index of 0.85, considered suitable within the scientific rigor of validity. the booklet produced and validated is an educational material whose main role is to provide knowledge and awaken caregivers' autonomy in providing home care to newborns.

The feasibility of the story as a quality instrument as a narrative quality improvement method

Background and objective: Stories from older adults give insight into their personal lives and in the care they receive. The story as a quality instrument is a narrative quality improvement method with which care professionals can interview older adults about how care is experienced. Each performed interview will be translated into a portrait containing the core themes of the shared story. The objective of this study was to assess the feasibility of and experiences with the story as a quality instrument amongst care professionals and older adults receiving long-term care.Methods: Five care locations providing nursing home care and one providing home care participated in the current study. In total 19 trained care professionals performed interviews with 52 older adults. Both the performed interviews and written portraits were scored according to preset criteria to establish the compliance to the predetermined protocol. Next to that, experiences from care professionals as insider researchers and respondents were gathered.Results: Overall the fidelity for performing the interview was good. In 90% of cases interviewers posed one inviting open question. Following, interviewers used proposed interviewing techniques such as asking in depth questions, asking for an example or summarizing what has been said. In 20 of the interviews, the respondents input accounted for over 80% of the total number of words, and in 27 interviews the respondents’ input accounted for 60%-80%. Fidelity with the protocol for drawing up portraits was sufficient in most cases. In 66% the portrait contained all important themes and in 32% the majority of important themes. One portrait missed a significant proportion of themes mentioned during the interview. The experiences from care professionals consist of successes, challenges, added value and prerequisites.Conclusions: Care professionals were mostly capable of following the method according to protocol after being trained. The method is believed to be a promising innovation because care professionals play a key role in gathering and using stories to improve quality of care. The outcomes can be used by care professionals to learn and improve within their care location according to the quality framework for nursing home care.

RESILIENCE IN FAMILY CAREGIVERS OF ASIAN OLDER ADULTS WITH DEMENTIA: AN INTEGRATIVE REVIEW

Abstract Resilience is the ability to rebound from adversity and the amount of resilience varies depending on the sociocultural contexts. Little is known about resilience in Asian family caregivers of older adults with dementia, although Asian countries show the fastest growth of dementia. An integrative review focused on resilience in Asian family caregivers was guided by Whittemore and Knafl (2005). A systematic search of five databases (CINAHL, EMBASE, PsycINFO, MEDLINE, PubMed) was conducted and limited to English-language empirical studies published between 2016 and 2021. A constant comparison approach was used for the data analysis. A total of 15 studies conducted in nine Asian countries were selected for review. Results revealed Asian family caregivers were most commonly adult children, female, and providing home care. Resilience was impacted by multiple interrelated factors. Two influences emerged from this review including risk factors (burden, stigma, family stress, social stress) and protective factors (positive aspect of caregiving [PAC], religiosity/spirituality, social support). Filial piety, derived from religiosity/spirituality, played a role in both risk and protective factors. Asian caregivers with a deep-rooted belief in filial piety exhibited more depression than US caregivers (d=.21, p <.05), as Asian caregivers restricted their other activities and dedicated themselves to caregiving. Other Asian caregivers who balanced a belief of filial piety experienced a PAC and were resilient. Future interventional research should focus on minimizing risk factors (burden) and maximizing protective factors (PAC and religiosity/spirituality) to promote resilience among Asian family caregivers. A culturally aligned family-centered approach to care should be considered.

IMPROVING MEDICATION MANAGEMENT FOR HOME-DWELLING OLDER ADULTS WITH COGNITIVE IMPAIRMENT: END-USER INPUT

Abstract HOPES™ Program is a joint community-university partnership, intended to build capacity for improving medication adherence and reducing medication mistakes, misuse, and abuse for community-dwelling older adults with reduced cognitive functioning (CWCs) in New York State (NYS). The goal of this program is to contribute to the health and safety of older adults, empower them and their caregivers to reduce medication non-adherence consequences and risks, and enable older adults to continue living at home while managing their health conditions. This program applied a collective user-centered approach to connect resources, identify and address barriers, and reach the most vulnerable groups. One aspect of our user-centered approach included a medication management and safety training module video that was adapted from the Medication Use Safety Training for Seniors™ (MUST for Seniors™) and underwent alpha and beta testing. A qualitative analysis was also conducted on input from home-care providers, CWCs, and their designated caregivers about the current practices, challenges, and solutions related to medication management. Our preliminary findings demonstrated a need for research on reducing the steep estimated national costs of medication non-adherence. Thus, a sub-team has developed a methodology to build an economic perspective on the scope and magnitude of interventions to enhance medication management practices for CWCs. A NYS-specific survey was also developed in close collaboration with providers, university partners, and state-level advocacy organizations according to our preliminary findings to document the state and magnitude of medication non-adherence, discern risk factors and determinants of non-adherence, and explore solutions and barriers.

FAMILY ACTIONS TO OVERCOME THE SIDE EFFECTS OF CHEMOTHERAPY IN PATIENTS AT HOME

To cancer patients, families are the first home care and support providers who help meet all their needs. This study aims to define their actions that help the patients deal with the side effects of chemotherapy at home. This is a descriptive quantitative research involving cancer outpatients who are taking chemotherapies in Arifin Achmad Hospital of Riau Province. A consecutive sampling technique obtained 134 families as samples, from which the data were collected using a questionnaire and analyzed univariately. The results showed several major actions in helping their members get through the side effects of chemotherapy, which include helping overcome nausea and vomiting by providing preferable food (in as many as 84 patients or 63%), helping overcome hair loss by keeping hair short and easy to manage (in as many as 54 patients or 40.5%), helping overcome fatigue by assisting to manage routines (in as many as 83 patients or 62.2%), helping battle appetite loss by preparing favorite foods on demand (in as many as 99 patients or 74.2%), and helping overcome diarrhea by giving 8-10 glasses of water per day (in as many as 91 patients or 68.2%). These actions have given proper results in helping the patients overcome chemotherapy side effects at home. Therefore, our study is expected to be a reference for other families whose members are dealing with similar conditions.

Equity in walking access to community home care facility resources for elderly with different mobility: A case study of Lianhu District, Xi'an.

As the aging of China's population continues to deepen, a number of elderly care facilities relying on community platforms to provide home care services have been established in urban communities, effectively alleviating the problem of difficult community elderly care, while a spatial mismatch between the facilities and the elderly population has also emerged. To solve this problem, this paper analyzes the equity in walking access to community home care facilities for elderly people with different mobility abilities in Lianhu District of Xi'an City, taking the resources of community home care facilities as the research object. Firstly, the coverage rate of the facilities was calculated based on the 15-minute walking range of the elderly with different mobility, and the accessibility of the facilities was measured using the Kernel Density-type two-step moving search method. Then, Gini coefficient, Lorenz curve and location entropy were used to analyze the spatial matching pattern of facilities and elderly population. The results show that there is a serious spatial mismatch between the resources of community home care facilities and the elderly population with mobility restriction. In addition, the available facility area per capita is low for more than 80% of the elderly with mobility restriction, and the road network density has a significant impact on the access of the elderly with mobility restriction to the community home care facility resources. These research results indicate that the spatial layout and configuration of community home care facilities are unfair to the elderly with poor mobility, and that these elderly care facility configurations do not favor the disadvantaged groups.

A Retrospective Cohort Study Evaluating the Association Between Implementation of a Digital Care Plan and Hospitalization Rates for Home Care Residents in the United Kingdom

Cera, a homecare provider, uses digital care plans (DCP), to streamline the provision of home care. DCP rollout is part of a larger digitization initiative, including carer visit reports collected through a mobile app and branch actions recorded in a web application supported by a secure central database. This retrospective cohort study aimed to assess the association of a DCP rollout with service user hospitalization rates. his study utilized retrospective data from 2 groups of service users, those for whom their first 30 days of Cera membership occurred prior to DCP rollout (pre-DCP group) versus those whose first 30 days of Cera membership occurred after DCP rollout (post-DCP group). The 30-day hospitalization rate was the primary outcome measure and was determined through a combination of carer reports, reporting from service users or their families, and branch staff follow-up. There were 55 hospitalizations among 392 users in the pre-DCP group in the 30 days after joining Cera (14.0% hospitalization rate), compared to 23 hospitalizations among 297 users in the post-DCP group (7.7% hospitalization rate). This represented a significant reduction in hospitalizations in the post-DCP group (6.3% absolute difference in hospitalization rate; 45% relative reduction; P < .001). This result was robust to multiple sensitivity analyses. The implementation of a DCP was associated with a 45% relative reduction in the 30-day hospitalization rate for new service users when compared to pre-DCP enrollment. These benefits could be further amplified by combining the DCP with additional initiatives aimed at the prediction and prevention of avoidable hospitalizations.

Quality and safety in home care with the Vidaza cooperation protocol

In a context of tense bed management in hospitals, the implementation of cooperation protocols between hospital services and home care providers has become necessary in recent years. The Albi hospital in the Tarn region has set itself the objective of developing care pathways in conjunction with the city in order to better structure the supply of care in the region and also to encourage exchanges between healthcare professionals. The "Vidaza (Azacitidine®) cooperation protocol for day hospital - home hospitalization" illustrates this approach in the field of oncology.

Management system of home transfusion in Japan: A nationwide survey in 2019.

In Japan, there are various opinions on the pros and cons of home transfusion because of safety concerns. We hence aimed to elucidate the safety and availability of home transfusion in Japan, which has not been clarified to date. Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The analysis period was February to December 2019. Basic information about the clinics, their collaboration system with core hospitals, storage method of red blood cells (RBCs) and the system for the management of patient information regarding transfusion reactions were investigated. Detailed information was obtained regarding the implementation of home transfusions by 51 clinics. The proportion of home care clinics performing home transfusions was 17.6%, and they were more frequently performed in urban regions. Approximately half of the clinics collaborated with a core hospital for emergency responses to transfusion reactions. At 84% of the clinics, RBC units were stored in refrigerators that were not exclusively allocated to blood storage. Nurses and family members were involved as patient attendants in 83% and 77% of the home transfusions, respectively. No serious transfusion reactions were reported among the 150 patients in 2019, nor the 623 patients up to 2018. From data on its availability and safety, home transfusions are considered to be in the developing phase in Japan. Increased cooperation between hospitals and clinics is crucial towards improving the home transfusion system in Japan in the future.

A service evaluation of joint working across sectors to promote self-administration of subcutaneous systemic anti-cancer therapy in breast cancer patients

Abstract Introduction Trastuzumab(T) is a humanized monoclonal antibody used in the treatment of HER2-positive breast cancer and is available as a subcutaneous(sc) formulation thereby allowing short and convenient administration. A lack of trained nurses to administer T at home and/or train patients at home to self-administer, together with challenges in maintaining cold-chain delivery have impeded uptake of home administration.1,2 In order to support patients’ ability to self-administer T at home, we have implemented an educational programme that includes nurse-led training, education material, support apps and follow-up telephone clinics. Home delivery of pre-filled syringes was enabled in collaboration with commercial providers for aseptics and logistic. Aim The aim of this service evaluation was to evaluate the utility of this programme from the patients’ perspective and to assess patient satisfaction and impact on quality of life (QOL). Methods A previously validated Self-Injection Assessment Questionnaire (SIAQ)3 was modified to assess patient satisfaction, perceptions and impact of the programme. Patients who had agreed to enrol on the ‘self-administration’ scheme, were asked to complete the questionnaire at baseline, at the third training session and at the second self-administered dose. Approval from a Research Ethics Committee is not required for this service evaluation. Results All 14 patients offered the questionnaire responded to all questions. The median age was 58 years old (age range 43-76), 11 patients were Caucasian, 2 were Asian and one was African/Caribbean. The average distance from their home address to hospital was 10.1 miles (range 4-19). Following completion of the one-to-one nurse training there was an improvement in patient confidence to self-administer sc. T. No differences in ‘feeling in control of their treatment’ or ‘satisfaction of attending hospital appointments’ were noted. Of the 11 patients who reached the self-administration stage, 10 reported that they felt ‘very confident’ and 8 reported that it was ‘very easy’ to give themselves the injection. All patients rated themselves ‘very satisfied’ with self-administration and reported that the nurse training programme helped them to be more confident. 10 patients reported that the App and written information was useful as well as the pre- and post- administration telephone clinics. All patients reported that the self-administration programme had a positive impact on their QOL by reducing the number of hospital visits. In the first 4 months of self-administration each patient reduced their hospital attendance by an average of 8 appointments (median=8) equating to 10 hours of time that would have been spent at hospital. Discussion/Conclusion The subcutaneous T self-administration programme was well received by patients. The nurse training sessions and supportive materials enabled patients to feel more confident about self-administration with no reported incidents or adverse events. This led to fewer hospital visits and improved QOL. This programme was critically dependent on the services of a commercial compounder and homecare provider, emphasizing the importance of joint working between the NHS and commercial sector. Evaluation of this programme will continue and will include other agents, including Phesgo® (sc trastuzumab and pertuzumab) which have more patients and will improve the reliability of the results.

Individual and organisational factors in the psychosocial work environment are associated with home care staffs’ job strain: a Swedish cross-sectional study

BackgroundHome care staff (HCS) provide essential service to enable older adults to age in place. However, unreasonable demands in the work environment to deliver a safe, effective service with high quality has a negative impact on the individual employee’s well-being and the care provided to the older adults. The psychosocial work environment is associated with employees´ well-being, although, knowledge regarding which individual and organisational factors that contribute to job strain for HCS is limited. These factors need to be identified to develop targeted interventions and create sustainable work situations for HCS. This study aimed to explore how HCS´s perceived job strain is associated with, and to what extent can be explained by, individual and organisational factors of the psychosocial work environment and psychosomatic health.MethodAn explorative cross-sectional questionnaire survey design was used in a large Swedish county. Five home care agencies with a total of 481 HCS were asked to respond to a questionnaire regarding their perceived level of job strain (Strain in Dementia Care Scale), psychosocial work environment (QPSNordic34+), and psychosomatic health (Satisfaction with Work Questionnaire). Multiple linear regression (MLR) analyses were conducted to explore the association between job strain and individual and organisational factors.ResultsIn total, 226 (46%) HCS responded to the questionnaire. Both individual and organisational factors were significant predictors of job strain and explained a variance ranging between 39 to 51% (p = 0.001). The organisational factor job demand and the individual factor feeling worried and restless was most frequently represented in these MRL models. A higher job strain was also associated with adverse outcomes regarding leadership, organisational culture and climate, and control at work.ConclusionThis study indicates that there is an intertwined complexity of individual and organisational factors that are associated with the HCS´s perception of job strain. Implementation of new multidimensional work strategies, such as a reablement approach, could support the development of efficient strategies for HCS and reduce the level of job strain. Policy changes for the provision of home care are also needed to support the development of a sustainable and healthy psychosocial work environment.

Public-private partnership in care provision for ageing-in-place: A comparative study in Guangdong, China.

This paper investigates how the public-private partnership (PPP) functions in the care provision for older people in Guangdong, China, particularly for ageing-in-place programs. Three cities with diversified PPP forms of care provision for older people were chosen as case studies. Focus groups were conducted in these cities for the local authorities and care homes involved in the partnerships. Three forms of PPP, including private sector involvement for the ownership, construction, and operation of the facilities delivering care services, were identified. The public-private co-constructed and privately run model with greater private sector involvement may lead to higher quality care in one specific program. The publicly constructed and privately run program is widely used in many cities, advancing the expansion of ageing-in-place programs in more communities. These PPPs reflect flexible and practical collaboration between the public and private sectors at the local level in the Chinese context. PPP have accelerated the development of a better care system for older people, mainly in terms of more affordable and higher-quality care options for the public. They are also a feasible solution for the local government due to more cost-effective and sustainable care provisions than previous publicly provided programs. The specific forms adopted are primarily associated with the scale of home care provision for ageing-in-place and the local government's financial capacity. Despite increasing private sector involvement, the public sector retains its crucial role in delivering care services targeting ageing in China.

GPs’ involvement in specialised palliative home care: A mixed methods study in Germany

Background General practitioners (GPs) are important providers of palliative home care (PHC). To deliver adequate palliative care, cooperation with specialised PHC teams is necessary. Specialised PHC is a type of care for severely ill patients by specialised providers. Little is known about the involvement of German GPs in specialised PHC. Objectives To analyse GPs’ experience with realised and desired involvement in specialised PHC. Realised involvement means GPs took part in specialised PHC patients’ care. Desired involvement is GPs’ hoped-for cooperation with specialised PHC teams: GPs could state whether they want to stay involved, be informed, or provide medical services themselves after referral to specialised PHC. Methods Mixed methods design (focus group with 6 GPs; survey of 445 GPs in North Rhine, Germany, about their experiences in PHC/specialised PHC): Qualitative data was interpreted using content analysis. The authors developed a questionnaire and performed descriptive analysis based on qualitative results. Results GPs are mostly satisfied with specialised PHC teams’ care, although they report cooperation is not always optimal. GPs describe a high satisfaction with quality of care by specialised PHC teams. However, physicians with higher PC knowledge are less satisfied with specialised PHC. Also, GPs are often less involved in specialised PHC than they wish, especially when they have a higher PC qualification. Conclusion In general, GPs are satisfied with the quality of care provided by specialised PHC teams but GPs do not always perceive cooperation as optimal. Involvement of GPs in specialised PHC needs to be improved.

Professional home care providers' conceptualisations of frailty in the context of home care: A focus group study.

In Norway, as in many other countries, more people receive health and care services in their homes than before. Home care professionals provide care and support to people with a range of health and care needs. Older home care service users are sometimes referred to as 'frail', but the terms 'frail' and 'frailty' have different meanings in different contexts, and little is known about the meaning ascribed to the terms in the context of home care services. Home care services are crucial for many older persons who have health challenges, and how home care professionals conceptualise frailty might shape clinical encounters. The purpose of this study is to explore how home care professionals conceptualised frailty in the context of home care. We conducted four focus group discussions with 14 home care professionals who worked in municipal home care in northern Norway and analysed the data using thematic analysis. Our analysis resulted in five themes: '"Frail" - a term which is too imprecise to be useful', 'Frailty as a consequence of ageing', 'Frailty as lack of engagement and possibilities for engagement', 'Frailty as a contextual phenomenon' and 'Frailty as potentially affected by care'. The home care professionals conceptualised frailty as an individual trait but also as resulting from the interplay between individual and environmental factors. Moreover, their conceptualisations of frailty represented a continuum between frailty as related to prevention and management ('cure') and frailty as related to ageing as natural decline ('care'). The home care professionals conceptualised frailty diversely, as moving along a continuum between cure and care. Diverse conceptualisations of frailty might be necessary if nurses are to meet the changing and varying care needs of older persons who live in their own homes and need health and care services.

Formal care of the elderly and health outcomes among adult daughters.

Health-care expenditures and the demand for caregiving are increasing concerns for policy makers. Although informal care to a certain extent may substitute for costly formal care, providing informal care may come at a cost to caregivers in terms of their own health. However, evidence of causal effects of care responsibilities on health is limited, especially for long-term outcomes. In this paper, we estimate short and long-term effects of a formal care expansion for the elderly on the health of their middle-aged daughters. We exploit a reform in the federal funding of formal care for Norwegian municipalities that caused a greater expansion of home care provision in municipalities that initially had lower coverage rates. We find that expanding formal care reduced sickness absence in the short run, primarily due to reduced absences related to musculoskeletal and psychological disorders. The reduction in sickness absence is concentrated among workers with little work flexibility (e.g., shift workers), whereas there are no effects for workers with more flexible jobs. We were unable to detect effects on long-term health and healthcare utilization outcomes. Our results imply that sickness absence uptake could be hiding a need for more flexibility around work for people with caregiving responsibilities.

Care ensembles: examining relational aspects of care in the context of home care

We adapt the concept of the ‘consumption ensemble’ to capture the nuanced collaborations between actors in the provision and receipt of home care. Data were from a ten-year study of home care clients, family carers and workers in selected Canadian provinces. Using the lens of the ‘ensemble’, we analysed interviews with 24 dyads (carers and clients) and reviewed findings of our previously published research. Evidence of agency as collective endeavour supporting client autonomy and of improvisation in the ensemble informed a revision of our previous interactive model of care, emphasising the bidirectional nature of care relationships.

Dynamic scheduling of home care patients to medical providers

Home care provides personalized medical care and social support to patients within their own homes. Our work proposes a dynamic scheduling framework to assist in the assignment of health practitioners (HPs) to patients who arrive stochastically over time and are heterogeneous with respect to their health requirements, service duration, and region of residence. We model the decision of which patients to assign to HPs as a discrete‐time, rolling‐horizon, infinite‐stage Markov decision process. Due to the curse of dimensionality and the combinatorial structure associated with an HP's travel, we propose an approximate dynamic programming (ADP) approach based on a one‐step policy improvement heuristic. Four policies are investigated: The first two prioritize HP fairness by balancing service and travel times, respectively, while the other two are based on fluid approximations of the system. We show that the first fluid model is optimal if the number of patient arrivals is sufficiently large while the second performs better experimentally; both approaches leverage pricing and decomposition strategies. We compare our framework to more commonly implemented policies—constrained versions of the classical vehicle routing problem—in a simulation study using data collected from a Canadian home care provider. We show that, in contrast to these approaches, by accounting for future uncertainty, substantial cost savings can be obtained while a fewer number of referrals are rejected. We also find that well‐performing policies assign patients to HPs operating within a small set of adjacent regions while considering the number of periods that a patient requires care for. Otherwise, HP workload may not be appropriately balanced over the long‐term even if travel time is minimized.

Analisa Tingkat Kepatuhan Pasien Home Care dalam Minum Obat Anti Hipertensi

Hypertension is often referred to as a hidden killer disease because this disease usually does not give specific symptoms to sufferers and is very dangerous. Compliance in taking hypertension medication is a major problem for patients so that many patients experience sudden attacks when their blood pressure rises. Providing home care with counseling is reported to provide patients with a better understanding of the disease and can improve the patient's quality of life. The purpose of this study was to determine the level of compliance of home care patients in taking anti-hypertensive drugs at Mitra Dasan Cermen Pharmacy, to determine the factors that influence the compliance of home care patients in taking anti-hypertensive drugs. The research method used was cross sectional using a compliance level questionnaire and a questionnaire of factors affecting the level of compliance, the data were analyzed by the spearman rank correlation test. The results showed that 57.6% of respondents had a moderate level of compliance 42.4% of respondents had a moderate level of compliance, 3 factors affecting the level of compliance that had a relationship, namely gender p = 0.001), education level (p = 0.000), family support (p = 0.001), 4 factors of compliance level that did not have a relationship, namely employment status (p = 0.189), duration of hypertension (p = 0.805), health insurance participation (p = 0.065).