To improve adherence, clinicians and educational interventions must better understand and engage with patients’ ideas about causality, experiences of symptoms, and concerns about drug side effects.IntroductionHypertension is a major health problem in both developed and developing countries and is estimated to cause more than 13% of deaths annually.1 Despite national and international guidelines and initiatives for hypertension, population based studies have found that around two thirds of people with hypertension are either untreated or inadequately controlled, including a substantial number who remain undiagnosed.2 3 4Among those with a diagnosis of hypertension pandora bracelets, the World Health Organization has stated that low adherence to treatment is a key factor impeding good control and has called for research into adherence promoting interventions.5 Estimates of the rate of poor adherence or non adherence to treatment range from 30 50%.6 The causes of poor adherence are complex and include complicated drug regimens, the costs of drugs, older age, poor social support, cognitive problems, and depression.7In 2005 a study reviewed the qualitative research on drug taking in a wide range of medical conditions and found that patients often actively decided not to take drugs (intentional non adherence) rather than unintentionally omitting them.8 To date, several patient educational interventions aimed at promoting drug adherence in hypertension have been tested in randomised controlled trials, but most simply informed patients about the importance of adherence and were ineffective.9A better understanding of patients’ perspectives, through qualitative research, is therefore critical to provide an explanation of the low rates of treatment https://www.jewelrymqsn.top/, adherence, and control and why educational interventions have so far failed, and to inform the development of evidence based interventions to improve management. Specifically, we examined lay understandings about the causes of hypertension and perspectives on drug taking. We also investigated how patients’ perspectives varied among different cultures and ethnic groups.MethodsWe searched electronic databases (Medline, Embase, the British Nursing Index, Social Policy and Practice, and PsycInfo) from inception until October 2011 and hand searched reference lists of relevant papers.
Twenty one items were scored ‘1’ or ‘0’ depending on the presence or absence of a particular aspect of the service. Consistency of coding was achieved by meetings and regular correspondence between key researchers from the earlier and current studies. For two items (supervision arrangements for mental health staff who undertake psychosocial assessments and emergency attendance by a mental health worker available to the hospital ED within 1h) where such a strict categorisation was not possible, scores of ‘0’, ‘0.5’ or ‘1’ were given in consultation with the research team.