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Effect of Hypertension Education on Antihypertensive Medication Adherence among Adults with Hypertension in Nigeria

Abstract

Hypertension is a major public health concern in Nigeria and is an important risk factor for cardiovascular disease, stroke, kidney disease, and premature death. Effective management of hypertension requires sustained adherence to prescribed antihypertensive medications, together with appropriate lifestyle and clinical care. However, medication non-adherence remains a significant challenge and may contribute to poor blood pressure control and increased risk of complications. Hypertension education provides adults with information about the nature and consequences of hypertension, the importance of blood pressure control, prescribed medications, dosage and timing, potential side effects, the risks associated with discontinuing treatment, and the importance of regular clinical follow-up. Antihypertensive medication adherence refers to the extent to which individuals take their prescribed blood pressure medications according to the recommended dose, timing, frequency, and duration. In Nigeria, inadequate knowledge, misconceptions about hypertension, perceived absence of symptoms, concerns about medication side effects, medication costs, forgetfulness, complex treatment regimens, and limited access to healthcare services may affect medication adherence among adults with hypertension. Effective hypertension education may improve patients' knowledge, perceptions, self-efficacy, and commitment to long-term medication use. Against this background, this study investigates the effect of hypertension education on antihypertensive medication adherence among adults with hypertension in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains medication-taking behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding patients' decisions to adhere to antihypertensive treatment. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping medication-taking behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from hypertension education may influence medication adherence. Collectively, these theoretical perspectives provide a suitable framework for explaining how hypertension education may influence antihypertensive medication adherence among adults with hypertension in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from adults diagnosed with hypertension and receiving treatment at selected healthcare facilities in Nigeria using a structured interviewer-administered questionnaire and a validated medication-adherence assessment tool. Where feasible, medication adherence may also be assessed using appropriate clinical or pharmacy records, with participants' consent and confidentiality safeguards. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, hypertension clinics, and eligible adults with hypertension. Where feasible, selected participant groups or healthcare facilities will be assigned to intervention and comparison groups. Participants in the intervention group will receive structured hypertension education covering the nature and consequences of hypertension, the importance of blood pressure control, prescribed antihypertensive medications, dosage and timing, potential medication side effects, strategies for managing common barriers to adherence, the risks of stopping medication without professional advice, lifestyle management, regular blood pressure monitoring, and the importance of follow-up care. Antihypertensive medication adherence will be assessed using indicators such as taking medications at the prescribed dose and frequency, adherence to medication schedules, consistency of medication use, avoidance of intentional treatment interruptions, timely medication refills, and appropriate communication with healthcare professionals regarding side effects or treatment concerns. Descriptive statistics will be used to summarize participants' sociodemographic and clinical characteristics, hypertension knowledge, exposure to education, and medication adherence. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of hypertension education on antihypertensive medication adherence. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that hypertension education has a significant positive effect on antihypertensive medication adherence among adults with hypertension in Nigeria. Adults exposed to structured hypertension education are expected to demonstrate improved understanding of hypertension and greater adherence to prescribed antihypertensive medications. Education may improve patients' understanding of the asymptomatic nature of hypertension, increase awareness of the benefits of sustained treatment, reduce misconceptions about medication, improve recognition and management of common side effects, and encourage regular medication use and clinical follow-up. However, education alone may not guarantee sustained medication adherence because patients may continue to face barriers such as medication costs, forgetfulness, complex treatment regimens, medication shortages, limited healthcare access, and concerns about adverse effects. Consequently, hypertension education is expected to be most effective when supported by affordable and consistent medication availability, patient-centred counselling, regular follow-up, medication-reminder strategies, accessible healthcare services, and supportive family and community environments. The study is expected to contribute to the literature on hypertension management, medication adherence, chronic disease education, non-communicable disease control, patient education, cardiovascular disease prevention, and public health in Nigeria by providing empirical evidence on the effect of hypertension education on antihypertensive medication adherence among adults with hypertension. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, primary healthcare facilities, hospitals, physicians, nurses, pharmacists, community health workers, development partners, and policymakers regarding strategies for improving hypertension treatment adherence and blood pressure control. The study will also provide evidence-based recommendations for strengthening hypertension education programmes, improving patient counselling, reducing barriers to medication adherence, promoting regular clinical follow-up, improving access to affordable antihypertensive medications, and supporting sustained medication adherence among adults with hypertension across Nigeria.

Keywords: Hypertension education, antihypertensive medication adherence, adults with hypertension, hypertension management, medication adherence, blood pressure control, chronic disease management, patient education, cardiovascular disease prevention, non-communicable diseases, public health, Nigeria.