Determinants of Medication Adherence among Hypertensive Patients in a Federal Government Health Institution in Bayelsa State, Nigeria

Abstract

Hypertension is a major contributor to cardiovascular morbidity and mortality in Nigeria. Despite availability of effective antihypertensive therapies, poor medication adherence remains a key barrier to optimal blood pressure control. Understanding adherence levels and their determinants is critical for designing targeted interventions. This study assessed the level of medication adherence and factors associated with adherence among hypertensive patients attending a federal tertiary hospital in Bayelsa State, Nigeria. A descriptive cross‑sectional study was conducted among adult hypertensive patients attending the cardiology clinic of the Federal Medical Centre (FMC), Yenagoa. Eligible participants (253) were 18 years and older, who were hypertensive, and had used antihypertensive medications for at least 6 months. Data were collected with an interviewer‑administered questionnaire. Adherence was measured using the 8‑item Morisky Medication Adherence Scale (MMAS‑8). Data were analysed using SPSS version 25 and summarised with descriptive statistics; chi‑square tests were used to explore associations and P-value was set at <0.05 for statistical significance. Respondents were predominantly female (66.8%) and mean age of the study population was 42.99 ±7.3. Most of the respondents were married (72.7%), Christian (99.6%), and had tertiary education (60.1%). The mean MMAS‑8 score was 3.68 (out of 8), indicating overall low adherence. A total of 137 (54.0%) patients had low adherence and 116 (46.0%) had medium adherence. The most frequently reported reasons for poor adherence were difficulty sticking to the treatment plan (87.7%), forgetfulness (83.0%), side effects (57.7%), and stopping or reducing medication when feeling well (55.7%). Female gender was significantly associated with higher medication adherence (82.3% vs. 64.3% adherent; χ2 = 15.23, P = 0.01). Age was significantly associated with adherence (χ2 = 8.35, P = 0.03), with highest adherence among those aged 41–45 years (48.6%). Marital status was also associated with adherence (χ2 = 8.27, P = 0.04), with married respondents showing the highest adherence (48.7%). Medication adherence among hypertensive patients attending FMC Yenagoa was suboptimal, despite a relatively well‑educated clinic population. Behavioural and perceptual barriers particularly forgetfulness, difficulty maintaining long‑term regimens, side effects, and symptom‑driven discontinuation were central determinants of poor adherence. Structured, behaviour‑focused adherence support, proactive side‑effect management, and reminder‑based strategies are needed to improve long‑term hypertension control in this setting.