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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015
AFRICA
29
Social support and management of hypertension in
south-west Nigeria
Pauline E Osamor
Abstract
Introduction:
Social support can facilitate compliance or
adherence to recommended treatment regimens, especially for
chronic disease management. There is little data from Africa
on the role of social support in the management of chronic
disease.
Objective:
The current study investigated the relationship
between social support for treatment compliance among
hypertensive subjects in a poor urban community in south-
west Nigeria. A second objective was identifying the corre-
lates of social support in the study sample.
Methods:
The study was a community-based, cross-sectional
and descriptive study of 440 community residents (mean age
60 years, 65.2% women) from Idikan community, Ibadan,
Nigeria who had hypertension.
Results:
Most subjects (~ 93%) reported receiving some
social support from family members and approximately 55%
reported receiving social support from friends. Social support
from friends (
p
<
0.0001) but not from family (
p
=
0.162) was
significantly associated with good compliance with treatment
for hypertension. Factors associated with receiving significant
support from both family and friends included marital status
and religion, while age and educational level were associated
with receiving significant support from family members only.
Gender was not significantly associated with receiving social
support.
Conclusion:
We concluded that social support is strongly
associated with hypertension treatment compliance in this
community in south-west Nigeria. These findings suggest a
need for exploring the promotion of social support as a useful
tool in chronic disease treatment programmes.
Keywords:
hypertension, social support, chronic disease, compli-
ance, Nigeria, Africa
Submitted 31/3/14, accepted 21/10/14
Cardiovasc J Afr
2015;
26
: 29–33
www.cvja.co.zaDOI: 10.5830/CVJA-2014-066
The relationship between social support and health has been of
great scientific interest for many years. Several epidemiological
studies have pointed out the importance of social support for
morbidity and mortality.
1
For mortality, there are consistent
indications of a lower risk of death among people with a large
social network.
2,3
This beneficial effect is confirmed for several
morbidities, including cancer, coronary heart disease and other
cardiovascular diseases (CVDs).
4,5
Over the past quarter of a century, much research has
convincingly documented the relationships between social
networks and social support on morbidity, mortality, and
a variety of positive chronic illness outcomes.
6,7
A number
of behaviours or mechanisms may modulate the relationship
between social support and self-management. For example, it
is reasonable to assume that family members and friends may
facilitate the self-management process in a variety of ways,
providing, for example, occasional advice, emotional support,
tangible support that indirectly facilitates self-management (e.g.
shopping for heart-healthy food), and more direct assistance
with illness-management activities.
There is some evidence that illness-specific support is more
predictive of health outcomes than general support.
8
Therefore
one might hypothesise that in the case of chronic illness self-
management, illness-specific or regimen-specific support may
have a stronger influence on self-management behaviour than
more global types of support.
Rozanski, Blumenthal and Kaplan
9
reviewed 15 studies and
found that people who reported low levels of social support were
at greater risk of developing CVD. Blazer
10
published similar
findings, indicating that low levels of perceived social support
were found to be risk factors for developing cardiac events.
Other research has suggested that adherence to drug therapy was
strongly associated with family support provided to patients with
hypertension.
11
Hypertension is a major public health problem and a major
risk factor for stroke, cardiac failure and chronic renal disease
in developing countries. Currently, one-quarter of the world’s
adult population has hypertension, and modelled projections
indicate an increase to 1.15 billion hypertensive patients by 2025
in developing countries.
12
Several studies have examined the factors influencing
compliance behaviours with hypertensive treatment. Among
these studies, Marin-Reyes and Rodriguez-Moran
11
found that
compliance with hypertensive treatment was directly linked to
the support of family members.
It has been well documented that patients from disrupted or
isolated social circumstances are less likely to be good compliers
than those with stable families and/or helpful friends. However,
only recently have there been systematic studies of attempts to
engender or direct social support in order to improve compliance
with antihypertensive therapy. These studies have not shown an
independent effect on compliance of attempting to promote
social support, but their results must be regarded as preliminary.
The present study investigated the influence of social support
on treatment compliance among hypertensive subjects in a poor
urban community in south-west Nigeria. A previous study
13
of
the factors associated with hypertension treatment compliance in
Institute of Child Health, College of Medicine, University of
Ibadan, Ibadan, Nigeria
Pauline E Osamor, MPH, PhD,
ejemenp@yahoo.com