32 / 68
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015
30
AFRICA
this community noted that having social support was associated
with treatment compliance. In the present study, we proceeded
to explore the issue of social support further by (1) exploring the
relationship between social support and good compliance with
treatment for hypertension, and (2) identifying factors associated
with receiving social support from family and/or friends.
Methods
This descriptive study was conducted in Idikan community,
Ibadan, a city in the south-western part of Nigeria, as part of
a larger community-based study of the sociological aspects of
hypertension. Ethical approval for the study was obtained from
the joint University of Ibadan–University College Hospital
ethical committee.
Idikan is located in the indigenous part of the city of Ibadan
and has a population of 15 042.
14
The health facilities in the
community include an outreach clinic run by the Department
of Preventive Medicine and Primary Care of the University of
Ibadan, four private clinics and a small dental clinic run by the
Dental Centre of University College Hospital (UCH). There are
over 150 registered patent medicine stores in the area. There are
three traditional healing homes, and they are all accessible to
members of the community.
The study was a descriptive, community-based, quantitative
study of hypertensive subjects aged 25 years and above
who were residents of Idikan community. Previous studies
in the community
15,16
had conducted household screening for
hypertension, which facilitated the identification of hypertensive
subjects in the community. The subjects for this study were
selected from a list of known hypertensive subjects residing
in the community that was developed from one such previous
hypertension study and updated for the present study during
home visits.
Four hundred and forty hypertensive subjects were enrolled
using a consecutive sampling method. After obtaining
informed consent, subjects were administered a semi-structured
questionnaire that had items on several issues, including
healthcare seeking for hypertension, their beliefs about
hypertension, compliance with treatment, and availability of
social support (from family and friends).
Social support for compliance was assessed in the structured
questionnaire using the questions: (1) Do you normally seek
financial support from family members for your hypertension?
(2) How concerned are your family members about your
hypertension? (3) How interested are your friends in talking
with you about your hypertension? (4) How helpful are your
family in reminding you to take your hypertension medication?
(5) How helpful are your friends in reminding you to take your
hypertension medication? Social support from family members
or friends was defined as reporting support from family as
‘helpful’ or ‘very helpful’ in being concerned about respondents’
hypertension (non-directive support), and reminding of
medication (directive support).
As previously described
13
compliance was defined using
the question on how frequently people missed taking their
medication. The use of compliance as a variable was defined by
first scaling compliance as ‘good’ or ‘high compliance’ (where
the respondent ‘never misses’ or ‘rarely misses’ taking his/her
medication doses), ‘medium compliance’ (where the respondent
‘sometimes misses’ taking medication) and ‘poor’ or ‘low
compliance’ (where the respondent ‘regularly misses’ or ‘fairly
regularly misses’ taking the medication. Since the desired goal
of treatment for hypertension is that the patient complies with
taking medication in order to control the high blood pressure,
we focused on ‘good compliance’ (where the respondent ‘never
misses’ or ‘rarely misses’ taking his/her medication doses) as the
main outcome variable to evaluate compliance in this study.
Statistical analysis
Management and analysis of the survey questionnaire data
was done using SPSS version 11 (SPSS Inc, Chicago, USA).
Frequencies of the responses to the questions were computed
and presented as percentages. Association between categorical
variables was tested using the Chi-square test.
Results
The 440 respondents comprised 65.2% women and 34.8% men.
About half (51.1%) of the respondents had no formal education
and half were traders. The ages of respondents ranged from
25 to 90 years, with a mean age of 60 (SD 12) years. Most
(71%) of the respondents were married (Table 1). Most (70.0%)
of the respondents knew about their hypertensive condition
only when they were invited to participate in a research study,
during which their blood pressure was measured, while 23.0%
of the respondents found out that they were hypertensive when
they were ill with some other ailment and went to hospital for
treatment. The most common perceived causes of hypertension
were anxiety (35.7%) and stress (25.2%), followed by mental
illness (7.5%) and ‘unhappiness’ (5.5%).
The majority (77.5%) of the respondents claimed they
complied with keeping their follow-up clinic appointments
every time, and 46% said they were on medication at the time
of the study. Roughly one-half (50.7%) of respondents had
good compliance with treatment as they claimed to be taking
their medication regularly, whereas 41.5% had poor compliance
at different levels, ranging from regularly missing taking their
medication to rarely taking their medication.
Social support and treatment compliance
Having a family member with hypertension was significantly
associated (
p
=
0.038) with compliance in general with 49.3% of
those who said ‘yes’ versus 61.7% of those who answered ‘no’.
Overall, 85 (19.3%) of the respondents reported that family
members were very concerned about their hypertension while
329 (74.8%) said family members were extremely concerned
about their hypertension. Also, 89 (20.2%) and 322 (73.2%),
respectively, reported that family members were very helpful
or extremely helpful in reminding them about taking their
medication.
Regarding support from friends, 116 (26.4%) of respondents
reported that friends were very concerned about their
hypertension while 127 (28.9%) said family members were
extremely concerned about their hypertension. Ninety-one
(20.7%) and 150 (34.1%) respectively reported that family
members were very helpful or extremely helpful in reminding
them about taking their medication.
Both having a family member with hypertension and having