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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015
32
AFRICA
In Ushie and Jegede’s study
22
on the paradox of family
support, concerns of tuberculosis-infected HIV patients about
involving family and friends in their treatment reported that
family support was
expressly
seen by participants as central
to medication adherence but one of the main drawbacks to its
maximal utilisation was fear of condemnation and stigma from
family members and friends, and from the family as a whole,
which makes people with HIV and/or TB hide their status.
Chronic illnesses that require life-long treatment (such as
hypertension and diabetes) pose unique challenges in such a
context, not least of which is the need to maintain the motivation
to adhere to treatment for many years. The need to understand
social support in such a context was the primary motivation of
this study.
In the present study, those who had support from friends or
family members (concerned about their illness, giving reminders
about medication) showed better treatment compliance than
those who did not, although this difference was greatest for those
who had the support of friends. This is an important finding
and is consistent with what has been reported for multiple
chronic diseases in several parts of the world.
23,24
Interestingly,
the evidence from this study shows that support from friends is a
stronger factor influencing good compliance than support from
family members.
By contrast, Marin-Reyes and Rodriguez-Moran
11
found
that compliance with hypertensive treatment was directly linked
to the support of family members. The findings of the present
study may be a reflection of the fact that most people in this
urban community (and in cities in general) talk and interact
more with their friends than with their family members who do
not live nearby. In this regard, it would be important to study
people who live in rural areas where living in extended-family
and multi-generational households is more common. Another
explanation may be that those with hypertension are more likely
to discuss their health problems with their friends than with
family members, thereby inadvertently limiting the support they
could receive from the latter.
Given the role played by social support in compliance with
hypertension treatment in this community, it was instructive
to attempt to identify the factors associated with receiving
such support. While a specific subset of factors (demographic
factors) was explored in this study, age, marital status, religion
and educational level were each associated with receiving social
support. Each of these factors is noteworthy. However, it is
difficult to evaluate how demographic factors interact with the
larger set of factors known to be associated with social support.
For example, it is known that marked cultural differences exist in
the types and effectiveness of social support, as well as in how
people use their support networks.
23
These cultural differences
may underlie some or most of the apparent relationships with
demographic factors observed in this study.
The findings of this study suggest ways in which social
support could be used in the treatment of hypertension in this
community. First, it would seem that adding social support to
treatment guidelines could improve awareness by healthcare
providers of this important component of treatment compliance.
Second, teaching health providers how to explore and utilise
their patients’ social support networks may help to improve
treatment compliance. Third, exploring the use of existing social
networks (e.g. peer groups, cultural groups, religious groups) in
this and similar communities may impact on how social support
can be leveraged to improve health behaviours.
To our knowledge, this is the first study focused on social
support with regard to treatment compliance in hypertension
or cardiovascular disease in Nigeria. The strengths of the study
include a large sample size, focus on a single non-communicable
condition, which limits heterogeneity from differing diseases
and their treatments, and a community-based design, which
better permits generalisation than a hospital-based design.
Limitations include a cross-sectional design, which does not
permit identification of cause and effect, and the use of self-
report measures.
However, this was an exploratory study and more studies
are needed to confirm and extend the findings. Such studies
should be designed to ameliorate or overcome the limitations
of the present study, including the use of more comprehensive
and validated social support assessment tools, collecting more
variables on each subject, inclusion of qualitative methods, and
Table 3. Social demographic characteristics and receiving social support among Nigerians with hypertension
Characteristic
n
Support
+
from family
n
(%)
χ
2
(p-value)
Support
+
from friends
n
(%)
χ
2
(p-value)
Age group
25–55 years
171
101 (59.1)
37.28
58 (33.9)
0.11
>
55 years
223
223 (85.1)
(
p
≤
0.001)*
93 (35.5)
(
p
=
0.736)
Gender
Male
137
99 (72.3)
1.34
56 (40.9)
3.17
Female
275
213 (77.5)
(
p
=
0.247)
88 (32.0)
(
p
=
0.075)
Current marital status
Unmarried
128
219 (70.2)
11.93
121 (38.8)
6.74
Married
312
110 (85.9)
(
p
=
0.0006)*
33 (25.8)
(
p
=
0.009)*
Religion
Islam
270
217 (80.1)
10.51
108 (39.9)
7.30
Christianity
169
112 (66.3)
(
p
=
0.001)*
46 (27.2)
(
p
=
0.007)*
Educational level
No formal education
225
190 (84.4)
22.83
77 (34.2)
0.12
Some education
215
139 (64.7)
(
p
≤
0.001)*
77 (35.8)
(
p
=
0.726)
+
Support defined as being ‘helpful’ or ‘very helpful’ in reminding of medication. *
p
<
0.05.