Document Type : Original Article


1 1 Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences

2 Department of Public Health, Faculty of Health, Qom University of Medical Sciences, Qom, Iran

3 Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan,


INTRODUCTION: Barriers to medication adherence in patients with hypertension can have significant
differences that made researchers confute to conclude that medication adherence is required to
be more explored, and then, beneficial interventions develop to decrease these barriers. Thus, the
current study was aimed to identify barriers to adherence in Iranian society.
MATERIALS AND METHODS: A qualitative content analysis was carried out. Participants were as
follow: Patients with hypertension who had clinic records in the health centers of Isfahan University of
Medical Science. Purposive sampling method was conducted and continued until data saturation, as
well. Semi‑structured interview was selected as the best‑qualified technique to select data. Data were
analyzed using qualitative content, constant comparative analysis, and MAXQDA (Ver 10) software.
RESULTS: After study and separation of basic concepts, 1620 basic codes were extracted from
interviews. Classes were made based on codes and after multiple reviews, summarizing as well
as similarity. Primary themes were identified using more explorations and comparison of classes.
Based on the nature, the conceptual themes were named. These themes include (1) environmental
challenges of life, (2) incompatibility of patients; (3) forget to take medicine, and (4) inefficient
recommendations of family.
CONCLUSION: Findings revealed that barriers to patient adherence to the treatment had four
dimensions that may be likely useful for managers and planners in the health field to plan and intervene
regarding medication adherence as the most critical preventing factor for patients with hypertension.


1. Nourian M, Kelishadi R, Najimi A. Lifestyle interventions
and weight control of adolescents with abdominal obesity:
A Randomized controlled trial based on health belief model. Iran
Red Crescent 2017;19:e30638.
2. Sharifirad G, Najimi A, Hassanzadeh A, Azadbakht L. Does
nutritional education improve the risk factors for cardiovascular
diseases among elderly patients with type 2 diabetes? A
randomized controlled trial based on an educational model.
J Diabetes 2013;5:157‑62.
3. Ruppar TM. Randomized pilot study of a behavioral feedback
intervention to improve medication adherence in older adults
with hypertension. J Cardiovasc Nurs 2010;25:470‑9.
4. Mostafavi F, Najimi A, Sharifirad G, Golshiri P. Beliefs about
medicines in patients with hypertension: The instrument validity
and reliability in Iran. Mater Sociomed 2016;28:298‑302.
5. Whiteley JA. Exploring Predictors of Medication Adherence in
Hypertensive African Americans: What is the Role of Psychosocial
Predictors? [Ed.D.]. Ann Arbor: Teachers College, Columbia
University; 2006.
6. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA,
Izzo JL Jr., et al. The Seventh Report of the Joint NationalCommittee on prevention, detection, evaluation, and treatment
of high blood pressure: The JNC 7 report. J Am Med Assoc
7. Najimi A, Mostafavi F, Sharifirad G, Golshiri P. Barriers
to adherence to pharmacotherapy among patients with
hypertension: A cross‑sectional study. IJMRHS 2016;5:47‑53.
8. Dolder CR, Lacro JP, Leckband S, Jeste DV. Interventions to
improve antipsychotic medication adherence: Review of recent
literature. J Clin Psychopharmacol 2003;23:389‑99.
9. Krueger KP, Berger BA, Felkey B. Medication adherence and
persistence: A comprehensive review. Adv Ther 2005;22:313‑56.
10. Silverman D. Doing Qualitative Research: A Practical Handbook.
California: SAGE Publications Limited; 2013.
11. Vermeire E, Hearnshaw H, Van Royen P, Denekens J.
Patient adherence to treatment: Three decades of research.
A comprehensive review. J Clin Pharm Ther 2001;26:331‑42.
12. Claassen D, Fakhoury WK, Ford R, Priebe S. Money for
medication: Financial incentives to improve medication adherence
in assertive outreach. Psychiatrist 2007;31:4‑7.
13. Piette JD, Heisler M, Wagner TH. Problems paying out‑of‑pocket
medication costs among older adults with diabetes. Diabetes Care
14. Wu JR, Moser DK, Chung ML, Lennie TA. Predictors of
medication adherence using a multidimensional adherence model
in patients with heart failure. J Card Fail 2008;14:603‑14.
15. Mellins CA, Brackis‑Cott E, Dolezal C, Abrams EJ. The role of
psychosocial and family factors in adherence to antiretroviral
treatment in human immunodeficiency virus‑infected children.
Pediatr Infect Dis J 2004;23:1035‑41.
16. Sayers SL, Riegel B, Pawlowski S, Coyne JC, Samaha FF. Social
support and self‑care of patients with heart failure. Ann Behav
Med 2008;35:70‑9.
17. LivingstonJD, BoydJE. Correlates and consequences of internalized
stigma for people living with mental illness: A systematic review
and meta‑analysis. Soc Sci Med 2010;71:2150‑61.
18. Bender BG, Bender SE. Patient‑identified barriers to asthma
treatment adherence: Responses to interviews, focus groups,
and questionnaires. Immunol Allergy Clin North Am
19. Charmaz K, Paterniti DA. Health, Illness, and Healing: Society,
Social Context, and Self: An Anthology. New York: Roxbury
Publishing Company; 1999.
20. Jensen BO, Petersson K. The illness experiences of patients
after a first time myocardial infarction. Patient Educ Couns
21. Hunt LM, Jordan B, Irwin S, Browner CH. Compliance and the
patient’s perspective: Controlling symptoms in everyday life.
Cult Med Psychiatry 1989;13:315‑34.
22. Pop‑Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG,
Goldstein MP, De Walque D, et al. Mobile phone technologies
improve adherence to antiretroviral treatment in a resource‑limited
setting: A randomized controlled trial of text message reminders.
AIDS (London, England) 2011;25:825.
23. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X.
Interventions for enhancing medication adherence. Cochrane
Database Syst Rev 2008;CD000011.
24. MacLaughlin EJ, Raehl CL, Treadway AK, Sterling TL,
Zoller DP, Bond CA, et al. Assessing medication adherence in
the elderly: Which tools to use in clinical practice? Drugs Aging
25. McDonald HP, Garg AX, Haynes RB. Interventions to enhance
patient adherence to medication prescriptions: Scientific review.
JAMA 2002;288:2868‑79.
26. Koch T, Kralik D, Sonnack D. Women living with type II diabetes:
The intrusion of illness. J Clin Nurs 1999;8:712‑22.
27. Wilkes L, White K, O’Riordan L. Empowerment through
information: Supporting rural families of oncology patients in
palliative care. Aust J Rural Health 2000;8:41‑6.
28. Broadhead RS, Heckathorn DD, Altice FL, Van Hulst Y,
Carbone M, Friedland GH, et al. Increasing drug users’ adherence
to HIV treatment: Results of a peer‑driven intervention feasibility
study. Soc Sci Med 2002;55:235‑46.
29. Mayer KH, Stone VE. Strategies for optimizing adherence to
highly active antiretroviral therapy: Lessons from research and
clinical practice. Clin Infect Dis 2001;33:865‑72.
30. Philis‑Tsimikas A, Walker C, Rivard L, Talavera G, Reimann JO,
Salmon M, et al. Improvement in diabetes care of underinsured
patients enrolled in project dulce: A community‑based, culturally
appropriate, nurse case management and peer education diabetes
care model. Diabetes Care 2004;27:110‑5.