Illness representations in Thai women diagnosed with hypertension and relationships to medication-taking behavior.

Abstract

Hypertension is the leading cause of death among Thai women (Thai Ministry of Public Health, 1997). One hypothesis supported by the medical literature is that uncontrolled blood pressure is due to failure to adhere to the medications prescribed (National Heart Lung & Blood Institute, 2002). Therefore, a goal of hypertension management is to increase medication adherence (Home, 1998). It is important to understand illness representations that are used to help guide health decision-making behavior. The application of Leventhal's Common-Sense Model of illness representations of hypertension (1992) in Thai women is the first attempt in this population. The purpose of the current study was to explore the relationships among illness representations of hypertension (identity, timeline, consequences, and control) and factors related to blood pressure and medication-taking behavior. Thai hypertensive women (<italic> N</italic> = 253) recruited from the Ramathibodi Hospital provided demographic information and completed questionnaires in Thai language: the Family History of Hypertension, the Illness Perception Scale, the Social Support Scale, and the Medication-Taking Behavior Scale. SPSS version 12.0 was used for descriptive and correlational analyses. The mean age of the participants was 61.04 (<italic> SD</italic> = 9.32) and the majority had received a 4<super>th</super> grade education or lower. The majority of the women had uncontrolled blood pressure. Internal consistency estimates for the four attributes of illness representation demonstrated acceptable Cronbach alphas, ranging from .62-.88, thus documenting the reliability for translated version of the instrument for Thai hypertensive women. Educational level was positively related to hypertension control. Analysis of the interrelationships among the illness representation attributes revealed that consequences were positively related to identity and timeline. Identity was negatively related to control, and medication-taking behavior was positively related to timeline, control, and social support. Conversely, medication taking behavior was negatively related to identity. Diastolic blood pressure was negatively related to age but positively related to systolic blood pressure. Among the attributes of illness representations, control was the most dominant, as expected. The positive relationship noted between medication-taking behavior and control suggests a high level of compliance with prescribed medications. Limitations of this study included a convenience sample drawn from two outpatient clinics, blood pressure data being extracted from clinic records, and patients' limited ability to recall family history of hypertension all of which could pose threats to reliability of the findings. In summary, it is recommended that future research focuses on examining illness representations in Thai women based on their blood pressure control status.