What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=253). Intervention: Hypertensive medication vs. null. Primary outcome: Adherence to hypertension treatment (ARR 8.58, 95% CI 1.23–83.28, p=0.031).

What does this research mean for the field?

The adherence to hypertension treatment among patients with cost-free access is extremely low at 11.1%. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

February 2, 2026Open Access

The predictors of treatment adherence among hypertensive patients with cost-free access

FNFelix Kwasi Nyande KKKennedy Diema KonlanUniversity of Health and Allied Sciences LALinda Serwaa AsiamahUniversity of Health and Allied Sciences

Key Result

The adherence to hypertension treatment among patients with cost-free access is extremely low at 11.1%.

Key Points

This study aims to identify predictors of treatment adherence among hypertensive patients with cost-free access in Ghana.
Conducted a cross-sectional descriptive study with 254 respondents.
Administered a questionnaire to assess adherence levels and influencing factors.
Utilized bivariate and generalised linear models for data analysis, comparing logistic and complementary log-log regression models.
88.9% of respondents exhibited low adherence to treatment.
Age, sex, location, busy schedule, time spent, and accessibility were significant predictors of adherence.
The complementary log-log regression model demonstrated better fitting compared to logistic regression based on AIC and BIC values.

Study Design

Type

Cross-Sectional (n=253)

Multicenter

Structured PICO

Population

253 hypertensive patients (staff or dependents) with cost-free access to treatment at the Volta River Authority (VRA) hospital at Akosombo, Ghana, clinically diagnosed for at least six months and on antihypertensive medication.

Intervention

Cost-free access to antihypertensive medication through a workplace policy

Outcome

Level of adherence to hypertensive medication measured by an adapted 8-item scalepatient reported

Despite cost-free access to antihypertensive medications, adherence remains extremely low (11.1%), highlighting the critical role of non-cost barriers such as accessibility, busy schedules, and time spent at the facility.

Main Result

Effect estimate: ARR 8.58 (95% CI 1.23–83.28)

p-value: p=0.031

Limitations

Single-center study may not represent broader populations.
Cross-sectional design limits causal conclusions.
Self-reported adherence may introduce bias.

Abstract

The level and predictors of medication adherence have not been given attention among populations for whom the cost of treatment is not a concern, especially in the Ghanaian healthcare setting. This study compared generalised linear models to determine the factors associated with adherence to treatment among hypertensive patients with a workplace policy that offers cost-free access in Ghana. We conducted a cross-sectional descriptive study to investigate the level of adherence and factors that influence practice among hypertensive patients with cost-free access to treatment. A total of 254 respondents were conveniently sampled and administered a questionnaire. The predictors of treatment adherence were assessed using Bivariate and generalised linear models (logistic and complementary log-log regression models). The complementary log-log regression model outperformed the logistic regression model in fitting the relationships in the data, by reporting lower AIC and BIC, and higher Nagelkerke and Cox and Snell pseudo-R-squared values. Most (88.9%) respondents scored low adherence, and only 11.1% adhered to treatment. The factors that affect adherence to hypertension medication included age (ARR = 8.58, 95%CI 1.23-83.28, p-value = 0.031), sex (ARR = 0.19, 95%CI 0.03-0.91, p-value = 0.042), location (ARR = 10.78, 95%CI 2.01-79.76, p-value = 0.007), busy schedule (ARR = 0.03, 95%CI 0.00-0.30, p-value = 0.016), time spent (ARR = 0.05, 95%CI 0.00-0.28, p-value = 0.002) and accessibility (ARR = 17.89, 95%CI 4.03-112.38, p-value < 0.001). The high level of non-adherence to treatment among patients, even when the cost of treatment is not a barrier, could contribute to overall treatment outcomes. Despite cost-free access, adherence remains low, highlighting the need for further investigation into non-cost barriers affecting treatment compliance. In addition, there is a need to design and implement measures to improve adherence among patients with hypertension in the country.

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