Effectiveness of Hybrid Nurse-Led Self-Management Education with a Digital Pocketbook on Medication Adherence and Blood Pressure Control among Patients with Hypertension: A Quasi-Experimental Study

Q: What are the key findings of this study?

Hybrid nurse-led education with a Digital Pocketbook reduced systolic blood pressure by 17.84 mmHg (p<0.001) and increased medication adherence by 2.18 points (p<0.001) vs routine care at 8 weeks.

Q: What is the clinical evidence from this study?

Population: Primary hypertension (n=62). Intervention: Hybrid nurse-led self-management education with a Digital Pocketbook and weekly WhatsApp follow-up vs. Routine hypertension care. Primary outcome: Systolic blood pressure (mmHg) at 8 weeks (MD -17.84 mmHg, 95% CI -22.77 to -12.91, p=<0.001).

Q: What does this research mean for the field?

Hybrid nurse-led self-management education incorporating a Digital Pocketbook significantly increases medication adherence and lowers blood pressure in adults with hypertension compared to routine care. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the association between hybrid nurse-led self-management education incorporating a Digital Pocketbook and medication adherence and blood pressure outcomes among adults with hypertension.

Prima Trisna Aji; Tukimin Bin Sansuwito; Chua Siew Kuan

doi:10.31674/mjmr.2026.v010i04.03

January 1, 2026Malaysian Journal of Medical ResearchOpen Access

Effectiveness of Hybrid Nurse-Led Self-Management Education with a Digital Pocketbook on Medication Adherence and Blood Pressure Control among Patients with Hypertension: A Quasi-Experimental Study

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Key result

Hybrid nurse-led education with digital support cuts systolic blood pressure by ~18 mmHg vs routine care.

MD -17.84 mmHg
95% CI -22.77 to -12.91
P<0.001
n=62

Why the study?

Sustained medication adherence and effective self-management are essential for hypertension control, motivating evaluation of hybrid nurse-led self-management education incorporating a Digital Pocketbook on medication adherence and blood pressure outcomes.

Does an eight-week hybrid nurse-led self-management education programme incorporating a Digital Pocketbook and weekly WhatsApp follow-up improve medication adherence and reduce blood pressure in adults with primary hypertension?

Key Points

To examine the association between hybrid nurse-led self-management education incorporating a Digital Pocketbook and medication adherence and blood pressure outcomes among adults with hypertension.
Non-randomized quasi-experimental pretest–posttest control-group design among 62 adults with hypertension (n = 31 intervention, n = 31 control) at a primary healthcare facility in Central Java, Indonesia.
The eight-week intervention combined an individualized 60-minute nurse-led education session, an evidence-based Digital Pocketbook, and weekly WhatsApp follow-up, while controls received routine care.
Outcomes were self-reported medication adherence measured via the eight-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure assessed by automated sphygmomanometer, analyzed using ANCOVA adjusting for baseline values.
The intervention group demonstrated significantly higher medication adherence scores post-intervention compared with controls (adjusted mean difference = 2.18; 95% CI: 1.56 to 2.80; p < 0.001).
Systolic blood pressure was significantly lower in the intervention group than in the control group (adjusted mean difference = −17.84 mmHg; 95% CI: −22.77 to −12.91; p < 0.001).
Diastolic blood pressure also showed a significant reduction favoring the intervention group (adjusted mean difference = −11.05 mmHg; 95% CI: −14.34 to −7.76; p < 0.001).

Structured PICO

Does an eight-week hybrid nurse-led self-management education programme incorporating a Digital Pocketbook and weekly WhatsApp follow-up improve medication adherence and reduce blood pressure in adults with primary hypertension?

P

Population

62 adults with primary hypertension (mean age ~57 years, 50% female) receiving antihypertensive treatment at a primary healthcare facility in Indonesia, followed for 8 weeks.

I

Intervention

Eight-week hybrid nurse-led self-management education programme combining one individualized face-to-face educational session (approximately 60 minutes), a Digital Pocketbook (containing educational content, illustrations, infographics, medication reminders, self-monitoring records, and lifestyle guidance), and weekly reinforcement via WhatsApp over eight consecutive weeks, integrated into routine hypertension care.

C

Comparator

Routine hypertension care, including standard medical consultation, prescribed antihypertensive treatment, and routine health education, without the structured educational programme, digital pocketbook, scheduled weekly WhatsApp follow-up, or attention-matched activity.

O

Outcome

Three primary outcomes evaluated at 8 weeks: self-reported medication adherence measured using the eight-item Morisky Medication Adherence Scale (MMAS-8), and systolic and diastolic blood pressure measured using standardized automated procedures (Omron HEM-7156).surrogate

Main Result

Mean Difference: -17.84 (95% CI -22.77–-12.91)

Absolute Event Rate: 132.48% vs 149.87%

p-value: p=<0.001

In a primary care setting in Indonesia, an eight-week hybrid nurse-led self-management programme utilizing a digital pocketbook and weekly WhatsApp follow-up was associated with significant short-term improvements in self-reported medication adherence and substantial reductions in systolic and diastolic blood pressure among adults with hypertension.

Limitations

Non-randomized group allocation based on geographical residence, risking residual confounding
Lack of blinding for participants, nurses, and outcome assessors
Self-reported medication adherence (MMAS-8) subject to recall and social-desirability bias without objective verification
Control group did not receive an attention-matched activity to account for increased nurse contact
Digital pocketbook underwent qualitative expert review rather than formal quantitative psychometric validation
Small sample size (N=62) at a single primary healthcare facility with short (8-week) follow-up
Non-randomized group allocation based on geographical area of residence cannot eliminate potential residual confounding or selection bias.
Lack of blinding for participants, nurses, and outcome assessors introduces potential performance and detection bias.
Medication adherence was self-reported using MMAS-8 without objective verification (such as pill counts, pharmacy-refill records, or electronic monitoring), making it susceptible to recall or socially desirable reporting.
No attention-matched activity was provided to the control group, resulting in differing amounts of healthcare-professional contact between groups.
Actual intervention fidelity was not quantified using a formal fidelity measure, and the digital pocketbook underwent qualitative expert review rather than formal psychometric validation.

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Implication

Should not yet change hypertension practice; hypothesis-generating for hybrid nurse-led digital interventions in randomized trials.

Abstract

Background: Sustained medication adherence and effective self-management are essential for hypertension control. This study examined the association between hybrid nurse-led self-management education incorporating a Digital Pocketbook and medication adherence and blood pressure outcomes among adults with hypertension. Methods: A non-randomized quasi-experimental study with a pretest–posttest control-group design involved 62 adults with hypertension at a primary healthcare facility in Central Java, Indonesia. Participants were allocated to an intervention group (n = 31) or control group (n = 31). The eight-week intervention combined individualized nurse-led education, a Digital Pocketbook, and weekly WhatsApp follow-up, while controls received routine care. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8), and blood pressure was measured using standardized automated procedures. Analysis of covariance (ANCOVA) adjusted for baseline outcome values. Results: Compared with controls, the intervention group demonstrated higher medication adherence (adjusted mean difference = 2.18; 95% CI: 1.56–2.80), lower systolic blood pressure (−17.84 mmHg; 95% CI: −22.77 to −12.91), and lower diastolic blood pressure (−11.05 mmHg; 95% CI: −14.34 to −7.76). All comparisons were statistically significant (p < 0.001), including after Bonferroni correction. Conclusions: Hybrid nurse-led education incorporating a Digital Pocketbook was associated with improved self-reported medication adherence and reduced blood pressure over eight weeks. Larger randomized trials with objective adherence measures and longer follow-up are needed to establish effectiveness and sustainability.

Discussion

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Cite This Study

Aji et al. (2026) studied Primary hypertension (n=62). Hybrid nurse-led self-management education with a Digital Pocketbook and weekly WhatsApp follow-up vs. Routine hypertension care was evaluated on Systolic blood pressure (mmHg) at 8 weeks (MD -17.84 mmHg, 95% CI -22.77 to -12.91, p=<0.001). Hybrid nurse-led education with a Digital Pocketbook reduced systolic blood pressure by 17.84 mmHg (p<0.001) and increased medication adherence by 2.18 points (p<0.001) vs routine care at 8 weeks.

synapsesocial.com/papers/6af0e999de503f37741409d6 https://doi.org/10.31674/mjmr.2026.v010i04.03

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Effectiveness of Hybrid Nurse-Led Self-Management Education with a Digital Pocketbook on Medication Adherence and Blood Pressure Control among Patients with Hypertension: A Quasi-Experimental Study

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Effectiveness of Hybrid Nurse-Led Self-Management Education with a Digital Pocketbook on Medication Adherence and Blood Pressure Control among Patients with Hypertension: A Quasi-Experimental Study

Key Points

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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