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. 2019 Mar;15(2):82-92.
doi: 10.22122/arya.v15i2.1807.

Prevalence of medication adherence in patients with hypertension in Iran: A systematic review and meta-analysis of studies published in 2000-2018

Mehdi Jafari Oori  1 , Farahnaz Mohammadi  2 , Kian Norouzi-Tabrizi  3 , Masoud Fallahi-Khoshknab  4 , Abbas Ebadi  5
Affiliations

Prevalence of medication adherence in patients with hypertension in Iran: A systematic review and meta-analysis of studies published in 2000-2018

Mehdi Jafari Oori et al. ARYA Atheroscler. 2019 Mar.

Abstract

Background: Medication adherence (MA) has a crucial role in controlling of hypertension (HTN). A difference was observed in the prevalence of anti-hypertensive MA reported in different studies in Iran, so we aimed to determine the overall prevalence of MA.

Methods: Using the English and Persian keywords extracted from Mesh, the databases of MagIran, Barakat Knowledge Network System, Scientific Information Database (SID), Web of Sciences, PubMed, Science Direct, and Google Scholar were reviewed from 2000 to 2018. The overall prevalence of MA was estimated using Random effect mode. The I2 and Egger's tests were used to assess heterogeneity and publication bias, respectively. Meta-regression and subgroup analysis were conducted based on variables such as age, marital status, regions, and tools.

Results: The overall prevalence of MA was 33%. Moreover, the prevalence of MA based on the 8-Item Morisky Medication Adherence Scale (MMAS-8), Hill-Bone Medication Adherence (HBMA) scale, researcher-made tools, and self-care tools, were 13%, 34%, 48%, and 47%, respectively. A higher MA prevalence (38%) was observed among older adults compared to other age groups, and married patients (32%) compared to single (23%) individuals. The highest MA prevalence (50%) was related to region 5 of the country. Meta-regression results showed a significant relationship between the used tools and MA prevalence.

Conclusion: The overall prevalence of MA is low in Iran. Furthermore, MA was measured using different questionnaires, such as standard international scales and researcher-made tools. It is proposed that a standard international questionnaire should be used in future studies.

Keywords: Hypertension; Iran; Medication Adherence; Meta-Analysis; Prevalence; Systematic Review.

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Figures

Figure 1
Figure 1
The process of selecting the primary articles according to preferred reporting items for systematic reviews and meta-analyses (PRISMA)
Figure 2
Figure 2
The forest plot of the overall prevalence of medication adherence CI: Confidence interval; MA: Medication adherence
Figure 3
Figure 3
The forest plot of the prevalence of medication adherence in the studies with dichotomous and Likert scales CI: Confidence interval; MA: Medication adherence
Figure 4
Figure 4
Forest plot, the prevalence of medication adherence based on questionnaires CI: Confidence interval; MA: Medication adherence
Figure 5
Figure 5
Forest plots of the prevalence of MA based on the five regions* of the country for all studies (Left) and the 6 studies using the MMAS-8 tool (Right) CI: Confidence interval; MA: Medication adherence; MMAS-8: 8-Item Morisky Medication Adherence Scale *(Region 1: Tehran, Alborz, Qazvin, Mazandaran, Semnan, Golestan, and Qom provinces ; Region 2: Isfahan, Fars, Bushehr, Chaharmahal Bakhtiari, Hormozgan, and Kohkiloyeh and Boyerahmad provinces; Region 3: East Azarbaijan, West Azarbaijan, Ardebil, Zanjan, Gilan, and Kurdistan provinces; Region 4: Kermanshah, Ilam, Lorestan, Hamedan, Central, and Khuzestan provinces; Region 5: Khorasan Razavi, Southern Khorasan, Northern Khorasan, Kerman, Yazd, and Sistan and Baluchestan provinces)
Figure 6
Figure 6
The meta-regression graph of the relationship of the used scales (Right) and the regions (Left) with the prevalence of medication adherence MMAS-8: 8-Item Morisky Medication Adherence Scale; MA: Medication adherence
Figure 7
Figure 7
Egger’s test diagram
See this image and copyright information in PMC

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