Overview
Hypertension is a leading modifiable risk factor for cardiovascular disease worldwide. In urban Morocco, women with hypertension face unique challenges that affect their ability to consistently take prescribed medications. This study examines how common medication adherence is among women attending urban primary health care facilities in Inezgane and identifies the factors that influence adherence, with implications for clinicians, policymakers, and patients alike.
Study Design and Setting
Using a cross-sectional design, the study recruited women aged 18 years and older who had a diagnosis of hypertension and were attending selected urban primary health care centers in Inezgane, Morocco. Adherence was assessed with a validated self-report tool, complemented by pharmacy refill data where available. The analysis explored sociodemographic, clinical, and psychosocial determinants of adherence, including age, education, income, duration of hypertension, comorbidities, perceived social support, and access to healthcare services.
Key Findings: Prevalence of Adherence
The overall adherence rate among participating women was moderate, with X% reporting adherence at a level consistent with guideline-based targets (e.g., taking medications as prescribed most days in the past month). A notable minority demonstrated high adherence, while a larger proportion fell into low adherence, highlighting a critical gap in sustained pharmacologic control of blood pressure. These results align with regional patterns that show adherence is often hindered by daily routines, side effects, and competing life demands.
Determinants of Adherence
The analysis identified several factors independently associated with better adherence:
- Age and duration of hypertension: Women with a longer history of hypertension reported higher adherence, possibly due to greater familiarity with medications and perceived risk.
- Education and health literacy: Higher educational attainment correlated with improved understanding of hypertension and the importance of consistent medication use.
- Socioeconomic status: Greater household income and better access to affordable medications were linked to higher adherence, underscoring the role of financial barriers.
- Social support: Perceived support from family and community was positively associated with adherence, suggesting that reminders and encouragement can influence daily routines.
- Access to care: Regular contact with healthcare providers, including reminder systems and follow-up appointments, supported better adherence.
Conversely, certain factors were associated with lower adherence:
- Comorbid mental health concerns or high perceived stress: These elements were linked to poorer medication-taking behavior in some participants.
- Side effects and complex regimens: Medication burden and adverse effects reduced adherence for a portion of the sample.
- Work and caregiving responsibilities: Busy schedules and competing demands hindered consistent medication intake.
Implications for Practice
The findings highlight actionable opportunities to improve adherence among women with hypertension in Inezgane. Clinicians can tailor interventions to patient realities by:
- Simplifying regimens where possible and discussing long-acting or combination therapies to reduce pill burden.
- Enhancing patient education with culturally appropriate materials that reinforce the importance of daily adherence and blood pressure monitoring.
- Strengthening social support networks, including family-centered counseling and adherence reminders.
- Addressing financial barriers by connecting patients with affordable medication programs or generic alternatives.
- Implementing regular follow-up, medication reconciliation, and side-effect management during primary care visits.
Public Health Considerations
Urban primary health care facilities in Inezgane play a crucial role in hypertension management. Strategies that integrate adherence-supportive services into routine care—such as patient education sessions, pharmacist-led counseling, and community health worker outreach—can improve blood pressure control at the population level and reduce cardiovascular risk for women in this setting.
Limitations and Future Research
The cross-sectional design limits causal inference about determinants of adherence. Self-reported adherence may be subject to social desirability bias. Future longitudinal studies are needed to track adherence trajectories over time and to test targeted interventions that address identified barriers in this population.
Conclusion
Medication adherence among women with hypertension attending urban primary health care facilities in Inezgane, Morocco, shows room for improvement. By addressing education, financial barriers, social support, and care access, health systems can enhance adherence and contribute to better blood pressure control and cardiovascular health outcomes for women in this community.
