Effectiveness of Nursing Instructional Program on Medication Adherence for Patients with Heart Failure
DOI:
https://doi.org/10.31674/mjn.2025.v16i03.008Abstract
Background: Heart failure (HF) is an important cause of death, first described as an emerging epidemic about 25 years ago. The frequency of HF keeps increasing, despite efforts to stop or delay the beginning of cardiovascular disease. Presently, the overall number of heart failure patients continues to rise due to the ageing and growing populations in certain areas. Objective: To evaluate the effectiveness of the nursing instructional program on medication adherence for patients with heart failure. Methods: A quasi-experimental design was used. A non-probability purposive sample of 70 patients was selected consisting of a study group that were exposed to the nursing instructional program, and a control group. A well-designed questionnaire consisting of three parts Demographic Data, Clinical Data and Morisky Medication Adherence Scale (MMAS-8) was constructed. Results: The study's findings indicated that medication adherence and pre-test scores were not significantly different for the study group from the control group, but post-test medication adherence scores were higher in the study group than the control group. Conclusion: The implementation of the instructional session significantly improved medication adherence among patients in the study group compared to the control group. This observed difference highlights the effectiveness of the instructional program in enhancing adherence, underscoring its potential as a targeted intervention for improving patient outcomes. It is necessary to add an instructional and guidance nursing unit to improve health outcomes for heart failure patients by providing an integrated counselling program for all patients.
Keywords:
Heart Failure Management, Instructional Program, Medication AdherenceDownloads
References
Abdulhussein, Z. Q., & Abd-Ali, D. K. (2020). Factors affecting self-care behaviors of patients with heart failure. Medico-Legal Update, 20(1), 955-960. https://doi.org/10.37506/mlu.v20i1.494
Ahmed, S. M. K., & Abd El-Aziz, N. M. (2017). Effect of medical and nursing teaching program on awareness and adherence among elderly patients with chronic heart failure in Assiut, Egypt. The Egyptian Journal of Internal Medicine, 29, 47-53. https://doi.org/10.4103/ejim.ejim_21_17
Al-Hchaim, M. H. S., Abdullah, A., & Ali, B. R. M. (2018). Assessment of self-care activities among patients with heart failure. International Research Journal of Natural and Applied Sciences, 5(4), 184-197.
Casas, G., Limeres, J., Oristrell, G., Gutierrez-Garcia, L., Andreini, D., Borregan, M., ... & Rodríguez-Palomares, J. F. (2021). Clinical risk prediction in patients with left ventricular myocardial noncompaction. Journal of The American College of Cardiology, 78(7), 643-662. https://doi.org/10.1016/j.jacc.2021.06.016
Cheng, C., Donovan, G., Al-Jawad, N., & Jalal, Z. (2023). The use of technology to improve medication adherence in heart failure patients: a systematic review of randomised controlled trials. Journal of Pharmaceutical Policy and Practice, 16(1). https://doi.org/10.1186/s40545-023-00582-9
Coats, A. J. S. (2019). Ageing, demographics, and heart failure. European Heart Journal Supplements, 21(Supplement_L), L4-L7. https://doi.org/10.1093/eurheartj/suz235
Deaton C. (2024). Understanding medication adherence in patients with heart failure: commentary. European Journal of Cardiovascular Nursing, 23(6), e104–e105. https://doi.org/10.1093/eurjcn/zvae029
Dunlay, S. M., Eveleth, J. M., Shah, N. D., McNallan, S. M., & Roger, V. L. (2011). Medication adherence among community-dwelling patients with heart failure. Mayo Clinic Proceedings, 86(4), 273–281. https://doi.org/10.4065/mcp.2010.0732
FarzanehRad, A., Allahbakhshian, A., Gholizadeh, L., Khalili, A. F., & Hasankhani, H. (2024). Randomized comparison of the effects of tailored text messaging versus pillbox organizers on medication adherence of heart failure patients. BMC Cardiovascular Disorders, 24(1). https://doi.org/10.1186/s12872-024-03884-1
Granger, B. B., Ekman, I., Hernandez, A. F., Sawyer, T., Bowers, M. T., DeWald, T. A., ... & Bosworth, H. B. (2015). Results of the chronic heart failure intervention to improve medication adherence study: a randomized intervention in high-risk patients. American Heart Journal, 169(4), 539-548. https://doi.org/10.1016/j.ahj.2015.01.006
Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart failure. European Journal of Heart Failure, 22(8), 1342-1356. https://doi.org/10.1002/ejhf.1858
Grove, S. K., & Gray, J. R. (2018). Understanding nursing research: Building an evidence-based practice. Elsevier health sciences. 7th Edition. Retrieved from; https://shop.elsevier.com/books/understanding-nursing-research/grove/978-0-323-53205-1. Accessed on 28th February, 2024.
Grove, S. K., Burns, N., & Gray, J. R. (2012). The practice of nursing research-E-book: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences. Retrieved from; https://books.google.co.in/books/about/The_Practice_of_Nursing_Research.html?id=r32jPNVYIacC&redir_esc=y . Accessed on 13th December, 2023.
Ibraheem, M. H., Amin, H. E., & Allawy, M. E. A. (2023). Effect of instructional scheme on adherence to health recommendations among patients with congestive heart failure. Trends in Nursing and Health Care Journal, 7(2), 120-141. https://doi.org/10.21608/tnhcj.2023.230785.1027
Jarrah, M., Khader, Y., Alkouri, O., Al-Bashaireh, A., Alhalaiqa, F., Al Marzouqi, A., ... & Oweis, A. (2023). Medication adherence and its influencing factors among patients with heart failure: A cross-sectional study. Medicina, 59(5). https://doi.org/10.3390/medicina59050960
Kittan, A. A. H., & Hamza, R. A. H. (2020). Effectiveness of an instructional programs on patient’s knowledge regarding self-care management after ischemic heart disease. Indian Journal of Forensic Medicine & Toxicology, 14(1), 1111-1116. https://doi.org/10.37506/ijfmt.v14i1.207
Kristinawati, B., Wijayanti, N., & Mardana, N. (2023). Improving medication adherence of patients with heart failure using tele-motivational interviewing. European Review for Medical and Pharmacological Sciences, 27(21), 10171–10180. https://doi.org/10.26355/eurrev_202311_34293
Mahmoud Abd Elaziz, N., Mustafa Kasem, S., & Zaki Azer, S. (2017). Effect of Nursing Teaching Program on Awareness and Adherence among Patients with Chronic Heart Failure Disease. Egyptian Journal of Health Care, 8(3), 195-207. https://doi.org/10.21608/ejhc.2017.47307
Malik, R., Begum, S., & Afridi, M. N. (2016). Acute myocardial infarction: Frequency of modifiable risk factors. The Professional Medical Journal, 23(03), 293-297. https://doi.org/10.29309/TPMJ/2016.23.03.1476
Mohamed, A. E. R., Said Habib, N., Mohamed, G., Radwan El-Nahas, M., & Hafez, E. E. (2021). Effect of instructional program on patients' knowledge regarding adherence to therapeutic regimen of type 2 diabetes mellitus. port Said Scientific Journal of Nursing, 8(2), 204-222. https://doi.org/10.21608/pssjn.2021.186883
Nelson, A. J., Pagidipati, N. J., & Bosworth, H. B. (2024). Improving medication adherence in cardiovascular disease. Nature Reviews Cardiology, 21(6), 417-429. https://doi.org/10.1038/s41569-023-00972-1
Oh, E. H., Kim, C. J., & Schlenk, E. A. (2024). A predictive model for medication adherence in older adults with heart failure. European Journal of Cardiovascular Nursing, 23(6), 635–643. https://doi.org/10.1093/eurjcn/zvae021
Rashidi, A., Kaistha, P., Whitehead, L., & Robinson, S. (2020). Factors that influence adherence to treatment plans amongst people living with cardiovascular disease: A review of published qualitative research studies. International Journal of Nursing Studies,110. https://doi.org/10.1016/j.ijnurstu.2020.103727
Rasmussen, A. A., Wiggers, H., Jensen, M., Berg, S. K., Rasmussen, T. B., Borregaard, B., ... & Johnsen, S. P. (2021). Patient-reported outcomes and medication adherence in patients with heart failure. European Heart Journal-Cardiovascular Pharmacotherapy, 7(4), 287-295. https://doi.org/10.1093/ehjcvp/pvaa097
Rezaei, S., Vaezi, F., Afzal, G., Naderi, N., & Mehralian, G. (2022). Medication adherence and health literacy in patients with heart failure: a cross-sectional survey in Iran. Health Literacy Research and Practice, 6(3), e191–e199. https://doi.org/10.3928/24748307-20220718-02
Ruppar, T. M., Cooper, P. S., Mehr, D. R., Delgado, J. M., & Dunbar-Jacob, J. M. (2016). Medication adherence interventions improve heart failure mortality and readmission rates: systematic review and meta-analysis of controlled trials. Journal of the American Heart Association, 5(6). https://doi.org/10.1161/JAHA.115.002606
Ruppar, T. M., Delgado, J. M., & Temple, J. (2015). Medication adherence interventions for heart failure patients: A meta-analysis. European Journal of Cardiovascular Nursing, 14(5), 395–404. https://doi.org/10.1177/1474515115571213
Savarese, G., Becher, P. M., Lund, L. H., Seferovic, P., Rosano, G. M. C., & Coats, A. J. S. (2023). Global burden of heart failure: A comprehensive and updated review of epidemiology. Cardiovascular Research, 118(17), 3272–3287. https://doi.org/10.1093/cvr/cvac013
Sayiner, Z. A., Savaş, E., Kul, S., & Morisky, D. E. (2020). Validity and reliability of the Turkish Version of the 8-Item Morisky Medication Adherence Scale in patients with type 2 diabetes. European Journal of Therapeutics, 26(1), 47-52. https://doi.org/10.5152/eurjther.2020.19132
Shah, D., Simms, K., Barksdale, D. J., & Wu, J. R. (2015). Improving medication adherence of patients with chronic heart failure: Challenges and solutions. Research Reports in Clinical Cardiology, 6, 87-95. https://doi.org/10.2147/RRCC.S50658
Wu, J. R., Moser, D. K., Lennie, T. A., Peden, A. R., Chen, Y. C., & Heo, S. (2008). Factors influencing medication adherence in patients with heart failure. Heart & Lung: The Journal of Critical Care, 37(1), 8–16. https://doi.org/10.1016/j.hrtlng.2007.02.003
Zhang, Y., Wang, R., Chen, Q., Dong, S., Guo, X., Feng, Z., & Rao, Y. (2021). Reliability and validity of a modified 8-item Morisky Medication Adherence Scale in patients with chronic pain. Annals of Palliative Medicine, 10(8), 9088–9095. https://doi.org/10.21037/apm-21-1878
Zheng, F., Ding, S., Lai, L., Liu, X., Duan, Y., Shi, S., & Zhong, Z. (2020). Relationship between medication literacy and medication adherence in in patients with coronary heart disease in Changsha, China. Frontiers in Pharmacology, 10. https://doi.org/10.3389/fphar.2019.01537
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Malaysian Journal of Nursing (MJN)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
