Illness perception, health literacy, and medication adherence in hypertension: A dyadic perspective
Introduction
Hypertension is a prevalent and preventable cause of mortality worldwide, affecting approximately 1.42 billion individuals globally, with projections indicating a rise to 1.56 billion by 2030. In China, the prevalence exceeds 25.2% among adults aged 18 and above, and rises to over 50% in those older than 60. The prevalence is notably higher in northern regions than in the south, with a narrowing gap between urban and rural areas. Major risk factors include high dietary salt intake, abdominal obesity, sedentary behavior, smoking, and aging, which increases risk fivefold in individuals over 65 years old. Hypertension significantly elevates the risk of cardiovascular diseases, such as stroke and myocardial infarction, as well as kidney and retinal complications. Globally, hypertension-related diseases are responsible for around 10 million deaths annually, and in China, over 40% of cardiovascular and cerebrovascular fatalities are directly attributed to hypertension.
Illness Perception, Health Literacy, and Medication Adherence
Mueller et al. found that individuals with higher health literacy were better able to comprehend medication instructions, resulting in improved adherence. Illness perception refers to a patient’s subjective understanding of their disease, shaped by personal knowledge and experiences. According to Chen et al., a stronger perception of illness severity correlates with heightened risk awareness and increased motivation for self-management, which in turn enhances adherence to prescribed medications. Moreover, health literacy may mediate this relationship, as patients’ comprehension of their illness influences their capacity to seek, understand, and apply health information effectively.
Actor-Partner Interdependence Model (APIM)
The Actor-Partner Interdependence Model (APIM) emphasizes the interdependent nature of dyadic relationships, particularly among close pairs such as spouses, and their influence on emotional, cognitive, and behavioral health outcomes. APIM allows simultaneous examination of an individual’s influence on their own outcomes (actor effect) and their influence on their partner’s outcomes (partner effect).
Study Findings
The study revealed that both hypertensive patients and their spouses exhibit moderate levels of illness perception, consistent with previous studies. However, health literacy levels in both groups were relatively low, lower than those reported by Lor et al. Medication adherence among patients was also suboptimal. This may be attributed to the adaptive cognitive mechanisms commonly found in chronic disease contexts.
Discussion
The findings suggest that incorporating spouses into chronic disease management programs through family-based education, skills training, and collaborative goal-setting may significantly enhance treatment outcomes and long-term adherence. Spousal health literacy plays a crucial role in linking the patient’s perception of illness to their medication-taking behavior. The spouse’s health literacy functions as a critical link between illness perception and medication adherence, emphasizing the importance of a robust familial support structure in chronic disease care.
Conclusion
The study highlights the importance of addressing both patients and their spouses in clinical interventions, focusing on strengthening the spouse’s role as a "collaborator" and optimizing patient self-management with personalized medication guidance and health literacy education.
