Empowerment Education to Increase Medication Adherence among Older People with Hypertension in Rural Areas in Indonesia

Authors

DOI:

https://doi.org/10.5294/aqui.2026.26.1.3

Keywords:

Empowerment Education, Hypertension, Medication Adherence, Elderly, Rural Area

Abstract

Introduction: Empowerment is one of the effective approaches to promoting health behavior change and improving medication adherence in older people. Objective: We aimed to investigate the effectiveness of empowerment education in enhancing medication adherence among older people with hypertension. Methods: We used a quantitative approach with a quasi-experimental design. Older people with hypertension were randomly divided into an intervention group (n=22) that received empowerment education and a control group (n=22) that received standard care from the health center. The empowerment education program included information about hypertension, the importance of medication adherence, and techniques to manage hypertension through lifestyle modification. Medication adherence was measured using the Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire. Statistical Analysis: To determine blood pressure and the category of compliance with taking geriatric medication from pre-, post-test, and follow-up in the intervention and control groups (within-subject), the Friedman Test post hoc and the Wilcoxon test were conducted. To determine the difference in blood pressure and the category of compliance with taking geriatric medication from pre, post-test, and follow-up between the intervention group and control group (between-subject), the Mann-Whitney Test was conducted, and to assess the strength of the effect size, the Cohen Effect Size test was applied. Results: Medication adherence in the intervention group showed a significant increase in adherence (p = 0.000) with a moderate effect size (d > 0.5). Meanwhile, medication adherence in the control group was not significant (p = 0.392). Conclusion: This intervention can be an option for nurses to help hypertensive older people improve their medication adherence and, in turn, their quality of life.

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References

WHO. Hypertension [Internet]. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension

Nawi AM, Mohammad Z, Jetly K, Razak MAA, Ramli NS, Ibadullah WAHW, et al. The Prevalence and Risk Factors of Hypertension among the Urban Population in Southeast Asian Countries: A Systematic Review and Meta-Analysis. Salvetti M, editor. Int J Hypertens. 2021;2021. DOI: https://doi.org/10.1155/2021/6657003

Zhou B, Perel P, Mensah GA. Global Epidemiology, Health Burden and Effective Interventions for Elevated Blood Pressure and Hypertension. Nat Rev Cardiol. 2021;18(November):785-802. DOI: https://doi.org/10.1038/s41569-021-00559-8

Mills KT, Stefanescu A, He J. The Global Epidemiology of Hypertension. Nat Rev Nephrol. 2020;16:223-37. DOI: https://doi.org/10.1038/s41581-019-0244-2

Kemenkes. Laporan Nasional Riskesdas, 2018. Vol. 1, Kementerian Kesehatan RI. 2018.

Delavar F, Pashaeypoor S, Negarandeh R. The Effects of Self-Management Education Tailored to Health Literacy on Medication Adherence and Blood Pressure Control among Elderly People with Primary Hypertension: A Randomized Controlled Trial. Patient Educ Couns [Internet]. 2020;103(2):336-42. DOI: https://doi.org/10.1016/j.pec.2019.08.028

Grace A, Mbchb K, Mbchb EN, Stephen P. Prevalence, Awareness and Factors Associated with Hypertension among Adults in Rural South-Western Uganda : A Cross-Sectional Study. Affiliations: 2024.

Cheng H, Gu Y, Ma X, Tang H, Liu X. Urban-rural Disparities in Hypertension Prevalence, Awareness, Treatment, and Control among Chinese Middle‑Aged and Older Adults from 2011 to 2015 : A Repeated Cross‑Sectional Study. BMC Cardiovasc Disord. 2022;1-10. DOI: https://doi.org/10.1186/s12872-022-02769-5

Peer N, Levitt N, Lombard C, George J, Kengne AP. Prevalence and Associations of Hypertension Detection, Treatment and Control in Cape Town. BMC Public Health. 2025;25(1674). DOI: https://doi.org/10.1186/s12889-025-22307-0

Vrijens B, Urquhart J. Methods for Measuring, Enhancing, and Accounting for Medication Adherence in Clinical Trials. Clin Pharmacol Ther. 2014;95(6):617-26. DOI: https://doi.org/10.1038/clpt.2014.59

Fuchs SC. Low Adherence to High Blood Pressure Treatments : Innovative Solutions Are Needed. 2025;1-4. DOI: https://doi.org/10.1161/JAHA.124.039045

Burnier M, Polychronopoulou E, Wuerzner G. Hypertension and Drug Adherence in the Elderly. 2020;7(April):1-9. DOI: https://doi.org/10.3389/fcvm.2020.00049

Chew SM, Lee JH, Lim SF, Liew MJ, Xu Y, Towle RM. Prevalence and Predictors of Medication Non-Adherence among Older Community-Dwelling People with Chronic Disease in Singapore. J Adv Nurs. 2021;77(10):4069-80. DOI: https://doi.org/10.1111/jan.14913

Mahmood S, Jalal Z, Hadi MA, Khan TM, Haque MS, Shah KU. Prevalence of Non-Adherence to Antihypertensive Medication in Asia: A Systematic Review and Meta-Analysis. Int J Clin Pharm. 2021;43(3):486-501. DOI: https://doi.org/10.1007/s11096-021-01236-z

Peng X, Wan L, Yu B, Zhang J. The Link between Adherence to Antihypertensive Medications and Mortality Rates in Patients with Hypertension : A Systematic Review and Meta-Analysis of Cohort Studies. 2025. DOI: https://doi.org/10.1186/s12872-025-04538-6

Pour ER, Aliyari S, Farsi Z, Ghelich Y. Comparing the Effects of Interactive and Noninteractive Education Using Short Message Service on Treatment Adherence and Blood Pressure among Patients with Hypertension. Nurs Midwifery Stud. 2020;9(2):68-76. DOI: https://doi.org/10.4103/nms.nms_82_19

Walid FG, Jerry LG, Zachary AM. A Systematic Review of Barriers to Medication Adherence in the Elderly: Looking Beyond Cost and Regimen Complexity. 2012;9(1):11-23. DOI: https://doi.org/10.1016/j.amjopharm.2011.02.004

Anwar N, Irwan AM, Saleh A, Usman S. Effect of Foot Massage on Decreasing Blood Pressure and Anxiety in Older People with Hypertension in Indonesia. J Health Manag. 2022;24(2):260-7. DOI: https://doi.org/10.1177/09720634221087786

Saleh A, Wirda W, Irwan AM, Latif AI. The Relationships among Self-Efficacy, Health Literacy, Self-Care and Glycemic Control in Older People with Type 2 Diabetes Mellitus. Work with Older People. 2021;25(2):164-9. DOI: https://doi.org/10.1108/WWOP-08-2020-0044

Irwan AM, Balabagno AO. Factors Related to Self-Care among Older Persons of Makassarese Tribe, Indonesia. Philipp J Nurs. 2014;84(2):24-30.

Mirzaei-alavijeh M, Yarmoradi S, Khashij S, Jalilian F. Application of the Information-Motivation-Behavioral Skills Model to Improve Medication Adherence among Older Adults with Type 2 Diabetes : Findings from a Quasi-Experimental Study in Kermanshah, Iran. BMC Geriatr. 2025;25(328). DOI: https://doi.org/10.1186/s12877-025-06000-w

Zuraida E, Irwan AM, Sjattar EL. Self-Management Education Programs for Patients with Heart Failure: A Literature Review. Cent Eur J Nurs Midwifery. 2021;12(1):279-94. DOI: https://doi.org/10.15452/cejnm.2020.11.0025

Funnell MM, Anderson RM. Patient Empowerment: From Revolution to Evolution. Struct Eng. 2014;99(6):5.

WHO. Health Promotion [Internet]. 2008 [cited 2023 May 23]. Available from: https://www.who.int/teams/health-promotion/enhanced-wellbeing/seventh-global-conference

Thojampa S, Daengthern L, Kumpeera K. The Effects of an Empowerment Program to Have a Good Quality of Life and Long Life for Elderly People in Phrae Province, Thailand. Int J Africa Nurs Sci [Internet]. 2020;12(April):100201. DOI: https://doi.org/10.1016/j.ijans.2020.100201

Irwan AM, Kato M, Kitaoka K, Ueno E, Tsujiguchi H, Shogenji M. Development of the Salt-Reduction and Efficacy-Maintenance Program in Indonesia. Nurs Heal Sci. 2016 Dec;18(4):519-32. DOI: https://doi.org/10.1111/nhs.12305

Dianati M, Asmaroud SR, Shafaghi S, Naghashzadeh F. Effects of an Empowerment Program on Self-Care Behaviors and Readmission of Patients with Heart Failure: A Randomized Clinical Trial. Tanaffos. 2020;19(4):312-21.

Shin DS, Kim CJ, Choi Y jun. Effects of an Empowerment Program for Self-Management among Rural Older Adults with Hypertension in South Korea. Aust J Rural Health [Internet]. 2016 Jun;24(3):213-9. DOI: https://doi.org/10.1111/ajr.12253

Riskesdas Sulawesi Selatan. Laporan Provinsi Sulawesi Selatan Riskesdas 2018 [Internet]. Vol. 110, Badan Penelitian Dan Pengembangan Kesehatan. 2018. 129 p. Available from: http://ejournal2.litbang.kemkes.go.id/index.php/lpb/article/view/3658

Morisky DE, Ang A, Krousel-wood M, Ward HJ. Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. 2008;10(5). DOI: https://doi.org/10.1111/j.1751-7176.2008.07572.x

Riani DA, Ikawati Z, Kristina SA. Validasi 8-Item Morisky Medication Adherence Scale Versi Indonesia Pada Pasien Hipertensi Dewasa Di Puskesmas Kabupaten Sleman Dan Kota Yogyakarta Defilia Anogra Riani, Prof. Zullies Ikawati., Ph.D., Apt.;Dr. Susi Ari Kristina, S. Farm., M. Kes., Apt. Repos UGM [Internet]. 2017;xiii-xiv. Available from: https://etd.repository.ugm.ac.id/home/detail_pencarian/109818

Notoatmodjo S. Metodologi Penelitian Kesehatan. Jakarta: Rineka Cipta; 2018.

Kadar KS, Mckenna L, Francis K. Scoping the Context of Programs and Services for Maintaining Wellness of Older People in Rural Areas of Indonesia. Int Nurs Rev. 2014;61(3):310-7. DOI: https://doi.org/10.1111/inr.12105

Wallerstein N, Bernstein E. Empowerment Education: Freire’s Ideas Adapted to Health Education. Heal Educ Behav [Internet]. 1988 [cited 2023 May 22];15(4):379-94. DOI: https://doi.org/10.1177/109019818801500402

Funnell MM, Anderson RM, Arnold ; Marilynns, Barr PA, Donnelly M, Johnson PD, et al. Empowerment: An Idea Whose Time Has Come in Diabetes Education. 2015;48109-083.

Cheng L, Sit JWH, Choi K chow, Chair S ying, Li X, Wu Y, et al. The Effects of an Empowerment-Based Self-Management Intervention on Empowerment Level, Psychological Distress, and Quality of Life in Patients with Poorly Controlled Type 2 Diabetes: A Randomized Controlled Trial. Int J Nurs Stud. 2021;116:103407. DOI: https://doi.org/10.1016/j.ijnurstu.2019.103407

Ramadhanty AF, Irwan AM, Setyawati A. Medication Adherence Among Older People With Hypertension in Southeast Asia : A Scoping Review. 2024;11(2):118-25. DOI: https://doi.org/10.34172/jech.2986

Al-Noumani H, Wu JR, Barksdale D, Knafl G, Alkhasawneh E, Sherwood G. Health beliefs and medication adherence in omanis with hypertension. J Cardiovasc Nurs. 2018;33(6):518-26. DOI: https://doi.org/10.1097/JCN.0000000000000511

Zhao J, Hu Y, Zhang X, Zhang G, Lin M, Chen X, et al. Efficacy of Empowerment Strategies for Patients with Hypertension: A Systematic Review and Meta-Analysis. Patient Educ Couns [Internet]. 2020;103(5):898-907. DOI: https://doi.org/10.1016/j.pec.2019.11.025

Gibson CH. The Process of Empowerment in Mothers of Chronically Ill Children. J Adv Nurs. 1995;21(6):1201-10. DOI: https://doi.org/10.1046/j.1365-2648.1995.21061201.x

Peter K, Christopher, Murtaugh M. The New England Journal of Medicine. 1999.

Rajpura J, Nayak R. Medication Adherence in a Sample of Elderly Suffering from Hypertension: Evaluating the Influence of Illness Perceptions, Treatment Beliefs, and Illness Burden. J Manag Care Pharm [Internet]. 2014 [cited 2023 Mar 21];20(1):58-65. DOI: https://doi.org/10.18553/jmcp.2014.20.1.58

Tan CS. Short communication The Need of Patient Education to Improve Medication Adherence Among Hypertensive Patients. 2020;6(1):1-5. DOI: https://doi.org/10.52494/MOEL1486

Sajjadi SL, Ghafourifard M, Khosroshahi HT. The Effect of Individualized Education on Learning Needs of Patients Undergoing Hemodialysis : A Randomized Controlled Clinical Trial. 2024. DOI: https://doi.org/10.1186/s12882-024-03886-3

Dsouza B, Prabhu R, Unnikrishnan B, Ballal S, Mundkur SC, Sekaran VC, et al. Effect of Educational Intervention on Knowledge and Level of Adherence among Hemodialysis Patients : A Randomized Controlled Trial. Global Health, Epidemiology and Genomic. 2023;2023. DOI: https://doi.org/10.1155/2023/4295613

Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al. Medication Adherence and Blood Pressure Control: A Scientific Statement from the American Heart Association. Hypertension. 2022;79(1):E1-14. DOI: https://doi.org/10.1161/HYP.0000000000000203

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Published

2026-03-11

How to Cite

Ramadhanty, A. F., Irwan, A. M., & Setyawati, A. (2026). Empowerment Education to Increase Medication Adherence among Older People with Hypertension in Rural Areas in Indonesia. Aquichan, 26(1), e2613. https://doi.org/10.5294/aqui.2026.26.1.3

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