Towards better blood pressure control : the effect of patients' and doctors' attitudes

Study aims were: Description of health beliefs and beliefs about medicines in patients with hypertension using questionnaires based on the self-regulatory model; Examination of the relationships between these beliefs; Assessment of patient compliance and the relationship between beliefs and compliance; Evaluation of current GP practices in the management of hypertension using self-report, clinical vignettes review of prescription data and audit of an actual GP practice; Assessment of GP’s cognitions in the management of hypertension in the elderly using the theory of planned behaviour; and Integration of information from both patient and doctors. A complex picture of patients’ beliefs about hypertension and its treatment were found. The most important beliefs in relation to compliance were about the necessity of therapy and perception of personal control of hypertension. Emotional response to hypertension was also important. A number of demographic variables were also important, most noticeably patients’ age. From this information, we suggest that compliance may be more consistently predicted by illness and medication beliefs than has been found with other factors in the past. We propose that the effects of various demographic variables may be mediated through beliefs and attitudes. We found a number of areas where current medical practice in primary care could be improved which in turn would impact hypertension control. These range from methods of measuring blood pressure, to treatment targets and choice of anti-hypertensive agents. Doctors’ thought-process may be involved, but although we could show that these fit the theory of planned behaviour, relating these to actual practice was more challenging. Overall, this thesis highlights areas for further research but more importantly potential targets for interventions to improve patients’ compliance and doctors’ management practices. Both approaches are needed to improve the control of hypertension and reduce the burden of cardiovascular and stroke disease.EThOS - Electronic Theses Online ServiceGBUnited Kingdo