Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.

2%& 2'13

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Knowledge about Hypertension and Antihypertensive Medication Compliance in a Jordanian Community Sample
(odour )l-J*our )ndalee* )*u +a,el - ./a, (ar0oo, 1acult/ of Nursing& )l-2a/toona0 3ni4ersit/ of Jordan& P# *o5 13' ),,an (11733 Jordan - E-,ail of t0e corresponding aut0or6 andalee*78u9.edu.9o & andalee*a*:7/,ail.co, Note: this paper was published in proceeding book of the 14th Arab creative student forum in ARABIC language Abstract ./pertension is a co,,on 0ealt0 pro*le, re;uires patients< co,pliance to ,edication. Non-co,pliance is t0e failure of patients to follow 0ealt0 instructions. =0e purpose of t0is cross sectional stud/ was to in4estigate w0at factors influence t0e elders< :nowledge a*out 0/pertension and elders< co,pliance to anti0/pertensi4e ,edications. Elders< :nowledge a*out 0/pertension and t0eir co,pliance le4els were satisfactor/. =0ere was a significant relations0ip *etween :nowledge and co,pliance. It was found t0at elders w0o reported 0ig0 scores on 0/pertension disease :nowledge were elders w0o earned ,ore t0an 3'' J>?,ont0& w0o re,e,*ered na,e of t0eir ,edications and w0o recei4ed ade;uate infor,ation a*out t0eir disease. +nowledge a*out 0/pertension and ,edication were *asic per;uisites for elders< co,pliance to ta:e anti0/pertensi4e ,edications. Nurses and ot0er 0ealt0 care personnel 0a4e a :e/ role in i,pro4ing elders< co,pliance to t0eir ,edication t0roug0 appropriate e4idence *ased inter4entions. Keywords: @o,pliance& Elders& ./pertension& Jordan 1. ntroduction 1 1 !iterature Review Since ,an/ decades& 0/pertension was considered a ,a9or pu*lic 0ealt0 pro*le, in de4eloping countries (Aicardo& Nina& Ei9a& Jaa::o& )uli::i& 2'''B C.#& 2'11 . In Eastern Dediterranean Aegion& t0e pre4alence of 0/pertension was 2EF and it was affected appro5i,atel/ 125 ,illion indi4iduals (C.#& 2'11 . >espite 0/pertension can *e controlled t0roug0 life-st/le ,odification& t0e co,plications of 0/pertension were reported as serious 0ealt0 pro*le, leading to stro:e& 0eart failure and :idne/ pro*le,s (Glo/d-Jones& et al.& 2'1'B C.#& 2'11 . Doreo4er& t0e life e5pectanc/ for 0/pertensi4e patients was s0orter t0an nor,tensi4e patients (Glo/dJones& et al.& 2''E . In Jordan& due to c0anges in life st/le& 0/pertension affected a*out 2HF of adult population (31F in ,en and 22F in wo,en (C.#& 2''E . )ccording to t0e Dinistr/ of .ealt0 in Jordan (2'11 & circulator/ diseases were t0e first cause of ,ortalit/ and were accounted for 3H.'F of t0e total deat0s. 1urt0er,ore& of circulator/ diseases& 0/pertension was t0e second leading cause of deat0 after isc0e,ic 0eart diseases (D#.& 2'11 . )nd it was considered a pu*lic 0ealt0 pro*le, affected 1H.3 of 5%5 Jordan co,,unit/-*ased sa,ple (Jaddou& (atei0a& )9louni& 2''' . 3ne5pectedl/& in t0e Jaddou& et al.& stud/& a considera*le nu,*er of t0e sa,ple (HEF 0ad aware of 0a4ing 0/pertension& *ut t0e/ failed to :eep t0eir *lood pressure under control. @ardio4ascular diseases included 0/pertension 0a4e 0ealt0& social and ad4erse effects not onl/ on t0e clients& *ut also on 0ealt0 care s/ste,s. In de4eloping countries& t0e pre4alence of 0/pertension influenced t0e le4el of gross national product per capita (Aicardo& et al.& 2''' . 1urt0er,ore& in 3S& t0e esti,ated direct and indirect cost of 0/pertension ,anage,ent during 2'1' was I7H.H *illion (Glo/d-Jones& et al.& 2'1' . It was found t0at t0e *lood pressure can *e controlled t0roug0 life st/le ,odification and ta:ing anti0/pertensi4e ,edications. .owe4er& failure of patients to follow 0ealt0 guidelines and ,edications led to undesira*le 0ealt0 conse;uences (Glo/d-Jones& et al& 2''E . =0is 0ealt0-related *e0a4iour is :nown in 0ealt0 care discipline as non co,pliance or non ad0erent. =0e non co,pliance *e0a4iour is a persistent concern in nursing practice& and it is one of i,portant nursing pro*le, of t0e Nort0 ),erican Nursing >iagnosis )ssociation (N)N>) & and it was defined as Jt0e state in w0ic0 an indi4idual or group desire to co,pl/ *ut factors are present t0at deter ad0erence to 0ealt0-related ad4ice gi4en */ 0ealt0 professionalJ (@arpenito-Do/et& 2''7 . =0e non co,pliance (non ad0erent is a worldwide 0ealt0 pro*le, in de4eloped and de4eloping countries (C.#& 2''3 . In 3nited +ingdo,& fift/ percent of older people do not co,pl/ wit0 t0eir ,edication plan (Kriffit0& 2'1' . Non co,pliance to ,edication plan particularl/ in older adult was reported as a co,plicated p0eno,enon and was considered as a c0allenging 0ealt0 issue for patients< fa,ilies and for t0e 0ealt0 care personnel (1ul,er& +i,& Dontgo,er/& G/der& 2''1 . =0e conse;uences of non co,pliance not onl/ affect patients and worsen t0e disease outco,es& *ut non co,pliance issue also influencing t0e entire 0ealt0 care s/ste,s (C.#& 2''3 . =0e conse;uences of non co,pliance could *e ,edication wastage& ,is,anage,ent of ,edical 0ealt0 cases& and increasing 0ospital read,ission rate (Kriffit0& 2'1' . !1

Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2%& 2'13

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Giterature reported ,an/ reasons for non co,pliance *e0a4iour suc0 as patientsL social conte5t& e,otional difficulties& forgetfulness& side effects of t0e ,edication& s0ortage of drugs& and nature of t0e disease ()l-De08a& )l-Du0aili9e& +0alfan& )l-Ma0/a& 2''EB >osse& @esarino& Dartin& @astedo& 2''EB Aussell >al/& .ug0es& #pLt .oog& 2''3 . In ot0er stud/& elders< *eliefs a*out t0e incura*ilit/ of t0e 0/pertension and ot0er co,or*id 0ealt0 pro*le,s were t0e ,a9or causes of non co,pliance *e0a4iour (I0 E8e& #9iea*u& 1e,i-#/ewo& Dartins& 2'11 . In a sur4e/& Nair& (elletti& >o/le& )llen& DcNueen& et al. (2'11 found t0at& *eing too *us/& degree of illness& disruption of dail/ e4ents& and ina*ilit/ to go to p0ar,ac/ were of ,ain reasons for non co,pliance to anti0/pertensi4e ,edications. =o fostering co,pliance& Nair et al.& suggested to pattern t0e patient<s co,pliance *e0a4iour as a dail/ routine and to esta*lis0 indi4iduali8ed re,inder s/ste,. In a +uwaiti literature& t0e non co,pliance *e0a4iour of 0/pertensi4e patients was related to lac: of :nowledge a*out 0/pertension ()l-De08a& et al.& 2''E . )l-De08a& reco,,ended increasing awareness of t0e patients to t0e diagnosis and ,ore e,p0asis on t0e i,portance of ,edication co,pliance to control t0e ele4ated *lood pressure ()l-De08a& et al.& 2''E . Nursing literature suggested different approac0es to sol4e t0e pro*le, of non co,pliance suc0 as assessing patients< conte5t& and fostering patient-centred approac0 for transferring power and aut0orit/ fro, 0ealt0 care professionals to patients (Aussell& et al.& 2''3 . 1urt0er,ore& pro4iding care t0roug0 a ,ultidisciplinar/ 0ealt0 tea, was a pro,ising solution for ,anaging non co,pliance *e0a4iour (>osse& et al.& 2''E . Pro4iding counselling a*out life st/le ,odification and anti0/pertensi4e ,edication in addition to ,edication sc0edule re,inder were effecti4e ,et0ods to increase co,pliance *e0a4iour in tertiar/ 0ealt0 care setting (Palanisa,/ O Su,at0/& 2''E . =0ere are no :nown Jordanian studies t0at 0a4e addressed t0e non co,pliance pro*le, in elders. 1urt0er,ore& Jordan Nursing @ouncil (2''! encouraged researc0ers to conduct e,pirical studies on t0e 0ealt0 needs of 4ulnera*le Jordanian population as a nursing researc0 priorit/ area. 1 " #urpose of the $tud% =0e pri,ar/ goal of t0is stud/ was to in4estigate t0e relations0ip *etween 0a4ing :nowledge a*out 0/pertension and ,edication co,pliance in a co,,unit/ *ased sa,ple of elders. =0e second goal was to in4estigate 4aria*les influenced elders< :nowledge a*out and co,pliance to ,edications. In4estigating t0e non co,pliance *e0a4iour in elders pro4ide 0ealt0 care decision ,a:er wit0 e4idence *ased data to ena*le t0e, to pro4ide appropriate inter4entions suc0 as increasing awareness& education& ,oti4ation& and consultation. !. Methodology " 1 &esign ) cross sectional design wit0 a con4enient sa,ple of 273 elder was used. ./pertensi4e elder patients w0o attended t0e Non-@o,,unica*le >iseases (N@> clinics for follow up in two 0ealt0 centres in ),,an were recruited in t0is stud/. )ll patients w0o were a*o4e H' /ear old& w0ose diagnosis was 0/pertension& were ,entall/ co,petent& and were a*le to co,,unicate 4er*all/ were accessed */ researc0ers and t0e/ were infor,ed a*out t0e purpose of t0e stud/ and a*out data collection strateg/. C0en elders agreed to participate& t0e/ signed infor,ed consents. 1or patients w0o cannot writeB a 4er*al agree,ent for participation was o*tained in t0e presence of a witness. Aesearc0ers used all ,easures to protect elders< rig0ts. =0is stud/ was appro4ed */ Scientific and Et0ics @o,,ittee of t0e 1acult/ of Nursing in )l-2a/toona0 3ni4ersit/& and t0e Scientific Aesearc0 co,,ittee of Dinistr/ of .ealt0. " " &ata Collection ) structured inter4iew was conducted in pri4ac/ wit0 elders to collect data a*out socio-de,ograp0ics and 0ealt0 0istor/. Elders< :nowledge a*out 0/pertension was assessed */ ./pertension +nowledge Nuestionnaire (.+N . =0e .+N was designed */ researc0ers *ased on related literature. =0irteen ;uestions were found to ,easure t0e ,a9or do,ains of elders< :nowledge a*out 0/pertension suc0 as definition& causes& co,plications& ,edications& and life st/le. =0e .+N ite,s were *roug0t t0ree option answers (/es P2& not sure P 1& and no ' & t0e ,a5i,u, score of t0e .+N was 2H and t0e ,ini,u, was 8ero. =0e ;uestionnaire was re4iewed */ panel of fi4e 0ealt0 e5pertsB two p0/sicians& two nurses and one p0ar,acist. =0e ite,s were ,odified according to t0eir feed*ac: to assure content and face 4alidit/ of t0e instru,ent. Doris:/ Scale as a widel/ used instru,ent (Doris:/& Kreen& Ge4ine& 1E!H was ad,inistered to elders to ,easure t0eir ,edication co,pliance le4el. =0e researc0ers used t0e original aut0or<s 4ersion of t0e scale. Doris:/ Scale is a four-ite, self report instru,ent of *inar/ responses (noQ/es wit0 '-% range of scores. =o assess t0e feasi*ilit/ of t0e stud/ and t0e suita*ilit/ of t0e used ,easure,ent tools& a pilot stud/ was conducted wit0 si5teen elders. =est and re-test relia*ilit/ coefficient was '.H% for t0e .+N and '.7E for t0e Doris:/ instru,ent. >ata was anal/8ed */ SPSS 17. >escripti4e statistics& correlation tests in addition to t-test and anal/sis of 4ariance ()N#$) were used to anal/8e t0e data.

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2%& 2'13

www.iiste.org

". #esults =0e age of t0e elders ranged fro, H'-E! /ears& wit0 ,ean age of HE (R 2.3 . =0e ,a9orit/ of t0e elders were wo,en& ,arried& and elders were li4ing wit0 t0eir spouses and c0ildren. Dore t0an t0ree-;uarters of t0e elders 0ad less t0an t0ree 0undred J>s inco,e?,ont0& and t0e/ spent 1-12 /ears in sc0ools (=a*le 1 . $able 1. Socio%&emographics o' the (lders n Kender Darital status Gi4e wit0 Dont0l/ inco,e Education Dale 1e,ale Single& widowQwidower& or di4orced Darried Spouse and c0ildren #t0ers t0an spouse and c0ildren Gess t0an 3'' J>?Dont0 Dore t0an 3''J>?Dont0 Illiterate 1-12 Dore t0an 12 !% 1!E 7! 1E5 1%' 133 227 %H H! 1!' 25 F 3'.! )*.! 2!.H +1., -1." %!.7 .".! 1H.! 2%.E )-.* E.2

Elders< ,ean s/stolic *lood pressure was 155 (R 11.2 ,,.g& and t0e ,ean for diastolic *lood pressure was E' (R 15.1 ,,.g. Elders 0ad 0istor/ of 0/pertension less t0an 5 /ears. =0e a4erage nu,*er of ta*lets t0at dispensed for elders was (3.1 R 1.H . =0irt/-si5 percent of t0e elders recei4ed t0ree or less ta*lets of ,edication in dail/ *asis. Elders could not re,e,*er t0e na,e of t0eir prescri*ed ,edication. =0e ,a9orit/ of elders recei4ed infor,ation a*out t0eir ,edication& t0e infor,ation was pro4ided ,ainl/ */ p0/sicians t0en */ nurses. Dore t0an 0alf of t0e elders 0ad ot0er 0ealt0 pro*le,s in addition to 0/pertension. Kood 0ealt0 status was reported */ elders as t0eir 0ealt0 self e4aluation (=a*le 2 . $able ! Health /ro'ile and History o' Hypertension n .istor/ of 0/pertension Nu,*er of anti-0/pertension ,edication?da/ Gess t0an 5 /ears Dore t0an 5 /ears 1-3 ta*lets?da/ %-7 ta*lets?da/ Mes Ae,e,*er t0e na,e of ,edication No Aecei4e full infor,ation a*out ,edication Mes No Source of disease and ,edication infor,ation P0/sicians Nurse 1riends P0ar,acists #t0er Sources (Dass ,edia and ot0er sources 21E 1EH 77 1!E 3E 2% ! 13 1'2 7' H' .0.! +1.. 2!.2 )*.! 1,." !.! 2.E %.7 37.3 25.H 21.E 152 121 172 1'1 5% F 55.7 %%.1 )".0 37.' 1E.!

Det0od of re,e,*ering ta:ing ,edication No 0elp So,e*od/ re,ind 0i,?0er to ta:e ,edication Ae,ind wit0 pra/ ti,e

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2%& 2'13

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n Put ,edication *eside cloc:& ,irror& or glass case or dine ta*le& etc Self report 0ealt0 E5cellentKoodPoor Mes No %1

F 15.'

7H 1H' 3H 1H2 111

27.! 5!.H 13.2 -*." %'.7

.ad ot0er diseases

=0e elders< ,ean scores on .+# was 1E.1 (R3.2 & and on Doris:/ scale was 2.! (R 1.1 . =0e .+N total scores was significantl/ positi4el/ correlated wit0 ,edication co,pliance (r P 71& p P '.'% . 1urt0er,ore& t0ere was an in4erse significant correlation *etween nu,*er of ta*let?da/ and Doris:/ co,pliance scores (-'.H1& p P '.'% . =a*le 3 re4eals t0at elders w0o 0ad 0ig0er scores on .+N were people w0o earned ,ore t0an 3''J>s?,ont0& w0o re,e,*ered t0eir ,edication */ na,e& and w0o recei4ed ade;uate infor,ation a*out t0eir ,edication t0an ot0ers. $able " Means &i''erences and t%test #esults o' (lders1 Knowledge about Hypertension 2 Kender Darital status Dont0l/ inco,e Gi4ing arrange,ent Dale 1e,ale Darried #t0er ,arital status Gess t0an 3''J>?,ont0 Dore t0an 3'' J>s?,ont0 Cit0 spouse and c0ildren Cit0 ot0ers Ae,e,*er na,e of ,edication Nu,*er of ta*lets?da/ Mears of 0/pertension Aecei4ed infor,ation a*out ,edication .ad ot0er diseases Mes No 1-3 %-7 Gess t0an 5 /ears Dore t0an 5 /ears Mes No Mes No 7E 1H% 172 71 2'1 %2 12% 11E 5' 1E3 153 E' 135 1'! 177 HH 1%2 1'1 Mean345 1E.3(R3.2 1!.7(R2.! 1E.2(R3.' 1!.2 (R3.5 1..* 34".15 2'.1(R3.% 1E.%(R3.1 -1.% 1!.! (R3.3 2'.% (R3.3 1... 34".15 1E.1 (R3.3 1E.2 (R3.' 1E.' (R3.2 1E.3(R3.2 1E.2 (R3.2 1+.*34!..5 1E.1 (R3.1 1E.2 (R3.% -3.' -'.% -'.! ".) 0.00 '.H! '.% 0.00 '.15 -2.2 0.0! -2.7 '.'H '.71 '.% t /

'.2

'.!

(p P S'.'5 =a*le % s0owed t0at ,en patients w0o recei4ed ade;uate infor,ation a*out ,edication reported significantl/ 0ig0er scores on Doris:/ tool t0an wo,en and t0an t0ose elders w0o did not recei4e ade;uate infor,ation a*out ,edication.

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2%& 2'13

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$able , Means &i''erences and t%test #esults o' (lders1 Compliance to medications 2 Kender Darital status Dont0l/ inco,e Gi4ing arrange,ent Dale 6emale Darried #t0er ,arital status Gess t0an 3''J>?,ont0 Dore t0an 3'' J>s?,ont0 Cit0 spouse and c0ildren Cit0 ot0ers Ae,e,*er na,e of ,edication Nu,*er of ta*lets?da/ Mears of 0/pertension Aecei4ed infor,ation a*out ,edication .ad ot0er diseases Mes No 1-3 %-7 Gess t0an 5 /ears Dore t0an 55 /ears Mes 2o Mes No !% 1!E 1E5 7! 227 %H 1%' 133 53 21E 172 1'1 152 12' 1EH 77 1H2 111 Mean345 3.' (R1.' !.+ 341.15 2.E (R1.' 2.7 (R1.1 2.!(R1.1 2.E(R'.E 2.! (R1.1 2.! (R1.1 2.E (R'.E 2.! (R1.1 2.! (R1.1 2.E (R1.' 2.! (R1.1 2.E (R'.E 2.E (R1.' !.- 341.!5 2.! (R1.' 2.E (R1.1 -'.! 3.' '.%1 0.00 '.%E '.H2 -'.7 '.%7 -'.1 -'.3 '.7H '.!7 -1.3 '.1E t 1.E p 0.0-

'.5

'.H'

(p P S'.'5 )n anal/sis of 4ariance ()N#$) s0owed t0at t0e elders< :nowledge of 0/pertension *ased on le4el of self reported 0ealt0 status (e5cellent& good& and poor was different significantl/ (1P3.57& p P '.'% . =0e Post 0oc anal/ses re4ealed t0at elders wit0 e5cellent 0ealt0 status 0ad ,ore :nowledge a*out 0/pertension (D P 1E.!& R 3.1 t0an elders wit0 good (DP1E.'& R 3.% or poor 0ealt0 (1!.2& R3.5 . Doreo4er elders co,pliance was different significantl/ in elders w0ose reported 0ealt0 as e5cellent (, P 2.E& R '.'5 ,ore t0an good (DP2.3& RP 1.2 or poor .ED P 2.'& R 1.3 . )N#$) test s0owed no significant differences of elder<s :nowledge (1 P '.52& p P '.5E or co,pliance (1P 2.2H& pP '.1H *ased on source of infor,ation (P0/sician& nurse& p0ar,acists& ot0ers . .+N scores were significantl/ 0ig0er in elders w0o were educated ,ore t0an illiterate or educated less t0an le4el 12 /ears of education (1P 7.5& p P '.'' . .owe4er co,pliance le4el was not different significantl/ across t0ree t/pes of education le4el (1 P '.!H& p P '.%2 . (No ta*le was enclosed ,. &iscussion =0is stud/ e,p0asi8es t0e i,portance of co,pliance to anti0/pertensi4e ,edication in t0e elderl/ and its relation to t0eir le4el of :nowledge a*out 0/pertension. Cit0 increasing nu,*er of 0/pertension and ot0er non co,,unica*le diseases incidents in Jordan& it is a c0allenge a tas: for 0ealt0 care professional to li,it t0e undesira*le co,plication of t0ose pro*le,s t0roug0 enforcing patients< co,pliance to t0eir ,edication and ot0er t0erapeutic plans. =0is stud/ 0ig0lig0ts t0e c0aracteristics of Jordanian 0/pertension patients. =0e ,ean age of t0e elder was in t0eir late si5ties& and t0e ,a9orit/ was wo,en& li4ing in low financial sc0e,e& and t0e/ 0ad attended sc0ools for 1-12 /ears. So,e c0aracteristics of t0e stud/ sa,ple reflect t0e actual Jordanian elders< social status of t0at agerelated group (>epart,ent of statistics& 2''7 . Elders in t0e current stud/ 0a4e to ta:e an a4erage of t0ree ta*lets of ,edication on dail/ *asisB t0is nu,*er of ta*lets is considered 0ig0& *ut si,ilar to $i:& et al. (2''5 and less t0an w0at was docu,ented in ot0er stud/ (I0 E8e& et al.& 2'11 . It was not possi*le to identif/ w0et0er t0ese ,edications prescri*ed to treat 0/pertension& or to treat ot0er co,or*id 0ealt0 pro*le,s. In t0e current stud/& 5E F of t0e elders suffered fro, ot0er 0ealt0 pro*le,& t0erefore it is e5pected t0at t0e prescri*e ,edications were not dispensed e5clusi4el/ to ,anage 0/pertension. In t0e current stud/ t0e non co,pliance was related significantl/ for nu,*er of ta*let. =0is result was docu,ented pre4iousl/ (Gin& .uang& Mang& Cu& @0ang& et al.& 2''7B +airu8& (/e& (irdsall& >eng& Dan& et al.& 2''! & and to o4erco,e t0is pro*le, I0 E8e& et al. (2'11 and Gin& et al.& (2''7 suggested to ,ini,i8e t0e dail/ doses of !5

Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2%& 2'13

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,edication and to prescri*e long-ter, ta*lets to 0elp co,pliance *e0a4ior. 1ro, anecdotal notes& in clinic& nurses< wor: includes assessing patients< *lood pressure& weig0t& 0eig0t& 4ision& and pro4iding 0ealt0 education for t0e patients. =opics of 0ealt0 education were suggested */ patients suc0 as diet& e5ercise& controlling weig0t& and ot0er 0ealt0 issues. Nurses were a source for 0ealt0 infor,ation in general& *ut t0e role of nurses as 0ealt0 educators regarding ,edication was li,ited *ecause suc0 infor,ation pro4ided e5clusi4el/ */ p0/sicians. .owe4er& elders were satisfied */ infor,ation pro4ided and t0e ,a9orit/ reported it as ade;uate. =0e elders< scores on :nowledge and co,pliance ;uestionnaires were ;uite satisfactor/B furt0er,ore& t0e elders< :nowledge a*out 0/pertension disease and ,edication was a prere;uisite for co,pliance *e0a4ior in t0e present stud/. =0is result was e5pected and supported ot0er studies (I0 E8e& et al.& 2'11B Gin et al.& 2''7B +airu8& et al.& 2''! . =o furt0er i,pro4e patients< co,pliance& infor,ational& *e0a4ioral& and co,*ined strategies were used in rele4ant literature (=ouc0ette O S0apiro& 2''! . =o 0a4e an effecti4e co,pliance *e0a4ior& an indi4iduali8ed and client-tailored inter4entions to reduce co,pliance *arriers was reco,,ended (=ouc0ette O S0apiro& 2''! Patients w0o earned ,ore t0an 3'' J>s?,ont0& w0o :new na,es of t0eir ,edications& and w0o 0ad infor,ation a*out t0eir disease s0owed *etter :nowledge a*out 0/pertension and ,edications. =0is result could *e attri*uted to *etter financial status and social conte5t of t0e elders. )not0er rational could *e t0e effect of recei4ing infor,ation a*out t0e disease and ,edication. =0erefore it is reco,,ended to stud/ t0e non co,pliance pro*le, */ e5peri,ental studies in future. Elders< :nowledge and co,pliance were 0ig0er in patients w0o reported t0eir 0ealt0 status as e5cellent. =0is could *e attri*uted to t0e integrit/ of t0eir sensor/ capa*ilities and cogniti4e le4el t0an w0o reported t0eir 0ealt0 as good or poor. 1urt0er,ore& elders< w0o were ,ore educated s0owed 0ig0er :nowledge and co,pliance le4el. =0is result was e5pected since our 0/pot0esis of 0a4ing *etter co,pliance re;uires good :nowledge was supported& and people w0o 0a4e good :nowledge are e5pected to *e educated. Elders w0o recei4ed infor,ation a*out 0/pertension and ,edication */ p0/sician& nurse or */ p0ar,acist were si,ilar in t0eir :nowledge le4el and co,pliance. =0is result could *e e5plained */ t0e s,all nu,*er of elders w0o recei4ed infor,ation fro, nurses (1%F & or fro, p0ar,acist (2.EF & in co,parison to t0ose w0o recei4ed infor,ation */ p0/sicians (HE.2F . -. Conclusion (ecause non co,pliance is a pu*lic 0ealt0 pro*le,& in Jordan& ,ultidisciplinar/ efforts are needed to progress co,pliance in 0/pertensi4e elders. It is reco,,ended to use a sur4e/ing tool to assess elders< :nowledge and co,pliance le4el. (ased on t0e sur4e/ed resultsB as e4idence& 0ealt0 care professional s0ould tailored indi4iduali8ed nursing inter4entions. >esigning 0ealt0 education considering t0e elders< socio-de,ograp0ics criteria& 0ealt0 status& past 0ealt0 0istor/ s0ould *e enforced in clinical areas. #e'erences )l-De08a& ).& )l-Du0aili9e& 1. +0alfan& D.& )l-Ma0/a& ). (2''E & >rug @o,pliancea,ong ./pertensi4e PatientsB an )rea (ased Stud/& 'uropean (ournal of )eneral *edicine& H(1 & H-1'. @arpenito-Do/et& G. (2''7 & +nderstanding the Nursing #rocess, Concept *apping and Care #lanning for $tudents& P0iladelp0ia& Gippincott Cillia,s O Cil:ins. >epart,ent of statistics. (2''7 & Jordan population and 0ealt0 sur4e/ 2''7& Aetrie4ed Da/ 3& 2'11& fro, www.dos.go4.9o?dosT0o,eTe?,ain?...?popT2'12.pdf >osse& @.& @esarino& @.& Dartin& J.& @astedo& D. (2''E & 1actors associated to patientsL nonco,pliance wit0 0/pertension treat,ent& Gatin American (ournal of Nursing& 17(2 62'1-H. 1ul,er& =.& +i,& =.& Dontgo,er/& G/der. (2''1 & C0at t0e literature tells us a*out t0e co,ple5it/ of ,edication co,pliance in t0e elderl/& )enerations& ""I$ (% & %3-%! . Kriffit0& A. (2'1' & Danaging ,edication co,pliance& British (ournal of -ealthcare *anagement& 1H(! & %'2%'!. I0 E8e& 3.& #9iea*u& C.& 1e,i-#/ewo& D.& Dartins& #. (2'11 & E4aluation of )d0erence in Elderl/ >ia*etic ./pertensi4e Patients& I(#I.s (ournal of -ospital and Clinical #harmac%/ 1(% & 3!-%H. Jaddou& .. M.& (atei0aD. I.& )9louni& +. D. (2''' & Pre4alence& awareness and ,anage,ent of 0/pertension in a recentl/ ur*ani8ed co,,unit/& Eastern Jordan& (ournal of -%pertension & 1%& %E7U5'1. JN@. (2''! . Nursing researc0 priorit/& Aetrie4ed June 2& 2'11& fro, 0ttp6??www.9nc.go4.9o?englis0?pu*lications?researc0F2'priorities.pdf +airu8& =.& (/e& G.& (irdsall& A.& >eng& =.& Dan& G.& Aoss& ).& Sa,arasin0a& I.& =autolo& E. (2''! & Identif/ing @o,pliance Issues wit0 Prescription Dedicines a,ong #lder People& &rugs Aging& 25 (2 & 153-1H2. Gin& M.& .uang& M.& Mang& M.& Cu& J.& @0ang& @.& Gu& 1. (2''7 & )d0erence to )nti0/pertensi4e Dedications a,ong t0e elderl/6 ) @o,,unit/-*ased sur4e/ in =ainan cit/& Sout0ern =aiwan& 0aiwan )eriatr )erontol& 2(3 &

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Journal of Education and Practice ISSN 2222-1735 (Paper ISSN 2222-2!!" (#nline $ol.%& No.2%& 2'13

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17H-1!E. Glo/d-Jones& >.& )da,s& A.& (rown& =.& @arnet0on& D. >ai& S.& >e Si,one& K.& et al. (2'1' & .eart >isease and Stro:e StatisticsT2'1' 3pdate. ) Aeport fro, t0e ),erican .eart )ssociation& Circulation& 1216e1-e17'. >#I6 1'.11H1?@IA@3G)=I#N).).1'E.1E2HH7 D#.. (2'11 & Dortalit/ data in Jordan 2''!& Aetrie4ed Da/ 2%& 2'11& fro, 0ttp6??www.,o0.go4.9o?D#.?1iles?Pu*lication?,ortalit/2''!F2'.pdf Doris:/& >. E.& Kreen& G.C.& Ge4ine& >. D. (1E!H & @oncurrent and predicti4e 4alidit/ of a self-reported ,easure of ,edication ad0erence& *edical Care& 2%(1 & H7-7%. Nair& +.& (elletti& >. >o/le& J.& )llen& A.& DcNueen& A.& Saseen& J.& et al. (2'11 & 3nderstanding *arriers to ,edication ad0erence in t0e 0/pertensi4e population */ e4aluating responses to a telep0one sur4e/& #atient #reference and Adherence/ 5& 1E5-2'H. >#I6 1'.21%7?PP).S1!%!1. Palanisa,/& S.& Su,at0/& ). (2''E & Inter4ention to i,pro4e patient ad0erence wit0 anti0/pertensi4e ,edications at a tertiar/ care teac0ing 0ospital& International (ournal of #harm0ech Research& 1(2 & 3HE-37%. Aicardo& 1.& Nina& I.& Ei9a& G.& Jaa::o& =.& )uli::i& N. (2''' & ./pertension in de4eloping econo,ies6 a re4iew of population-*ased studies carried out fro, 1E!' to 1EE!& (ournal of -%pertension& 1! (5 & 521U52E. Aussell& S.& >al/& J.& .ug0es& E.& #pLt .oog& @. (2''3 & Nurses and VdifficultL patients6 negotiating nonco,pliance& (ournal of Advanced Nursing& %3(3 & 2!1U2!7. =ouc0ette& >.& S0apiro& N. (2''! & Dedication co,pliance& ad0erence& and persistence6 current status of *e0a4ioral and educational inter4entions to i,pro4e outco,es/ (ournal of *anaged Care #harmac%& 1%(H & 21'. $i:& S.& Da5well& @.& .ogan& >.& S.& Patten& S.& Jo0nson& J.& Ao,on:o-Slac:& G. (2''5 & )ssessing ,edication ad0erence a,ong older persons in co,,unit/ settings& Canadian (ournal of #harmacolog%& 12(1 & 152-1H%. C.#. (2'11 & Non @o,,unica*le >iseases-./pertension& Aetrie4ed )pril 2'& 2'11& fro, 0ttp6??www.e,ro.w0o.int?ncd?0/pertension.0t, C.#. (2''E & Jordan .ealt0 Profile& Aetrie4ed Da/ 15& 2'11& fro, 0ttp6??www.w0o.int?g0o?countries?9or.pdf C.#. (2''3 & )d0erence to long ter, t0erapies& e4idence for action& Aetrie4ed Da/ 2'& 2'11& fro, 0ttp6??www.w0o.int?c0p?:nowledge?pu*lications?ad0erenceTreport?en? 1. (odour )l-J*our& AN& (Sc 2. )ndalee* )*u +a,el& AN& P0>. $ice >ean-1acult/ of Nursing in )l-2a/toona0 3ni4ersit/ of Jordan. .er specialt/ is @o,,unit/ .ealt0 Nursing and 0er Da9or Aesearc0 )rea is #lder )dult .ealt0 Aelated Issues. 3. ./a, (ar0oo,& AN& (Sc Note: this paper was published in proceeding book of the 14th Arab creative student forum in ARABIC language And we are eager to e1tend our audience be%ond Arab world

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