‘What Happened?’: Perceptions of Patients with Hypertension of Conflicting Results between Self-Reported Medication Adherence and Chemical Adherence Testing: A Qualitative Study

Abstract Aims To explore the perceptions of outpatients with hypertension regarding the conflicting results between their self-reported medication adherence and chemical adherence testing. Methods and results An exploratory generic qualitative study design with semi-structured interviews was conducted. Thirteen adult patients being treated with antihypertensives were interviewed. Patients had a negative chemical adherence test for at least one prescribed antihypertensive, while they reported adhering to their medication. Audio-recorded interviews were thematically analysed. Six themes emerged: (1) becoming frustrated with medication intake, (2) being uncomfortable with addressing medication nonadherence, (3) feeling ashamed and angry about their nonadherence, (4) feeling falsely accused of nonadherence, (5) experiencing results as a wake-up call, and (6) wanting to be heard and listened to. Participants reacted differently to the adherence test results. Two distinct groups were identified among the participants: the first group felt shameful, disappointed, and angry at themselves for being nonadherent; the second group felt falsely accused and rejected the adherence test results. No differences between both groups were found in their reasons for becoming frustrated with medication intake and their behaviour after the adherence test results. Patients felt that communication with clinicians is key in the treatment support of patients with hypertension. Conclusion Clinicians need to consider the reasons for nonadherence and the different responses of patients to the chemical adherence test results in their support to optimize treatment for patients with hypertension.