Is the Therapeutic Adherence of Hypertensive Patients
Closely Related to the Pharmacist-Patient
Communication?
Setiyo Budi Santoso
1*
, Nurkholis Ashari
2
, Ika Mulyono Putri Wibowo
3
1
Department of Community and Clinical Pharmacy, Faculty of Health Science, Universitas Muhammadiyah
Magelang
2
Pharmacy Undergraduate Program, Faculty of Pharmacy, Universitas Muhammadiyah Magelang
3
Department of Center Medication Information and Pharmaceutical Care, Faculty of Pharmacy, Universitas
Surabaya
Corresponding author’s email: [email protected]
ABSTRACT
Two-thirds of hypertensive patients are spread in developing countries. In Indonesia, hypertension, nowadays, ranks
second nationally and becomes a priority in non-communicable disease control. Pharmacist-patient communication is
presumably related to therapy adherence of hypertensive patients. However, no research focuses on presenting this data.
this article is aimed to present the readers with the correlation between the level of adherence to therapy of hypertensive
patients and the communication behaviour of pharmaceutical personnel. We took the observations by recording the
communication between pharmacists and hypertensive patients. We placed the research in two different Community
Health Centers (Puskesmas), namely Puskesmas Muntilan 2 and Puskesmas Tempuran (Magelang Regency-Indonesia).
The cross-sectional study in March 2020 collected data. The records were analysed using the Roter Interaction Analysis
System (RIAS) instrument. Simultaneously, the medication adherence item was measured by the Medication Adherence
Report Scale (MARS-5) instrument. The results showed that the pharmaceutical personnel providing drug information
services to hypertensive patients have carried out two communication functions; task-focused (199 utterances) and
socio-emotional (130 utterances). The hypertensive patients in this research had a relatively high mean adherence score
of 24.1. The findings of the research demonstrated that task-focused communication was not related to overall items of
therapy adherence. On the other hand, socio-emotional communication is closely related to the frequency of stop drug
consumption for a while (0.265). The researchers underlined that the high frequency of socio-emotional communication
was closely related to patient adherence to not stop drug consumption as being prescribed.
Keywords: Roter Interaction Analysis System; Socio-emotional, Task Focused; Medication Adherence
Report Scale; Puskesmas
1. INTRODUCTION
A record of 1.13 billion people in the world is
suffering from hypertension. Two-thirds of them are
spread in developing countries. The national second
spread of this disease is 9,365,000 people. Hypertensive
patients are the top priority of non-communicable disease
control through the Chronic Disease Management
Program (Prolanis).
The success of Prolanis is influenced by optimal
counselling and drug information services. These support
services are proven to have a significant effect on
symptoms of disease refinement, motivation, adherence
to therapy, and satisfaction towards services [1]–[3].
Patients through these services can solve problems faced
during therapy. For the implication, the patient gained a
positive impression and became more regular in carrying
out therapeutic instructions [4], [5].
The quality of drug information and counselling
services is closely related to pharmacist skills in
managing interactions [6], [7]. While good interaction is
oriented for patient needs fulfilment (patient-
centeredness). The success of managing interactions
reflects in the skill to combine knowledge of drugs and
https://doi.org/10.2991/978-2-494069-49-7_7
© The Author(s) 2023
Z. B. Pambuko et al. (Eds.): BIS-HSS 2021, ASSEHR 667, pp. 34
–39, 2023.

interpersonal sensitivity [8], [9]. However, recent
findings suggest that pharmacist-patient interaction
practices are pharmacist-centred and fully controlled by
service providers [10]. So that patients tend to hesitate in
asking questions to pharmaceutical personnel.
Hypertension participants of Prolanis in Indonesia
increase every year. The drug information services and
counselling are part of Prolanis therapy management
strategies. Pharmacist skills to interact with patients
affect the success of therapy. However, pharmacist-
patient interaction practices do not reflect patient-
centeredness efforts that focus on therapy adherence.
Based on our previous research, chronic disease patients
require specific approaches to solve drug therapy
problems and optimize their health clinic indicators.
[11]–[14].
In the researchers' review, research exploring
pharmaceutical communication exchange to
hypertensive patients is available in tiny numbers.
Therefore, this article is aimed to present the readers with
the correlation between the level of adherence to therapy
of hypertensive patients and the communication
behaviour of pharmaceutical personnel.
2. METHOD
2.1. Subject
This study is a non-experimental study with a
descriptive design (observational) of the communication
between the pharmacists and hypertensive patients
undergoing Prolanis at Puskesmas Muntilan 2 and
Puskesmas Tempuran, and the convenience techniques
use the sampling method. The time of the research was in
March 2020 besides there were 48 subjects involved in
this research.
2.2. Methods
We researched by recording the conversations of
pharmacists and hypertensive patients (the research
subjects). After all records of the pharmacist-patient
conversations have been collected, it transcribed by the
researchers. The first three authors coded manually
according to RIAS category lists, while this coding
activity was under the supervision of the fourth author.
The records have been verified and approved by the
fourth author as the fourth author is a person who has
published research using this method before [10]. We
obtained hypertensive patients' adherence to medication
through the Medication Adherence Report Scale
(MARS-5) questionnaire.
2.3. Data Analysis
The characteristic of research subjects, interaction
coding, and therapy adherence measurement were
analysed descriptively. Additionally, the researchers
analysed the correlation of interaction coding results with
therapy adherence results in Spearman’s rho through the
IBM SPSS Statistic-26 application.
3. RESULT AND DISCUSSIO N
An overview of respondent characteristics involved
in this research is shown in Table 1. The amount of
woman respondents is slightly dominant over the man.
Half of the respondents are college alumni. Additionally,
most respondents are covered by the Social Insurance
Administration Organization (BPJS). As this research
being carried out, a significant proportion of respondents
have controlled their blood pressure in pre-hypertension
and stage 1 hypertension. The adherence of these
research subjects in taking the medication showed a
relatively high mean score of 24.1 (Table 2).
Table 1 Characteristic of the respondents
Characteristics Total (Percentage)
Gender Woman 28 (58.33%)
Age 26 – 45 years
46 – 65 years
>65 years
2
26
20
(4.16%)
(54.16%)
(41.66%)
Level of education Primary School
Secondary School
University
16
6
24
(33.33%)
(12.5%)
(50%)
Financial status coverage Independent
BPJS Premium
BPJS Non-Premium
Other insurance
1
19
20
8
(2.08%)
(39.58)
(41.66%)
(16.66%)
Hypertension status
(examination during the research)
Optimal
Normotensive
Prehypertension
Stage 1 hypertension
Stage 2 hypertension
Hypertense stage 3
2
9
16
15
5
1
(4.16%)
(18.75%)
(33.33%)
(31.25%)
(10.41%)
(2.08%)

Is the Therapeutic Adherence of Hypertensive Patients Closely Related to the Pharmacist-Patient Communication? 35

Table 2 Medication Adherence Report Scale (MARS-5) result of Hypertensive Patients
Content Mean Score
1. Forget to take 4.60
2. Change dosage 4.85
3. Stop taking for a while 4.85
4. Skip one of the dosages 4.90
5 Take less than prescribed 4.90
Mean score total of MARS-5 24.1

Table 3 Socio-emotional Communication Exchange between The Pharmacist and The Hypertensive Patient
Domain
Frequency
Pharmacist/s Patient/s
Personal remarks 64 2
Show agreement or understanding 34 60
Shows approval-direct 30 54
Laughs or tells jokes 1 5
Shows disapproval-direct 1 0
Backchannel responses 0 2
Total 130 123

This study indicates that the pharmacist has limited
interest in the patient's personal experiences (Table 3).
The pharmacist can improve the quality of
communication by harmonizing or balancing task-
focused and socio-emotional communication. Generally,
task-focused communication becomes more dominant
than another one (Table 4). It happens because of the
pharmacist’s masters in the drug explanation skill, rather
than the patient's personality [15]. Frequently,
pharmacists' interactions do not consider patients'
background but only focus on drug explanations [16].


Table 4 Task -focused Communication Exchange of the Pharmacist with The Hypertensive Patient
Domain
Frequency
Pharmacist/s Patient/s
Give information on another therapeutic regimen 152 7
Give information on a therapeutic regimen 32 1
Give Orientation/Instruction 5 0
Ask for understanding 4 1
Ask for permission 2 0
Ask a closed-ended question on another therapeutic regimen 2 37
Ask an open-ended question on another therapeutic regimen 1 16
Ask for opinion 1 3
Ask an open-ended question on a therapeutic regimen 0 3
Ask a closed-ended question on a therapeutic regimen 0 3
Bid for repetition 0 3
Total 199 74

On the other hand, the communication in the study
occurs differently than the previous explanation.
Probably it happens because the pharmacist focuses more
on the patient's problems than on the healing process.
However, another argument states, that the tendency to
explain or provide more in-depth information to patients,
may not be effective without the adequate exploration of
the patient's attention, beliefs, attitudes, and behaviour at
the beginning of the consultation. This phenomenon
frequently happens in Asian countries [15].
From the researcher's note, the pharmacist's socio-
emotional conversations are more dominant in
instructing administrative activities. This communication
includes expressions of concern, empathy, legitimacy,
partnership, and motivation in a small number.
Meanwhile, the patients in this study already practised
the socio-emotional items and tended to initiate
discussions about social issues. The pharmaceutical
counselling process should ideally pay more attention to
the patient and regard it as not just a medical problem to
be diagnosed and treated indifferently [17].
S. B. Santoso et al.
36

Table 5 Correlation between The Communication Functions of Pharmaceutical Personnel and The Level of
Adherence to Therapy of Hypertensive Patients
No Communication functions M1 M2 M3 M4 M5 T
1. Task-Focused .172 .036 .129 -.109 .012 .159
2. Socio-emotional .240 .075 .265* -.010 .231 .221
Where: M1: Forget to take, M2: Change dosage, M3: Stop taking for a while, M4: Skip one of the dosages, M5: Take
less than prescribed, T: Mean score total of adherence
*Correlation is significant at the 0.05 level (1-tailed)

The task-focused communication in this study did not
significantly correlate to the medication adherence of
hypertensive patients. According to [18], this
communication focuses on pharmaceutical services as
technical-based skills used in solving problems acquired
through education. From the communication perspective,
the pharmacist's task-focused communication includes
communication relating to the performance of medical
functions, such as data collection, tests and procedures,
physical examinations, and patient education and
counselling [10].
Based on the results from Table 5, social-emotional
communication is closely related to patient activity to
stop drug consumption for a while (0.265). It showed that
the high frequency of socio-emotional communication is
related to patients' high adherence not to stop drug
consumption rules. This phenomenon has been
highlighted by two previous papers, [19] and [20] which
states that everyone needs the support of empathy and
sympathy love, trust, and respect. The pharmacist and the
patients' concern can alleviate the problems and even
help solve the problems faced.
The partnership communication style has a
significant positive correlation to patient satisfaction and
treatment. However, in this study, the researchers found
that patients did not convey their concerns to the
pharmacist as a whole. It showed that pharmacists also
did not optimize the partnership counselling style. In
contrast, interpersonal communication quality affects
patient adherence and satisfaction [21] [22].
In another study, utterances related to consent were
sometimes not a reflection of agreement, since patients
only said 'Yes' but did not indicate their true
understanding. Although most patients in the study
volunteered for counselling, some patients appeared to
speed up the counselling process by saying 'Yes' to the
pharmacist's additional questions, particularly, when
pharmacist had already answered their questions. This
trend also shows that communication is not yet
completely patient-centred [23].
4. CONCLUSION
The pharmaceutical personnel providing drug
information services to the hypertensive patients have
carried out two communication functions; task-focused
(199 utterances) and socio-emotional (130 utterances).
The hypertensive patients in this research subject had a
relatively high mean adherence score of 24.1.
The researchers' findings demonstrated that task-
focused communication was not correlated to overall
items of the therapy adherence. On the other hand, social-
emotional communication is closely related to the
frequency of activity to stop drug consumption for a
while (0.265).
The researchers underlined that the high frequency of
social-emotional communication was closely related to
patient adherence to not stop drug consumption as being
prescribed.
ACKNOWLEDGMENT
This research received funding from Universitas
Muhammadiyah Magelang through a research funding
scheme to revitalize the basic research category's
institutional vision in 2020.
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S. B. Santoso et al.
38

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Is the Therapeutic Adherence of Hypertensive Patients Closely Related to the Pharmacist-Patient Communication? 39