Document Type : Original Article(s)


1 Associated Professor, Department of Health Psychology , Behavioral Science Research Centre, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Medical Practitionare ,School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of epidemiology and biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Pharmacognosy, Isfahan,University of Medical Sciences, Isfahan, Iran


Background: One of the most severe problems that patients with Hypertension (HPN) face are lack of medication adherence, which is influenced by psychological factors. Thus, the current survey sought to compare medication beliefs, cognitive defusion and valued living in hypertensive patients with varying medication adherence.
Method: A cross-sectional study with 162 HPN patients from three clinics at Isfahan University of Medical Sciences was conducted in 2019. Participants completed the BMQ (Beliefs about Medicines Questionnaire), MMAS (Morisky Medication Adherence Scale), CFQ (Cognitive Fusion Questionnaire), and VLQ (Valued Living Questionnaire). The data were analyzed using descriptive statistics, chi-square, and analysis of variance (ANOVA). 
Results: Only 22.2% of patients scored high in medication adherence (MA). MA levels increased with age in a significant correlation (P=0.03). ANOVA results revealed that the three MA levels (low, medium, and high) had substantial differences in both VLQ subscales (importance of person-valued living and allotted time for values; P=0.002 and P=0.023). However, no significant differences in MA levels were found in the CFQ (cognitive defusion and cognitive fusion) and BMQ subscales (specific necessity, specific concern, general overuse, and general harm).
Conclusions: This study discovered that a higher MA is associated with increasing age. In addition, patients with HPN who value living and devote more time to their values have higher MA.


The Google Scholar and PubMed links for Fatemeh Zargar

Google Scholar




1.    Filippini T, Violi F, D’Amico R, Vinceti M. The effect of potassium supplementation on blood pressure in hypertensive subjects: a systematic review and meta-analysis. Int J cardiol. 2017; 230: 127-35.
2.    Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief.  2020; (364): 1-8.
3.    Nikparvar M, Farshidi H, Madani A, Ezatirad R, Azad M, Eftekhaari TE, et al. Prevalence, awareness, treatment, and control of hypertension in Hormozgan Province, Iran. Int Cardiovasc Res J. 2019; 13(3): 91-5.
4.    Bijani M, Parvizi S, Dehghan A, Sedigh-Rahimabadi M, Rostami-Chijan M, Kazemi M, et al. Investigating the prevalence of hypertension and its associated risk factors in a population-based study: Fasa PERSIAN COHORT data. BMC Cardiovasc Disord. 2020; 20(1): 503.
5.    Bundy JD, Mills KT, Chen J, Li C, Greenland P, He J. Estimating the association of the 2017 and 2014 hypertension guidelines with cardiovascular events and deaths in US adults: an analysis of national data. JAMA Cardiol. 2018; 3(7): 572-81.
6.    Barikani A, Saeedi F. Prevalence of hypertension among women aged 30+ in Minoodar region of Qazvin in 2009. J Inflammatory Disease. 2010; 14(1): 41-8.
7.    Kitt J, Fox R, Tucker KL, McManus RJ. New approaches in hypertension management: a review of current and developing technologies and their potential impact on hypertension care. Curr  Hypertens Rep. 2019; 21(6): 1-8.
8.    Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright Jr JT, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation. 2018; 137(2): 109-18.
9.    Masror Roudsari DD, Dabiri Golchin M, Parsa Yekta Z, Haghani H. Relationship between adherence to therapeutic regimen and health related quality of life in hypertensive patients. 2013; 26(85): 44-54.
10.    Michel B, Egan B. Adherence in hypertension. Circ Res. 2019; 124(7): 1124-40.
11.    Oori MJ, Mohammadi F, Norouzi-Tabrizi K, Fallahi-Khoshknab M, Ebadi A. Prevalence of medication adherence in patients with hypertension in Iran: A systematic review and meta-analysis of studies published in 2000-2018. ARYA Atheroscler. 2019; 15(2): 82-92.
12.    Pirzadeh A, Peyman TS, Hassanzadeh A, Mostafavi F. Adherence to self-care behaviors among hypertensive patients. J Health Literacy. 2019;4(3):17-24.
13.    Drawz PE, Pajewski NM, Bates JT, Bello NA, Cushman WC, Dwyer JP, et al. Effect of intensive versus standard clinic-based hypertension management on ambulatory blood pressure: results from the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory blood pressure study. Hypertension. 2017; 69(1): 42-50.
14.    Bjertness E, Wu T, Stigum H, Nafstad P. Acute mountain sickness, arterial oxygen saturation and heart rate among Tibetan students who reascend to Lhasa after 7 years at low altitude: a prospective cohort study. BMJ Open. 2017; 7(7): e016460.
15.    Hayward KL, Valery PC, Martin JH, Karmakar A, Patel PJ, Horsfall LU, et al. Medication beliefs predict medication adherence in ambulatory patients with decompensated cirrhosis. World J Gastroenterol. 2017;23(40):7321.
16.    AlHewiti A. Adherence to long-term therapies and beliefs about medications. Int J family Med. 2014; 2014.
17.    Fernandez-Arias M, Acuna-Villaorduna A, Miranda JJ, Diez-Canseco F, Malaga G. Adherence to pharmacotherapy and medication-related beliefs in patients with hypertension in Lima, Peru. PloS One. 2014; 9(12): e112875.
18.    Mostafavi F, Najimi A, Sharifirad G, Golshiri P. Beliefs about medicines in patients with hypertension: The instrument validity and reliability in Iran. Mater Sociomed. 2016; 28(4): 298-302.
19.    Minaiyan M, Taheri M, Mirmoghtadaee P, Maracy M. Comparative role of patient’s belief about prescribed medicine and demographic factors in adherence to drug treatment in asthma, renal failure and cancer diseases. J Isfahan Med School. 2011; 29(156): 1303-11.
20.    Hayes SC. Acceptance and commitment therapy: towards a unified model of behavior change. World Psychiatry. 2019; 18(2): 226-227.
21.    Zhang C-Q, Leeming E, Smith P, Chung P-K, Hagger MS, Hayes SC. Acceptance and commitment therapy for health behavior change: a contextually-driven approach. Front Psychol. 2018; 8: 2350.
22.    Gaudiano BA, Wenze SJ, Weinstock LM, Tezanos KM, Miller IW. Valued living and its relationship to medication adherence in patients with bipolar and comorbid substance use disorders. J Nerv Ment Dis. 2017; 205(3): 178-181.
23.    Kamody RC, Berlin KS, Rybak TM, Klages KL, Banks GG, Ali JS, et al. Psychological flexibility among youth with type 1 diabetes: relating patterns of acceptance, adherence, and stress to adaptation. Behav Med. 2018; 44(4): 271-9.
24.    Harrison A, Scott W, Timmins L, Graham CD, Harrison AM. Investigating the potentially important role of psychological flexibility in adherence to antiretroviral therapy in people living with HIV. AIDS Care. 2021; 33(3): 337-46.
25.    Cheung KW, Mak YW. Association between psychological flexibility and health beliefs in the uptake of influenza vaccination among people with chronic respiratory diseases in Hong Kong. Int J Environ Res Public Health. 2016; 13(2): 155.
26.    Kalbasi R, Hatami M, Seyrafi M, Hakemi MA, Sabet M. The effectiveness of acceptance and commitment therapy in quality of life and blood pressure index of hemodialysis patients. EBNESINA. 2021; 23(1): 25-34.
27.    Baradaran M, Zare H, Alipour A. Farzad V. Effectiveness of Acceptance and commitment therapy (ACT) on cognitive fusion and physical Health Indicators in essential hypertensive patients. J Cognitive Psychol. 2016; 4(1): 1-9. [Persian]
28.    Haddadi S, Malihi Alzakerini S, Tajbakhsh R, Tajvidi M, Kakavand A. Comparing the Effects of Acceptance and Commitment Therapy and Metacognitive Therapy on Blood Pressure in Hemodialysis Patients. Qom Univ Med Sci J. 2021; 15(1): 10-9.
29.    Karbownik MS, Jankowska-Polańska B, Horne R, Górski KM, Kowalczyk E, Szemraj J. Adaptation and validation of the Polish version of the Beliefs about Medicines Questionnaire among cardiovascular patients and medical students. PloS One. 2020; 15(4): e0230131.
30.    Ben AJ, Neumann CR, Mengue SS. The Brief Medication Questionnaire and Morisky-Green test to evaluate medication adherence. Rev Saude Publica. 2012; 46: 279-89.
31.    Moharamzad Y, Saadat H, Shahraki BN, Rai A, Saadat Z, Aerab-Sheibani H, et al. Validation of the Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Iranian hypertensive patients. Glob J Health Sci. 2015; 7(4): 173-183.
32.    Gillanders DT, Bolderston H, Bond FW, Dempster M, Flaxman PE, Campbell L, et al. The development and initial validation of the cognitive fusion questionnaire. Behav Ther. 2014; 45(1): 83-101.
33.    Zare H. Standardizing of the social scale of cognitive fusion Gillanders based on Bohrnstedt model. Social Psychology Research. 2014; 4(15): 16-28. [Persian]
34.    Wilson KG, Sandoz EK, Kitchens J, Roberts M. The Valued Living Questionnaire: Defining and measuring valued action within a behavioral framework. Psychol. Rec. 2010; 60(2): 249-72.
35.    Akbari M. The Reliability and Validity of Persian version of the Valued Living Questionnaire: based on Acceptance and Commitment approach. 2018; 16: 239-249.
36.    Maguire LK, Hughes CM, McElnay JC. Exploring the impact of depressive symptoms and medication beliefs on medication adherence in hypertension—a primary care study. Patient Educ  couns. 2008; 73(2): 371-6.
37.    Gast A, Mathes T. Medication adherence influencing factors—an (updated) overview of systematic reviews. Sys Rev. 2019; 8(1): 112.
38.    Tiffe T, Morbach C, Rücker V, Gelbrich G, Wagner M, Faller H, et al. Impact of patient beliefs on blood pressure control in the general population: findings from the population-based STAAB cohort study. Int J Hypertens. 2019; 2019.
39.    Scala D, Menditto E, Caruso G, Monetti VM, Orlando V, Guerriero F, et al. Are you more concerned about or relieved by medicines? An explorative randomized study of the impact of telephone counseling by pharmacists on patients’ beliefs regarding medicines and blood pressure control. Patient Educ Couns. 2018; 101(4): 679-86.
40.    Saarti S, Hajj A, Karam L, Jabbour H, Sarkis A, El Osta N, et al. Association between adherence, treatment satisfaction and illness perception in hypertensive patients. Journal of human hypertension. J Hum Hypertens. 2016; 30(5): 341-5.