Hindawi
International Journal of Hypertension
Volume 2019, Article ID 7489875, 9 pages
https://doi.org/10.1155/2019/7489875
Research Article
Personality Traits, Clinical Characteristics, and
Health-Related Quality of Life of Patients with Hypertension
in a Primary Hospital in Ghana
Irene A. Kretchy ,1 Franklin Acheampong,2 Jane Laryea,1 Joseph Osafo,3
Emmanuel Asampong,4 and Erica Dickson3
1Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences,
University of Ghana, Legon, Ghana
2Department of Research, Korle Bu teaching Hospital, Accra, Ghana
3Department of Psychology, School of Social Studies, College of Humanities, University of Ghana, Legon, Ghana
4Department of Social and Behavioral Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
Correspondence should be addressed to Irene A. Kretchy; ikretchy@ug.edu.gh
Received 6 August 2018; Revised 12 December 2018; Accepted 20 December 2018; Published 2 January 2019
Academic Editor: Tomohiro Katsuya
Copyright © 2019 IreneA.Kretchy et al.This is an open access article distributed under theCreative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Hypertension is a major health problem that remains a significant threat to the health and general wellbeing of many
people all over the world. In some patients, the etiology and prognosis of hypertension have been linked to psychological factors
including personality traits. One primary goal of management is to improve the health-related quality of life (HRQoL) of patients
with hypertension. This study aimed to examine the association between personality traits, clinical characteristics, and HRQoL
in hypertension. Methods. A hospital-based cross-sectional quantitative study was conducted in a sample of 331 individuals with
hypertension. Data on sociodemographic characteristics, clinical information, personality traits, and HRQoL were obtained from
participants using an interviewer administered questionnaire. Results. The number of participants with a 1–10 years’ duration of
diagnosis for hypertension was highest (56.8%), with 52.9% having comorbidities such as diabetes (40.2%) and dyslipidaemia
(20.9%). The average number of medications taken per patient was 2.14 (SD±0.79) and about 47.1% of the participants reported
adequate medication adherence. Significant associations for age, education, monthly income, number of years with hypertension,
and HRQoL were observed. While conscientiousness was significantly associated with all HRQoL domains, extraversion and
agreeableness were significantly related to only the environmental domain. Conclusion. This study has demonstrated that clinical
characteristics and patients’ perception of their personality are relevant to their health-related quality of life outcomes. The
findings suggest that when intervention efforts to improve the quality of life of patients with hypertension are being considered, a
biopsychosocial approach should be employed. The implication is that treatment of hypertension in Ghana should be broadened
to include the expertise of mental health professionals.
1. Background in Ghana, the primary goal of management is to reduce long
term cardiovascular risk, reduce blood pressure, lessen risk
Hypertension is a major health problem that remains a of complications, and improve the quality of life of patients
significant threat to the health and general wellbeing of many [5–7].
people all over the world. Even though there is a significant Quality of life is an important indicator when evaluating
advancement in the detection, evaluation, and treatment of hypertensive treatment outcomes and health-related quality
hypertension, the prevalence rates are high worldwide and in of life (HRQoL) is directly influenced by health-related
Ghana [1–4].While hypertension is among the leading causes issues which reflect the patient’s burden associated with the
of hospital admissions, heart failure, renal failure, and death disease [8–10]. Examples of such health-related issues include
2 International Journal of Hypertension
Table 1: Assessment areas and tools.
Assessment area Assessment tool
Sociodemographics Age, sex, marital status, education, employment status, and estimated monthly income
Clinical factors Period since diagnosed, presence of comorbidities, and number of medications taken
Medication adherence using Medication Adherence Questionnaire
Personality trait Ten Item Personality Inventory
Health-related quality of life WHO Quality of Life (WHOQOL-BREF) scale
the coexistence of hypertension with other illnesses, total but 19 questionnaires were rejected due to incomplete infor-
number of antihypertensive medications taken, extent of mation. Therefore, information from a total number of 331
adherence to these medications, and the type of medications, patients was used in data analysis.
although no class of antihypertensive agent offers a definite Participants were eligible for inclusion if they were
advantage over the others in terms of impact on HRQoL [11– 18 years and older, were diagnosed with hypertension
15]. with/without comorbidities, and were on medications for at
In some patients, hypertension has been reported to be least 6 months prior to data collection.
a psychosomatic or behavioral disorder, where its etiology
and prognosis have been linked to some psychological factors 2.4. Study Measures. The sociodemographic characteristics,
including personality traits [16–25]. Personality traits refer to clinical information, personality characteristics, medication
relatively stable emotional, cognitive, and behavioral differ- adherence, andHRQoL information were obtained frompar-
ences among individuals and have been shown to be highly ticipants using an interviewer administered questionnaire. A
consistent across adulthood [26].Themost common person- summary of the assessment areas and tools has been provided
ality model explored has been the Big Five personality traits in Table 1. The questionnaire was translated from English to
which suggests five broad domains used to describe human Ga and Twi which are the predominant local languages and
personality. The five dimensions comprising agreeableness, were backtranslated into English by professional translators.
conscientiousness, extraversion, neuroticism, and openness Participants could choose the language of preference to
to experience have shown various associations with health respond to the questionnaire.
outcomes in patients with hypertension and cardiovascular The sociodemographic characteristics included age, sex,
diseases [10, 19, 27, 28]. marital status, education, employment status, and an esti-
While HRQoL may be compromised in patients with matedmonthly income. Somemedical information including
hypertension, there is limited body of research examining the period since diagnosed, presence of comorbidities, and num-
determinants of HRQoL among persons with hypertension ber of medications taken were also obtained from the patient
particularly in Ghana. This study aims to contribute to filling records.
this gap by examining the association between personality, The Ten Item Personality Inventory (TIPI) is a very brief
clinical characteristics, and HRQoL. measure of the Big Five personality domains and was used
for the assessment of personality traits, comprising two items
for each of the traits of agreeableness, conscientiousness,
2. Methods extraversion, neuroticism, and openness [30]. Each item was
2.1. Study Design. A hospital-based cross-sectional study of assessed using a 7-point response scale ranging from 1 = dis-
patients with hypertension was carried out from December agree strongly to 7 = agree strongly. The TIPI is scored using
2015 to January 2016. items 2R, 7 for agreeableness; 3, 8R for Conscientiousness;1, 6R for Extraversion; 4R, 9 for Emotional Stability; and 5,
10R for Openness (‘R’ represents the items that were reverse-
2.2. Study Setting. Thestudywas conducted at the Ledzokuku scored). Each personality trait was classified as low (0.5–2.5),
KroworMunicipal Assembly (LEKMA)Hospital inTeshie, an moderate (3.0–5.0) and high (5.5–7.0) based on the TIPI
urban poor community in Accra, Ghana, which serves as a norms. The use of this personality instrument was guided by
primary hospital for the people in the surrounding commu- its potential to provide an easy assessment of personality in a
nities. The hospital runs specialized clinics on Tuesdays and clinical setting as compared to the existing oneswhich require
Thursdays for patients with hypertension during which data longer duration to complete.
were collected from the patients. The Medication Adherence Questionnaire (MAQ) was
used to assess medication adherence and the questions cov-
2.3. Study Participants. The minimum sample size was esti- ered medication intake behavior of patients. The total score
mated at 312 using a projected prevalence of hypertension ranged from zero to four representing low (3-4), moderate
in an urban poor community in Ghana at 28.3% [3], a (1-2), and high (0) adherence, respectively [31].
95% confidence interval, and a standard value of 1.96 [29]. The HRQoL was measured using the shorter version of
To compensate for losses, incomplete information, and low the WHO Quality of Life Scale (WHOQOL-BREF) which is
response rates from the participants, additional participants a 26-item cross-cultural scale that covers the four domains
were enrolled for the study using a 10% nonresponse rate, of quality of life: psychological, physical, social relationships,
International Journal of Hypertension 3
and environmental domains [32]. The mean score of items 3.2. Patient Characteristics and Health-Related Quality of
within each domain was used to calculate the domain mean Life. Table 3 shows the linear regression analysis between
where higher scores denoted higher quality of life. The mean the study variables and the different domains of HRQoL
score of each domain was then multiplied by 4, making with significant associations for age (p < 0.05), education
it comparable with the WHOQOL-100 [32]. The Cronbach (p < 0.001), and the physical domain. For the psychological
alpha values of 0.81, 0.82, 0.68, and 0.80 have been reported domain, the model showed significant relationships with
for psychological health, physical health, social relationship, education (p < 0.05) and monthly income (p < 0.001). Age (p
and environmental health, respectively [33]. < 0.001) and education (p< 0.05)were significantly associated
To ensure the reliability and appropriateness of the with the social and environmental domains, respectively.
questionnaire, a pilot study was conducted involving 30 There was no statistically significant relationship between
participants. The TIPI was reliable with Cronbach alpha of adherence and quality of life (p > 0.05).
9.1, 9.2, 7.8, 7.8, and 8.8 for agreeableness, conscientiousness, Table 4 shows the statistically significant results of the
extraversion, neuroticism, and openness, respectively. Simi- linear regression analysis of each of the quality of life dimen-
larly, the psychological (0.92), physical (0.88), social relations sions and demographics, clinical factors, and adherence.
(0.90), and environmental (0.87) domains of HRQoL scale as The demographic variables did not explain much of the
well as the MAQ (0.75) were reliable. variance of HRQoLwith the largest effect seen on the physical
dimension.
2.5. Data Analysis. The data were entered into SPSS version The result of the Pearson product-moment correlation
20 for analysis. Descriptive analysis was carried out to deter- analysis showed that conscientiousness was significantly
mine frequencies, means, and standard deviations. Linear associated with all the dimensions of HRQoL. Extraversion
regression analysis and a three-step hierarchical regression and agreeableness were also significantly associated with the
model were performed to evaluate the effect of clinical environmental dimension of HRQoL (Table 5).
characteristics on HRQOL dimensions [10]. During the first Only the conscientiousness personality trait correlated
step, demographic characteristics (age, sex, monthly income, statistically significantly with adherence to medication
employment status, and education) were entered. In step (Table 6).
two, comorbidity, number of medications, and number of
years with hypertension were added to the demographics and 4. Discussions
in the final step medication adherence was included in the
model. Finally, univariate analyses were performed among The present study examined the association between clinical
personality traits, adherence, and HRQoL dimensions. characteristics, personality traits, and health-related quality
of life outcomes. While 47.1% of patients adequately adhered
3. Results to their medications, the findings revealed that age, edu-
cation, monthly income, and presence of comorbid health
3.1. Characteristics of Patients. Table 2 presents the frequency conditions were associated with HRQoL. In relation to the
and percentages of patient characteristics in the study. The Big Five personality characteristics, agreeableness, conscien-
majority of the participants were females (81.9), were above tiousness, and extraversion were also associated with HRQoL
59 years of age (55%), were married (52%), had attained while only conscientiousness was related significantly to
up to the secondary school level of education (62.2%), were medication adherence.
unemployed (58.6%), and make an average monthly income Some important observations on the demographics
of less than 25 US Dollars (64%). showed that most women reporting to the hospital were
The number of participants with a 1–10 years’ duration above the age of 50 years and had the lowest level of income. A
of diagnosis for hypertension was highest (56.8%), followed plausible reason for this observation could be the likelihood
by 11–20 years (20.2%), and least for >40 years (1.8%). The of health seeking behavior among women although they may
presence of comorbidities was high (52.9%) with the follow- be in the lower socioeconomic level [34, 35].
ing comorbidities recorded: diabetes (40.2%), dyslipidaemia An inverse relationship between age and HRQoL was
(20.9%), stroke (10.7%), peptic ulcer (7.4%), osteoarthritis found in this study and this is consistent with findings from
(4.1%), ischaemic heart disease (3.7%), asthma (3.3%), uri- previous studies [19, 36]. This may be because hypertension
nary tract infection (2.9%), anaemia (2.1%), gastritis (2.1%), is more common in the elderly [37] and as age increases the
gout (0.8%), lumbago (0.4%), benign prostatic hyperplasia period of having hypertension is also prolonged resulting in
(0.4%), and goitre (0.4%). a build-up of factors that could negatively impact on partic-
The number of medications taken per patient was noted ularly the physical aspect of quality of life of a patient over a
(mean = 2.14± 0.79).The average number of antihypertensive period. Similarly, some studies have identified hypertension
medications taken per patient wasmean= 2.89± 1.09with the as a risk factor for a decline in the quality of life of the elderly
following frequencies: Amlodipine (n = 219), Lisinopril (n = population [38–40].
212), Nifedipine (n = 201), Bendrofluazide (n = 184), Atenolol The association between educational level and quality
(n= 42), Losartan (n= 14), propranolol (n= 12), Frusemide (n of life has been reported [41, 42], where like the current
= 8), carvedilol (n = 8), Candesartan (n = 6),Methyldopa (n = study education was associated with HRQoL outcomes,
5), and Hydrochlorothiazide (n = 4). Patients who adequately particularly for the physical and environmental domains.
adhered to their medications were 47.1%. This observation may be explained by the fact that patients
4 International Journal of Hypertension
Table 2: Characteristics of patients (n=331).
Characteristics Number Percentage
Gender
Male 60 18.1
Female 271 81.9
Age Ranges (years)
2 0.6
20 – 29 2 0.6
30 - 39 10 3.0
40 - 49 45 13.6
50 – 59 90 27.2
182 55.0
Marital status
Single 16 4.8
Married 172 52.0
Widowed 100 30.2
Divorced 43 13.0
Level of education
None 84 25.4
Primary 21 6.4
Secondary 206 62.2
Postsecondary 15 4.5
Tertiary 5 1.5
Employment status
Unemployed 194 58.6
Employed 115 34.7
Retired 22 6.7
Monthly income ($)
212 64.0
26-125 78 23.6
126-250 37 11.2
251-500 3 0.9
1 0.3
Period since diagnosed (years)
49 14.8
1–10 188 56.8
11–20 67 20.2
21–40 21 6.3
6 1.8
Presence of Comorbidity
Yes 175 52.9
No 156 47.1
Medication adherence
High 156 47.1
Poor 175 52.9
Number of medications taken per patient, Mean (±S.D) = 2.14 (0.79)
who are educated tend to be knowledgeable about their low socioeconomic status have been associated with poor
conditions, leading to lower levels of anxiety, increased quality of life, and undesirable health outcomes such as poor
physical functioning, and better general health ratings which general health, decline in mobility, social isolation, poor
improve HRQoL [43]. emotional coping, and long-term disability [44, 45].
Our results indicated that monthly incomewas negatively Coexisting diseases may have considerable effects on
associated with the physical domain of HRQoL. Income and patients' well-being. Individuals with chronic conditions
International Journal of Hypertension 5
Table 3: Adjusted mean differences (and 95% confidence intervals) from a linear regression analyses evaluating the effect of sociodemo-
graphic/economic factors, presence of comorbidity, number of years with hypertension, and number of medications taken on HRQOL
dimensions.
Physical Psychological Social Environmental
Gender
Male Ref
Female 1.75 (-1.36, 4.88) 2.25 (1.77, 6.28) 0.52 (-1.41, 2.44) 3.32 (-1.43, 8.06)
Age ∗ ∗
Ref
20 – 29 -3.94 (-23.77, 15.88) 4.57 (-20.99, 30.13) 13.19 (-25.40, -0.97) -14.62 (-44.72, 15.49)
30 - 39 -7.7 (-22.96, 7.55) 6.01 (-13.66, 25.68) 13.96 (-23.36, -4.56) -10.91 (-34.07, 12.25)
40 - 49 3.07 (-11.49, 17.65) 12.38 (-6.41, 31.16) 8.27 (-17.25, 0.70) -5.56 (-27.68, 12.25)
50 – 59 -2.89 (-17.24, 11.45) 11.40 (-7.09, 29.89) 9.89 (-18.72, -1.05) -7.06 (-28.84, 14.71)
-1.56 (-15.90, 12.78) 13.00 (-5.49, 31.49) 9.54 (-18.38, -0.71) -8.40 (-30.17, 13.37)
Education ∗ ∗ ∗ ∗ ∗
None Ref
Primary 1.9 (-2.90, 6.71) -1.31 (-7.51, 4.89) 2.26 (-0.70, 5.22) 6.33 (-0.97, 13.63)
Secondary 6.12 (3.40, 8.83) 2.59 (-0.91, 6.08) 2.20 (0.53, 3.87) 6.35 (2.23, 10.46)
Post-secondary 7.15 (2.05, 12.26) 6.42 (-0.15, 13.00) 1.09 (-2.06, 4.23) 9.64 (1.90, 17.39)
Tertiary 7.27 (1.78, 12.76) 3.08 (-10.16, 4.00) 0.86 (-2.53, 4.24) 5.56 (-2.78, 13. 90)
Monthly income ∗ ∗ ∗
None/Pension Ref
2.1 (-2.17, 6.38) 2.42 (-7.93, 3.10) 2.26 (-4.90, 0.38) -2.08 (-8.58, 4.41)
500-999 0.86 (-3.12, 4.85) 0.47 (-4.68, 5.60) 0.29 (-2.17, 2.75) 3.76 (-2.30, 4.42)
1000 + -2.59 (-9.95, 4.77) 17.55 (8.06, 27.04) 2.25 ( -2.28, 6.79) 5.37 (-5.80, 16.55)
Employment
Unemployed Ref
Employed 0.91 (-2.64, 4.47) -0.50 (-5.09, 4.09) 0.90 (-1.29, 3.09) -0.33 (-5.74, 5.07)
Retired 2.04 (-3.34, 7.42) 2.52 (-4.42, 9.47) 1.43 (-1.89, 4.75) 7.09 (-1.09, 15.26)
Comorbidity
No Ref
Yes -1.7 (-4.00, 0.59) 0.39 (-2.57, 3.35) -0.48 (-1.89, 0.04) -0.25 (-3.72, 3.25)
Years with hypertension ∗
Ref
1-9 years 0.77 (-2.43, 3.98) 5.97 (1.83, 10.10) 1.01 (-0.96, 2.99) -0.25 (-5.12, 4.62)
10-19 years 0.66 (-3.27, 4.61) 2.23 (-2.86, 7.32) -0.27 (-2.71, 2.16) -2.40 (-8.39, 3.59)
20+ years 0.19 (-4.87, 5.27) 2.67 (3.87, 9.21) -0.89 (-4.01, 2.24) 4.49 (-3.20, 12.20)
Adherence
Poor Ref
High -0.073 (-0.052, 0.183) 0.009 (0.002, 0.875) -0.011 (-0.007, 0.842) -0.073 (-0.009, 0.185)
∗p<0.05, ∗∗p<0.01, and ∗∗∗p<0.001.
usually have comorbidities [46]. The findings of this study determining their HRQoL. Our findings add to the literature
indicated that the majority of participants had comorbidities on the possible association between personality and HRQoL
which had a significant relationship with their HRQoL by showing that conscientiousness relates significantly with
especially in the physical domain. The inverse relationship all domains of HRQoL, while agreeableness and extraversion
between comorbidity and quality of life has also been were associated with the environmental domain. Conversely,
reported [7, 47]. neuroticism, which refers to the propensity of an individual
Personality has been proposed to be relatively stable to experience negative affect, and openness to experience,
emotional, cognitive, and behavioral characteristics of an which also refers to creativity and originality, did not predict
individual which is consistent across adulthood [26]. Since HRQoL in this group of patients.
personality is a relatively stable inclination of a person to The association between conscientiousness and quality
interpret different circumstances, it is probable that the of life has been demonstrated for all and some domains of
personality of patients with hypertension play a role in quality of life [18, 48] with some contradicting views [10, 19].
6 International Journal of Hypertension
Table 4: Hierarchical regression model of demographic characteristics, clinical variables, and HRQoL domains.
Physical Psychological Social Environmental
Step 1 R2 5.2% 0.8% 0.7% 3.2%
Step R2 (R22 change) 6.1% (0.9%) 1.0% (0.2%) 1.3% (0.6%) 3.2% (0%)
Step R2 (R23 change) 6.5% (0.4%) 1.0% (0.0%) 1.3% (0.0%) 3.6% (0.4%)
Age -0.201(0.028) 0.146 (0.115) - 0.13 (0.235) - 0.040(0.132)
Sex 0.114 (0.365) 0.013 (0.471) - 0.042 (0.479) 0.022(0.419)
Education 0.152(0.003) 0.024 (0.258) 0.016(0.103) 0.124(0.010)
Employment status -0.075(0.086) 0.013 (0.407) -0.032(0.282) 0.016(0.383)
Monthly income -0.128(0.001) 0.022 (0.365) -0.003(0.447) -0.040(0.050)
Co-morbidity 0.102 (0.032) - 0.046 (0.200) 0.071 (0.100) 0.013(0.409)
Number of medications taken -0.006 (0.455) 0.023 (0.452) 0.024 (0.303) - 0.074 (0.090)
Number of years with hypertension -0.120 (0.138) 0.023 (0.335) - 0.039 (0.090) - 0.023(0.462)
Adherence -0.254 (0.270) 0.010 (0.298) -0.025 (0.859) -0.409 (0.232)
Step 1: only demographics (Age, sex, monthly income, employment status, and education) were entered; step 2: Comorbidity, number of medications, and
number of years with hypertension were added to the demographics; step 3: adherence was then added to the other variables.
Table 5: Univariate analysis of the Big Five Personality Traits and HRQoL domains.
Physical Social Environmental Psychological
Extraversion 0.08(0.17) 0.11(0.05) 0.21 (<0.001) 0.10(0.083)
Agreeableness 0.11(0.06) 0.06(0.25) 0.11(0.05) -0.004(0.95)
Conscientiousness 0.12(0.03) 0.16(0.003) 0.26(<0.001) 0.17(0.002)
Emotional stability 0.05(0.34) 0.08(0.16) 0.08(0.14) 0.04(0.46)
Openness to experience 0.04(0.51) -0.09(0.12) 0.08(0.18) 0.01(0.80)
Correlation coefficients (p value).
Table 6: Univariate analysis between the Big Five Personality traits and level of adherence.
Correlation Coefficients p value
Extraversion -0.062 0.259
Agreeableness 0.002 0.970
Conscientiousness 0.118 0.032
Emotional stability -0.075 0.175
Openness to experience -0.105 0.057
p value<0.05.
It is remarkable to note that conscientious individuals are significant associations with the environmental domain of
more devoted to maintaining their roles, having subtraits of HRQoL.The observed positive association implied that high
self-efficacy, order, dutifulness, and self-discipline [49]. It also scores on agreeableness and extraversion were related to
describes the extent to which one works towards goals in a better environmental quality of life. Considering the fact
disciplined manner and this may have also contributed to that agreeableness could be useful for harmony in many
the association between conscientiousness and medication environments [50], it suggests that the patients may be coop-
adherence observed in this study. Our findings are important erating and considerate towards the environmental factors in
because it concerns patients with hypertension who as part relation to their health provision, leading to desirableHRQoL
of their goals of management have to adhere to both phar- outcomes [51]. Similarly, extraverts enjoy interacting with
macological and lifestyle behaviors to control blood pressure, people and are often perceived as being full of life, energy,
reduce risk of complications, and improve quality of life [6]. and positivity and these attributes may impact on quality
The more orderly and organized the patients are, the more of life. The associations between agreeableness, extraversion,
critical it is for the performance of habits and routines for and quality of life have also been reported elsewhere [10, 52].
better quality of life outcomes. This study acknowledges the limitation that it employed
Agreeableness, which refers to the degree of selfless- a quantitative approach and though an adequate sample
ness or hostility towards others, and extraversion, which is was used, some in-depth interviews could have been con-
characterized by attributes such as sociability, also showed ducted to really understand the personality traits in illness
International Journal of Hypertension 7
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