Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Carole A. Pepa


Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health literacy screening program to identify patients who may be at risk of non-adherence to antihypertensive medication therapies. The theoretical framework of Lewin’s Change theory and the ARCC© model guided this EBP project. Using the REALM-SF health literacy screening tool, 65 participants (N=65) were screened for health literacy. The participants ranged in age from 35 to 86 years with the majority (33.8%) in the 66-74 age range. Six (N= 6) participants scored less than seven on the REALM-SF indicating low health literacy. Low health literacy participants were all 56 years and older. If participants had low literacy and hypertension (N= 6), a Hill-Bone HBP Compliance Scale was then administered. Interventions to increase adherence to antihypertensive medications were then delivered to the participant. A four-week post intervention Hill-Bone Compliance Scale was obtained to measure any change. A paired t-Test comparing the pre and post intervention Hill-Bone HBP Compliance Scale revealed that the intervention was not statistically significant, N = 6, t (5) = -1.688, CI = -5.88 – 1.22, p =.152. However, there was a difference in variance, which may indicate a sampling error or small sample size. Further investigation in delivering low literacy interventions aimed at increasing antihypertensive medication adherence with a larger sample size may be indicated.