Promoting medication adherence through visual education: a prison-based study among women with hypertension

PURPOSE: This study aims to assess the effectiveness of a poster-based visual health education intervention in improving medication adherence among incarcerated women diagnosed with hypertension. DESIGN/METHODOLOGY/APPROACH: A one-group repeated-measures pretest-posttest (pre-experimental) design was conducted in a women's correctional facility designated for individuals convicted of drug-related offenses in Indonesia. A total of 39 incarcerated women clinically diagnosed with hypertension participated in the study. Poster-based educational materials were installed in communal spaces over a 30-day period. Medication adherence was measured using a validated self-report adherence questionnaire (score range 0-40, higher scores indicating better adherence) at three time points: Day 0 (pretest), Day 15 (midtest) and Day 30 (posttest). Data were analyzed using the Friedman test for overall change, followed by post hoc Wilcoxon signed-rank and McNemar tests with Bonferroni correction. FINDINGS: There was a significant upward trend in medication adherence scores over the 30-day intervention. Mean medication adherence scores increased from 16.7 at pretest to 31.5 at posttest. The proportion of participants with high adherence rose from 17.9% to 76.9%. All pairwise comparisons between time points were statistically significant, indicating that poster-based visual education contributed to improved adherence behavior. PRACTICAL IMPLICATIONS: Posters may serve as a scalable and sustainable tool to promote chronic disease self-management in correctional environments. SOCIAL IMPLICATIONS: Improving adherence through simple visual tools may reduce long-term health disparities among incarcerated populations. ORIGINALITY/VALUE: This study demonstrates the potential of low-cost, visual-based educational interventions in prison health settings, an area where health education strategies remain underexplored.