Factors Associated with Medication Adherence among Patients with Stroke in rural Nanhe County, China

Abstract

Aims: This study aimed to examine the prevalence of use of the four medications, to investigate medication adherence, and to identify factors influencing medication adherence in a model of five interacting dimensions (social and economic factors, healthcare system factors, condition-related factors, therapy-related factors, and patient-related factors) in rural patients with stroke in Nanhe County, China. Methods: A cross-sectional analysis used data from 857 stroke patients enrolled in a previous trial. The outcome variable was medication adherence. It was measured using the Morisky Green Levine Scale (MGLS). The independent variables were social and economic factors (age, sex, marital status, education, current job, and annual total income), health system-related factors (Non-communicable disease insurance and frequency of visiting village clinics), condition-related factors (stroke recurrence, far vision, near vision, hearing capability, disability, overall health status, whether having a family caregiver), therapy-related factors (number of diseases patients have and total number of medication use), and patient-related factors (patients’ attitudes towards medication, smoking status, and depression). Bivariable analysis and logistic regression models were used to analyze the association between medication adherence and five dimensions of factors. Analyses were stratified by four medication classes ((anti-hypertensive drugs, statins, anti-platelet drugs, and anti-hypoglycemic drugs). Results: For anti-hypertensive drugs: Higher education (OR=1.87, 95% CI:1.06–3.30), better health-related quality of life (EQ-5D-5L Index; OR=3.24, 95% CI:1.23–8.54), good hearing capability (OR=1.79, 95% CI:1.20–2.67), and active attitudes toward medications (OR = 1.62, 95% CI: 1.03 - 2.53) were associated with high adherence. For anti-hyperglycemia drugs: Male sex (OR=0.13, 95% CI:0.03–0.58) and frequently visiting clinics (OR=0.23, 95% CI:0.07–0.73) were associated with lower adherence, while primary (OR=5.71, 95% CI:1.28–25.44) and higher education (OR=4.65, 95% CI:1.11–19.57) were associated with high adherence. For statins and anti-platelet drugs: No significant associations were identified. Conclusions: Medication adherence in rural stroke patients was associated with sex, education level, health status, and active attitudes toward viii medications. Contrary to expectations, frequent healthcare utilization was associated with medium to low adherence. These findings provide essential information for the current status of secondary stroke prevention in China's underserved rural population. Keywords: Medication adherence, stroke, rural health, China, secondary prevention.