Influencing Factors of Adherence Dynamics in Young Adults with Hypertension: A Mixed-Methods Study

Context Young adults with hypertension are a susceptible group prone to changes in adherence influenced by external factors, which are associated with lower control rates and adverse long-term prognoses. However, the factors influencing the dynamics of adherence among young Chinese patients with hypertension remain unclear.

Objective The present study investigates the factors influencing the dynamics of medication and non-medication adherence in young Chinese adults with hypertension.

Study design and analysis explanatory sequential mixed methods.

Setting or Dataset general outpatient clinic of a tertiary hospital in Chengdu.

Population Studied A single-center cohort study.

Intervention Demographic characteristics, clinical characteristics, social support.

Outcome Measures Behaviors and treatment adherence measured by standard questionnaire.

Results A total of 89 young patients with hypertension were included. During the 6 months follow up, the groups with decreased, unchanged, and increased medication adherence consisted of 16 (28%), 30 (53%), and 11 (19%) cases, respectively. For lifestyle adherence, that is 41 (46%), 28 (31%), and 20 (23%) cases, respectively. Based on changes in medication and lifestyle adherence, semi-structured interviews were conducted with 27 and 36 patients. The results showed that the impact of the social environment on medication adherence was family, social, and instrumental support. The main facilitating factors were family reminders, encouragement, and use of portable pill boxes. The common main hindering factors were busy work, frequent socializing, and taking care of children. The results showed that the impact of the social environment on lifestyle adherence was family, social, instrumental, workplace, natural environment support. The common main facilitating factors were encouragement and reminders from family and friends, easy access to healthy food, sports apps, sports watches, regular health check-ups, weighing with a scale, and mild weather. The common main hindering factors were caring for children, frequent socializing, takeout, the COVID-19 pandemic, busy work, extreme weather conditions, and high cost of healthy food.

Conclusions Young adults with hypertension tend to have low levels of medication and lifestyle adherence, both of which can change significantly over time. The adherence to medication and lifestyle is primarily influenced by socio-environmental factors and patient-specific factors.