Medication adherence among geriatric patients with chronic diseases in rural China: a social ecological model perspective

BACKGROUND: The global aging trend has heightened attention to chronic diseases (CDs) among the elderly, highlighting the importance of improving medication adherence. China, home to a fifth of the world's elderly population, exemplifies the challenges of managing medication adherence in rural settings. This study aimed to assess the prevalence of medication adherence among elderly individuals with CDs in rural northwestern China, and to examine multilevel factors based on the Social Ecological Model (SEM) as the theoretical framework. METHODS: A total of 700 rural residents aged ≥ 60 years were surveyed through structured face-to-face interviews in Shaanxi Province, China. Descriptive statistics, t-tests, and chi-square tests were used to compare group differences. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with medication adherence within the SEM framework. RESULTS: Among all 700 participants, 496 (70.86%) had at least one CD, and among these, 55.04% had multiple conditions. Overall, 59.68% of patients exhibited full adherence to their medication regimens, while 22.78% and 17.54% reported partial and non-adherence, respectively. Multivariable analysis showed that comorbidity, employment status, travel time to primary healthcare centers, distance to county hospitals, and exposure to community health education were significantly correlated with adherence (p < 0.05). CONCLUSIONS: Medication adherence among rural elderly with CDs remains suboptimal and is shaped by factors spanning individual, interpersonal, organizational, and community levels. Interventions should integrate these multilevel influences to strengthen adherence and chronic disease management in resource-limited rural settings.