Long-term Medication Adherence Attitudes and Behaviors of Stroke Patients in Rural Areas of China and Related Factors: Based on Follow-up Data from a Certain County in Hebei Province

Background Good medication adherence can significantly reduce the risk of recurrence in stroke patients and is crucial for the secondary prevention of stroke. However, existing research primarily focuses on short-term medication and adherence behaviors among rural stroke patients, while studies on the long-term medication adherence behaviors of patients with a history of stroke in rural areas are limited. Objective To analyze the long-term medication behavior, adherence attitude and behavior of stroke survivors in rural areas of China, and identify the factors related to medication behavior. Methods System-integrated technology-enabled intervention (SINEMA) study, a research project focusing on the management of stroke patients in rural areas, which was conducted in 60 villages across 5 towns of Nanhe County, Hebei Province in 2017—the subjects of this study were all stroke survivors who had previously participated in the 2017 SINEMA study, consented to participate in the follow-up survey conducted from May to July 2024, and completed the survey. The study investigated the medication use of the subjects, including antihypertensive drugs, statins, antiplatelet drugs, and hypoglycemic drugs. Meanwhile, the Maastricht Utrecht Adherence in Hypertension-16 (MUAH-16) scale was employed to assess the subjects' medication adherence attitudes, specifically focusing on the dimensions of positive medical and medication attitudes. The Morisky Green Levine Scale was used to measure the medication adherence behaviors of patients taking the above four categories of drugs, with a score of 0 defined as high adherence. Descriptive analysis was applied to present the basic characteristics of the patients, their medication adherence status, and the relevant factors identified through multivariate Logistic regression analysis. Results A total of 912 participants were included in this study, with a mean age of (72.0±7.9) years. Among them, 46.1% (420/912) were female. Regarding medication use, 772 cases (84.6%) reported taking antihypertensive drugs, 547 cases (59.9%) took antiplatelet drugs, 427 cases (46.8%) used statins, and 203 cases (22.3%) took hypoglycemic drugs. Among patients currently taking these four types of drugs, the adherence rate to hypoglycemic drugs was 77.3% (157/203), to antihypertensive drugs was 71.5% (552/772), to antiplatelet drugs was 71.2% (392/547), and to statins was 71.2% (304/427). The survey also showed that 49.2% (449/912) of the patients held a relatively positive attitude towards medication use. Results from multivariate Logistic regression analysis showed that among patients taking antihypertensive medications, those with higher educational attainment (secondary school and above: OR=1.87, 95%CI=1.13-3.09) and positive attitudes toward medical care and medication use (OR=1.53, 95%CI=1.08-2.17) had higher medication adherence, while patients capable of independently completing work tasks (OR=0.56, 95%CI=0.32-0.99) and those visiting village clinics ≥1 time per month (OR=0.68, 95%CI=0.53~0.88) had lower medication adherence (P