Predicting Medication Adherence Using Psychosocial Factors: A Comprehensive Analysis through Regression and Path Models: doi: 10.7417/CT.2026.2047

Background: This study aimed to identify psychosocial determinants of medication adherence among hypertensive patients and examine urban-rural disparities. Methods: In this cross-sectional study, 385 hypertensive patients from urban and rural areas completed a comprehensive questionnaire assessing demographic characteristics, psychosocial factors, and medication adherence measured by the Morisky Medication Adherence Scale (MMAS-8). Multiple statistical approaches, including logistic regression, path analysis, and structural equation modeling, were employed to examine direct and indirect relationships between predictors and medication adherence. Results: 52.7% of participants demonstrated high medication adherence, with significantly higher rates in urban (62%) than rural (43%) populations. Multivariate analysis identified family support (AOR=2.34, 95% CI: 1.76-3.12), self-efficacy (AOR=1.87, 95% CI: 1.38-2.54), and health literacy (AOR=1.93, 95% CI: 1.42-2.61) as significant positive predictors of adherence, while perceived stigma (AOR=0.63, 95% CI: 0.48-0.83) and cultural beliefs about traditional remedies (AOR=0.58, 95% CI: 0.43-0.78) were significant barriers. Path analysis revealed that psychosocial factors mediated the relationship between education level and medication adherence, with health literacy accounting for 42% of this relationship. Significant urban-rural differences were observed in the strength of associations between psychosocial factors and adherence. Conclusions: This study provides novel insights into the complex interplay between demographic characteristics, psychosocial determinants, and medication adherence among hypertensive patients in Saudi Arabia. The identified urban-rural disparities and cultural influences highlight the need for tailored interventions that address specific psychosocial barriers in different contexts. Our findings suggest that comprehensive approaches enhancing health literacy, self-efficacy, and family support while addressing cultural beliefs could significantly improve medication adherence.