Factors affecting treatment adherence among patients with hypertension based on the PRECEDE model: A cross-sectional study from a delay discounting perspective

Background: Hypertension is a significant global public health concern, and research shows that treatment adherence plays an important role in hypertension control. This study incorporated a novel factor in behavioral economics, delay discounting, into the predisposing factors within the PRECEDE model to explore the factors influencing adherence to treatment of patients with hypertension. Design: This cross-sectional study was conducted in Jiangsu Province, China, in 2023 and included 1,123 patients with hypertension. Methods: Data collection tools included demographic variables and predisposing, reinforcing, and enabling factors. Delay discounting was assessed using a self-designed computer program. The collected data were analyzed using descriptive statistics and hierarchical regression. This study used the STROBE Reporting Checklist. Results: The variables accounted for 30.4% of the total variance in adherence to treatment of patients with hypertension. Hierarchical regression analyses revealed that the predisposing (knowledge, delay discounting, and self-efficacy), reinforcing, and enabling factors were significantly associated with treatment adherence. Conclusions: Delay discounting was associated with hypertension treatment adherence. Enhancing the predisposing, enabling, and reinforcing factors may lead to increased adherence among patients with hypertension. It is recommended that hospitals and healthcare providers offer educational lectures and training sessions, and that some simple delayed discount interventions be added to supplement this. Additionally, government and institutional efforts should be made to increase the availability of community-level resources for patients with hypertension.