Structural equation modeling of the association between factors related to medication adherence, perceived social support, and patients’ resilience to hypertension: a cross-sectional study

BACKGROUND: Hypertension affects over a billion people in the world, despite this prevalence, poor adherence to antihypertensive medication remains the main problem in low-income regions. Social support and resilience might influence adherence to antihypertensive medication.This cross-sectional study investigated the associations among perceived social support, resilience, and antihypertensive medication adherence in hypertensive patients in Izeh County, Iran. METHODS: This descriptive-analytical cross-sectional study was conducted, from April to December 2024 among adults with hypertension selected through a two-stage cluster sampling method from urban and rural health centers in Izeh County. Of the 600 initially enrolled participants (350 urban, 250 rural), 70 were excluded due to more than two missing items on the MMAS-8 questionnaire, leaving 530 participants for analysis. Data were collected using self-administered validated questionnaires under researcher supervision at urban and rural health centers, including the Morisky Medication Adherence Scale (MMAS-8), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Resilience Questionnaire.No resilience subscales were removed due to intellectual property restrictions, and potential conceptual overlap was statistically controlled. Analyses were conducted using SPSS 24 and AMOS 20, applying regression, path analysis, and structural equation modeling (SEM) to assess direct and indirect pathways. RESULTS: Perceived social support showed a significant positive effect on resilience (β = 0.43, p < 0.001) and an indirect effect on medication adherence (β = 0.10, p < 0.001). Resilience had a significant direct effect on medication adherence (β = 0.19, p = 0.002). The direct effect of social support on medication adherence was not statistically significant (p = 0.070). Among social support dimensions, family support was the strongest (M = 15.82, SD = 2.82). The SEM model demonstrated The model demonstrated an acceptable fit to the observed data (RMSEA = 0.054; CFI = 0.91). CONCLUSION: These findings bring out the imperative of social support and resilience to medication adherence among hypertensive patients. It is important to strengthen the social networks and psychological resilience to improve adherence to antihypertensive medication and overall disease management,Psychosocial strategies should thus be incorporated into future interventions to improve adherence to antihypertensive medication within resource-limited settings.