Abstract
In rural China, treatment adherence of patients with hypertension remains a challenge. Although early research on patient adherence has confirmed the importance of trust in doctors, the relative contribution and influence of the two-dimensional structure of trust on adherence has not been explored. Thus, this study examined the effects of patient trust in primary care physicians' (PCPs) benevolence and ability on medication adherence, dietary management, and physical activity. The data were derived from 2,533 patients at 54 primary health institutions in China (village level) from February 2017 to May 2018. Participants were assessed using the Chinese version of the Wake Forest Physician Trust Scale and the Therapeutic Adherence Subscale for Hypertensive Patients. Other information included region, gender, age, and self-rated health status. The results of multiple linear regression and structural equation modeling confirmed that patient trust in PCPs' benevolence was positively correlated with patient adherence to medication, diet management, and physical activity. Patient trust in PCPs' ability was negatively correlated with adherence to dietary management and physical activity. We concluded that interventions aimed at increasing PCP benevolence have the greatest potential to improve patient adherence to hypertension treatment. Under the country's policy of advocating to improve PCPs' diagnoses and treatment technology, it may be important to cultivate doctors' communication skills, medical ethics, and other benevolent qualities to improve patients' adherence with drug and Non-drug treatments.
Highlights
Hypertension is a worldwide public health challenge [1, 2], and by 2025, an estimated two billion people worldwide are expected to suffer from it [1–3]
The results show that the level of trust in primary care physicians’ (PCPs)’ benevolence can predict the above three adherence behaviors of patients to a certain extent
Patients in eastern provinces may have better educational backgrounds and more channels to gain hypertension-related knowledge, which may lead to increased demand for medical participation and increased interaction with PCPs, thereby resulting in higher treatment adherence by patients
Summary
Hypertension is a worldwide public health challenge [1, 2], and by 2025, an estimated two billion people worldwide are expected to suffer from it [1–3]. Epidemiological surveys show that the current global hypertension control rate is only 31.7% [1–3]. China has the largest number of patients with hypertension. The government has announced detailed health management service specifications for hypertensive patients, including screening, follow-up visits, classified intervention, and service procedures and requirements, [4, 5], the domestic hypertension control rate is only 16.8% [2]. In rural areas of China, hypertension is the chronic disease with the highest prevalence rate [6–8]. The prevalence rate exceeds that of urban areas (28.8 vs 26.9%), but the control rate is much lower than in urban areas (13.1 vs 19.4%) [2, 8]. Improving the blood pressure control rate in China is key to improving the health of its rural populations
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