Effects of the Two-Dimensional Structure of Trust on Patient Adherence to Medication and Non-pharmaceutical Treatment: A Cross-Sectional Study of Rural Patients With Essential Hypertension in China

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.

Relationship between self-care compliance, trust, and satisfaction among hypertensive patients in China

“…The total score of the C-WFPTS ranges between 10 and 50, with a higher score indicating a higher level of trust in physicians. The reliability and validity of the C-WFPTS are adequate, with a Cronbach's alpha ranging between 0.728 and 0.789 ( 2 , 38 ), and a Kaiser-Meyer-Olkin (KMO) value of 0.833 ( 5 ), suitable for evaluating the trust of Chinese patients in their physicians. The Cronbach's alpha of the scale is 0.827.…”

“…Hypertension is a crucial public health challenge worldwide ( 1 ). It is estimated that the number of people with high blood pressure will reach ~2 billion by 2025 ( 2 – 4 ). Hypertension is the leading risk factor for all-cause mortality, and its complications include cardiovascular disease, stroke, and kidney failure, causing a heavy financial burden on families and society ( 5 – 10 ).…”

“…Previous studies of trust, satisfaction, and compliance have focused on the relationship between any two of these factors. For example, a study targeting China has found a significant association between patient trust in their physicians and compliance with diet management and physical activity ( 2 ). Another study targeting Lebanon has reported that patients who feel more satisfied with healthcare services have higher hypertension compliance ( 6 ).…”

An Idealized Clinicogenomic Registry to Engage Underrepresented Populations Using Innovative Technology

“…The forum where the information is collected can also impact transparency and willingness to disclose. For minorities and other marginalized populations, trust is also an especially meaningful factor in participation and engagement rates and is related to many of the identified barriers [ 22 , 23 , 24 , 25 ]. In rural populations, a trusted primary care provider might be better positioned to enroll a subject in a longitudinal registry program versus a specialist at an urban academic medical center to whom the patient has recently been referred and with whom they do not yet have a personal relationship.…”

Analysis of prescription status of antihypertensive drugs in Chinese patients with hypertension based on real-world study

“…More than one billion adults are estimated to have high blood pressure, while the current worldwide hypertension control rate is only 31.7% [ 3 ]. It is predicted that by 2025, the number of people living with high blood pressure will reach 2 billion globally [ 4 ]. At the same time, China has a large number of patients with high blood pressure.…”