The influence of value reference point and risk preference on adherence in hypertensive patients in a low-income area of China

ABSTRACT

Aims: Prevention and control of hypertension can be achieved by improving patient adherence to long-term treatment regimens. Non-adherence is an obstacle to chronic disease management. We studied the impact of value reference point and risk preference on patient adherence and influencing factors from the perspective of behavioral economics so as to offer targeted recommendations to improving patient adherence in low-income areas.

Methods: A representative impoverished area, Qianjiang District in Chongqing was selected as the sample district. A cross-sectional survey using questionnaire augmented with an interview was conducted to collect information with 321 patients previously diagnosed with hypertension stage 3. Preference experiments conducted through scenario simulation were used to elicit and measure patients’ value and risk preferences. We constructed a structural equation model to verify the impact of value reference points and risk preference on adherence behavior decision-making. Logistic regression models were constructed to analyze other factors that may influence adherence.

Results: Adherence was determined by patients’ value reference points (path coefficient = 0.876, p < 0.01) and risk preference (path coefficient = 0.715, p < 0.01). The factor loadings of all indicators on the latent variables were significant (p < 0.01). Hypertensive patients in our cohort adhered poorly to health management and were heavily influenced by knowledge of hypertension, expectation, health literacy and opportunity costs. Certainty effect, overconfidence and optimism significantly affected patients’ risk preference in decision-making progress. In the face of the uncertain benefits of adherence, patients preferred to delay treatment until condition affected their quality of life, resulting in poor adherence. Satisfaction with current services and relationship with physicians, as well as type of drugs also influenced adherence.

Conclusions: Adherence may be improved by changing patients’ value reference points and perceptions through health education and better health service resources. One of the key to increasing adherence is through identifying and eliminating bias.

KEYWORDS:

• Adherence
• value reference point
• risk preference
• decision-making
• prospect theory
• hypertension

Acknowledgments

The authors wish to thank the Chongqing Qianjiang health bureau for assistance in fieldwork and the respondents who took the time to participate in the survey.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors declare that they have no competing interests. All authors have read and approved the final manuscript and agree that the article will be freely available on the internet for the general public.

Limitations of the study

This cross-sectional study looked at factors affecting adherence in hypertensive patients, but did not test interventions or the efficacy of interventions in shifting patient perceptions. Future work is planned to bridge this gap.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The study was supported by grant 11-069 from the China Medical Board and the algorithm for data analysis was supported by grant 2018-RGZN-02042 from the Special Research Foundation of the Shanghai Municipal Health Commission. Tao Wu is a full-time employee of Shanghai Jiao Tong University and obtained the funding from the Shanghai Municipal Health Commission; Liang Zhang is a full-time employee of Tongji Medical College, Huazhong University of Science and Technology and obtained the funding from China Medical Board.