The influence of value reference point and risk preference on adherence in hypertensive patients in a low-income area of China
- 3 January 2020
- journal article
- research article
- Published by Taylor & Francis Ltd in Postgraduate Medicine
- Vol. 132 (2), 132-140
- https://doi.org/10.1080/00325481.2019.1702849
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
Funding Information
- China Medical Board (11-069)
- Special Research Foundation of the Shanghai Municipal Health Commission (2018-RGZN-02042)
This publication has 34 references indexed in Scilit:
- Association of Health Literacy With Elevated Blood PressureMedical Care, 2014
- Behavioral Economics Holds Potential To Deliver Better Results For Patients, Insurers, And EmployersHealth Affairs, 2013
- Efficiently Assessing Patient Health LiteracyClinical Nursing Research, 2013
- Behavioral EconomicsAmerican Journal of Preventive Medicine, 2013
- Evaluating self‐efficacy for managing chronic disease: psychometric properties of the six‐item Self‐Efficacy Scale in GermanyJournal of Evaluation in Clinical Practice, 2011
- Entitlements to health care: Why is there a preference for private facilities among poorer residents of Chennai, India?Social Science & Medicine (1982), 2011
- Identifying and Managing Factors that Interfere with or Worsen Blood Pressure ControlPostgraduate Medicine, 2010
- Does Participatory Decision Making Improve Hypertension Self-Care Behaviors and Outcomes?The Journal of Clinical Hypertension, 2007
- Practical Issues in Structural ModelingSociological Methods & Research, 1987
- Prospect Theory: An Analysis of Decision under RiskEconometrica, 1979