IIntegrative Strategy for Improving Hypertension Medication Adherence Based on Social Determinants of Health and Health Philosophy

Andis Triyanto; Bambang Budi Raharjo

doi:10.14710/jpki.21.3.244-250

DOI: https://doi.org/10.14710/jpki.21.3.244-250

IIntegrative Strategy for Improving Hypertension Medication Adherence Based on Social Determinants of Health and Health Philosophy

*Andis Triyanto - UNNES Semarang, Indonesia

Bambang Budi Raharjo - Faculty of Medicine, Universitas Negeri Semarang, Indonesia, Indonesia

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

BibTex Citation Data :

@article{JPKI84006,
    author = {Andis Triyanto and Bambang Raharjo},
    title = {IIntegrative Strategy for Improving Hypertension Medication Adherence Based on Social Determinants of Health and Health Philosophy},
    journal = {Jurnal Promosi Kesehatan Indonesia},
  volume = {21},
    number = {3},
    year = {2026},
    keywords = {Social determinants of health, Health philosophy, Hypertension, Patient autonomy},
    abstract = {   Background:    Hypertension remains a major public health problem in Indonesia, with a steadily increasing prevalence and a significant contribution to cardiovascular morbidity and mortality. One of the main challenges in its management is low patient adherence to long-term treatment. This study aims to develop an integrative strategic model to improve adherence to hypertension treatment by combining the perspectives of social determinants of health and health philosophy, which are still rarely integrated in public health studies.     Method:    This study employed a mixed-methods explanatory sequential design. Quantitative data were collected from 250 hypertensive patients using structured questionnaires and analyzed using multiple linear regression to identify determinants of medication adherence. Subsequently, 20 purposively selected participants were interviewed in-depth, and qualitative data were analyzed using thematic analysis. Significant quantitative determinants were integrated into an adherence model, and its performance     Result:    The results showed that treatment adherence was significantly influenced by health literacy (β = 0.41; p < 0.001), family support (β = 0.32; p < 0.01), quality of healthcare services (β = 0.29; p < 0.05), and patient autonomy awareness (β = 0.27; p < 0.05). The developed integrative model demonstrated higher predictive power (R  = 0.62) compared to conventional sociodemographic-based models (R² = 0.38). Qualitative findings further confirmed that reflective awareness and individual moral responsibility play important roles in shaping long-term adherence. This integrative approach has the potential to improve long-term medication adherence among patients with hypertension through the integration of health literacy, family support, healthcare service quality, and patient autonomy.  },
   issn = {2620-4053},   pages = {244--250}  doi = {10.14710/jpki.21.3.244-250},
    url = {https://ejournal.undip.ac.id/index.php/jpki/article/view/84006}
}

Citation Format:

Abstract

Background: Hypertension remains a major public health problem in Indonesia, with a steadily increasing prevalence and a significant contribution to cardiovascular morbidity and mortality. One of the main challenges in its management is low patient adherence to long-term treatment. This study aims to develop an integrative strategic model to improve adherence to hypertension treatment by combining the perspectives of social determinants of health and health philosophy, which are still rarely integrated in public health studies.

Method: This study employed a mixed-methods explanatory sequential design. Quantitative data were collected from 250 hypertensive patients using structured questionnaires and analyzed using multiple linear regression to identify determinants of medication adherence. Subsequently, 20 purposively selected participants were interviewed in-depth, and qualitative data were analyzed using thematic analysis. Significant quantitative determinants were integrated into an adherence model, and its performance

Result: The results showed that treatment adherence was significantly influenced by health literacy (β = 0.41; p < 0.001), family support (β = 0.32; p < 0.01), quality of healthcare services (β = 0.29; p < 0.05), and patient autonomy awareness (β = 0.27; p < 0.05). The developed integrative model demonstrated higher predictive power (R= 0.62) compared to conventional sociodemographic-based models (R² = 0.38). Qualitative findings further confirmed that reflective awareness and individual moral responsibility play important roles in shaping long-term adherence. This integrative approach has the potential to improve long-term medication adherence among patients with hypertension through the integration of health literacy, family support, healthcare service quality, and patient autonomy.

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Keywords: Social determinants of health, Health philosophy, Hypertension, Patient autonomy

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Section: Research Article

Language : EN

In Vol 21 No 3: July 2026

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Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441–50
Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison HC. 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension. 2018;71(6):e13–115
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Vrijens B, Antoniou S, Burnier M, De Geest S, Urquhart J. Current situation of medication adherence in hypertension. Front Pharmacol. 2017;8:100
Vrijens B, De Geest S, Hughes DA, Kardas P, Demonceau J, Ruppar T. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2017;73(5):691–705
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Lee H, Shin JY, Kim HJ. Factors influencing medication adherence in patients with hypertension: a systematic review. Patient Prefer Adherence. 2018;12:227–39
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Shin S, Konlan KD. Determinants of medication adherence among hypertensive patients: a systematic review and meta-analysis. Patient Prefer Adherence. 2023;17:1053–66
Metlock FE. Impact of social determinants of health on hypertension outcomes: a systematic review. Hypertension. 2024;81(8):1675–700
Kirschbaum TK, Sudharsanan N, Manne-Goehler J, De Neve JW, Lemp JM, Theilmann M, et al. The association of socioeconomic status with hypertension in 76 low- and middle-income countries. J Am Coll Cardiol. 2022;80(8):804-817
Stringhini S, Carmeli C, Jokela M, Avendano M, Muennig P, Guida F. Socioeconomic status and the 25x25 risk factors as determinants of premature mortality. Lancet. 2017;389(10075):1229–37
Burnier M, Egan BM. Adherence in hypertension: a review of prevalence, risk factors, impact, and management. Circ Res. 2019;124(7):1124–40
Raharjo BB. Philosophical perspective of health promotion in community health behavior. J Public Heal Res Dev. 2020;11(3):215–21
Raharjo BB. Health behavior and social determinants in community health development. Health Educ J. 2018;3(2):65–72
Raharjo BB. Health literacy and community empowerment in improving public health behavior. Health Educ J. 2019;4(1):1–7
Arifin H, Chou KR, Ibrahim K, Fitri SUR, Pradipta RO, Rias YA, et al. Analysis of modifiable, non-modifiable, and physiological risk factors of non-communicable diseases in Indonesia: evidence from the 2018 Indonesian basic health research. J Multidiscip Healthc. 2022;2203–21
Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96(4):e5641
Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health. 2013;13:658
Khatib R, Schwalm JD, Yusuf S, et al. Medication adherence interventions for hypertension management: an umbrella review. Hypertension. 2024
Zhang Y, Li X, Wang J, et al. Health literacy and medication adherence among patients with chronic diseases: a systematic review. BMC Public Health. 2024
Kim H, Lee J, Park S, et al. Family-centered interventions to improve medication adherence among hypertensive patients: a systematic review. Patient Preference and Adherence. 2025
Silva DS, Martins A, et al. Patient empowerment and autonomy in chronic disease management: implications for medication adherence. International Journal for Equity in Health. 2024

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