Exploration of Determinants of Adherence to Antihypertensive Medication: A Multilevel Analysis of the Fifth Wave of the Indonesia Family Life Survey

Abstract

Introduction: The prevalence of hypertension in Indonesia is increasing, but adherence to antihypertensive medication remains low. Previous studies have mostly examined medication adherence determinants separately at individual and environmental levels, with limited research integrating these factors comprehensively. This study investigates the factors influencing adherence to antihypertensive medication in Indonesia. Materials and methods: The study utilised data from the IFLS-5, involving 2,334 respondents aged ≥ 15 years diagnosed with hypertension. Multilevel logistic regression is used to identify predictor variables for medication adherence. The effect size is determined by odds ratio (OR) and significance at p-value < 0.05. Result: Contextual household factors influence up to 22.45% of the variation in adherence to antihypertensive medication. Variables that influence medication adherence are comorbid diabetes (OR = 1.53, 95% CI: 1.04 – 2.23, p=0.029), had a heart attack (OR = 2.84, 95% CI: 1.79-4.52, p<0.0001), comorbid stroke (OR = 2.79, 95% CI: 1.59 – 4.90, p<0.0001), routine medical check-up (OR = 1.70, 95% CI: 1.23-2.36, p=0.001), feel healthy (OR = 0.59, 95% CI: 0.43-0.72, p<0.0001), aged ≥ 47 years (OR = 2.84, 95% CI: 2.10-3.84, p<0.0001), and households with social protection cards (OR = 0.61, 95% CI: 0.40-0.93, p=0.022). Conclusion: Higher adherence occurs in hypertensive patients with diabetes, stroke, heart attack, routine check-ups, and aged ≥ 47 years. However, lower in feeling healthy and households with social protection cards. Programs to improve medication adherence should focus on hypertension without comorbidities, aged <47 years, feeling healthy, and low-income families.