Do Patient Preferences and Treatment Beliefs Explain Patterns of Antihypertensive Medication Nonadherence? A Discrete Choice Experiment

Si Ning Germaine Tan, Charles Muiruri and Juan Marcos Gonzalez Sepulveda
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Si Ning Germaine Tan: Duke-NUS Medical School, Singapore
Charles Muiruri: Duke Department of Population Health Sciences, Duke Global Health Institute
Juan Marcos Gonzalez Sepulveda: Duke Department of Population Health Sciences

Medical Decision Making, 2026, vol. 46, issue 1, 47-59

Abstract: Background Medication adherence is a critical factor in hypertension management, which remains a challenge for public health systems. Methods Graded-pair questions were used to quantify the perception of how much nonadherence to antihypertensives increases the risk of serious cardiovascular events. A discrete-choice experiment was used to quantify the relative importance of medication outcomes (e.g., reduction in cardiovascular event risk and medication side effects). Rating questions were used to assess perspectives of the effect of treatment nonadherence on treatment side effects. Results were combined to assess how preferences and outcome expectations influence adherence. Results Patients perceived treatment adherence as the most significant contributor to cardiovascular event risk. A reduction in cardiovascular risk was the most significant consideration when choosing medication. Missing consecutive (v. alternate) doses was associated with greater perceived cardiovascular risk and fewer side effects. The differences between complete adherence and any level of nonadherence were significantly larger for side effects than for changes in the risk of cardiovascular events, suggesting that side effects are perceived to be more sensitive to nonadherence than treatment efficacy. Limitations Our study relied on hypothetical scenarios, which may not fully capture real-world decision making. While our findings shed light on the relationship between adherence patterns and treatment perceptions, it is essential to recognize the complexity of adherence behavior. Conclusions Patients believe that they can manage medication side effects by skipping doses without compromising the efficacy to the same degree and that they can offset compromises in efficacy by avoiding missing consecutive doses for prolonged periods. Implications Health care providers should understand the importance of patient education and counseling to address misconceptions and promote realistic expectations regarding treatment efficacy and the consequences of nonadherence. Highlights The average patient believes that they can manage medication side effects by skipping doses without compromising the efficacy to the same degree. There is a belief that patients can offset some of the impact of nonadherence on their cardiovascular event risk, particularly if they avoid missing consecutive doses for prolonged periods of time. This highlights the importance of patient education and counseling to address misconceptions and promote realistic expectations regarding treatment efficacy and the consequences of nonadherence.

Keywords: cardiovascular risk perception; discrete choice experiment (DCE); graded-pair questions (GPQ); health-production function; hypertension; Medication adherence; nonadherence patterns; ordered logit model; patient preferences; random-parameters logit model (search for similar items in EconPapers)
Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:46:y:2026:i:1:p:47-59

DOI: 10.1177/0272989X251388046

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