Impact Factors for Trajectories of Medication and Healthy Lifestyle Adherence in Young Adults With Hypertension: A Mixed Methods Study

Treatment adherence is a cornerstone of effective hypertension management. However, the dynamic patterns of adherence and their influencing factors among young Chinese adults with hypertension remain insufficiently understood. This study aimed to explore the trajectories of medication adherence and healthy lifestyle behaviors, as well as the associated influencing factors, in this population. A mixed methods design was employed. First, a prospective cohort of 89 young hypertensive patients was established. Adherence was assessed using guideline-recommended questionnaires from the 2018 Chinese Hypertension Guidelines at the 3rd and 6th months of follow-up. Medication adherence was categorized as low, moderate, or high. The healthy lifestyle adherence score encompassed six dimensions: diet, salt intake, alcohol consumption, smoking status, physical activity, and weight control. Second, semi-structured interviews based on the Health Belief Model were conducted to identify factors influencing adherence. Qualitative data were coded accordingly. During follow-up, 28.07% of participants exhibited a decline in medication adherence, whereas 19.30% showed improvement. For healthy lifestyle adherence, 46.07% declined and 22.47% improved. Baseline characteristics did not differ significantly across different adherence trajectory groups (p > 0.05). A total of 27 and 36 individuals participated in interviews regarding medication and lifestyle adherence, yielding 553 and 878 codes, respectively. Social, environmental, and patient-related factors accounted for 73% and 85% of these codes, respectively. The most frequently reported influencing factors included reminders and encouragement from family members, childcare responsibilities, occupational demands, social obligations, and awareness of hypertension. In conclusion, young adults with hypertension commonly experience fluctuations in both medication and lifestyle adherence. These variations are predominantly influenced by a combination of social, environmental, and individual-level factors. Trial Registration: Chinese Clinical Trial Registry (https://www.chictr.org.cn/): ChiCTR2000033434.