p-Values generated using independent samples t-tests.
Declarations
Author contributions
MJB, DL, and YKC: Conceptualization. MJB: Writing—original draft. DL and DM: Data Curation, Investigation, Project Administration. EH and YKC: Methodology. AMG: Supervision. MJB, DL, DM, EH, AMG, and YKC: Writing—review & editing. All authors read and approved the submitted version.
Conflicts of interest
The authors declare no conflicts of interest.
Ethical approval
The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Northwell Health (Protocol version 24-1048-MRB approved 11/20/2024).
Consent to participate
Informed consent was obtained from all subjects involved in the study.
Consent to publication
Informed consent to publication was obtained from relevant participants.
Availability of data and materials
Access to de-identified data and analysis code is available upon request to the corresponding author.
Funding
This work was supported by the Barbara Zucker Emerging Scientist award. This is an internal award to Northwell Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Schroeder SA. Shattuck Lecture. We can do better--improving the health of the American people.N Engl J Med. 2007;357:1221–8. [DOI] [PubMed]
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000.JAMA. 2004;291:1238–45. [DOI] [PubMed]
Moy E, Garcia MC, Bastian B, Rossen LM, Ingram DD, Faul M, et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas- United States, 1999-2014.MMWR Surveill Summ. 2017;66:1–8. [DOI] [PubMed] [PMC]
The Global Cardiovascular Risk Consortium. Global effect of modifiable risk factors on cardiovascular disease and mortality.N Engl J Med. 2023;389:1273–85. [DOI]
Lindholt JS, Søgaard R. Why and when to screen for cardiovascular disease in healthy individuals.Heart. 2021;107:1010–7. [DOI] [PubMed]
Corrao G, Parodi A, Nicotra F, Zambon A, Merlino L, Cesana G, et al. Better compliance to antihypertensive medications reduces cardiovascular risk.J Hypertens. 2011;29:610–8. [DOI] [PubMed]
Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V, et al. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients.Circulation. 2009;120:1598–605. [DOI] [PubMed]
Yang Q, Chang A, Ritchey MD, Loustalot F. Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population-Based Cohort Study.J Am Heart Assoc. 2017;6:e006056. [DOI] [PubMed] [PMC]
Digne-Malcolm H, Frise MC, Dorrington KL. How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure.Front Physiol. 2016;7:320. [DOI] [PubMed] [PMC]
Laurent S. Antihypertensive drugs.Pharmacol Res. 2017;124:116–25. [DOI] [PubMed]
Shin S, Song H, Oh SK, Choi KE, Kim H, Jang S. Effect of antihypertensive medication adherence on hospitalization for cardiovascular disease and mortality in hypertensive patients.Hypertens Res. 2013;36:1000–5. [DOI] [PubMed]
Kronish IM, Woodward M, Sergie Z, Ogedegbe G, Falzon L, Mann DM. Meta-analysis: impact of drug class on adherence to antihypertensives.Circulation. 2011;123:1611–21. [DOI] [PubMed] [PMC]
Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis.Medicine (Baltimore). 2017;96:e5641. [DOI] [PubMed] [PMC]
Peacock E, Krousel-Wood M. Adherence to Antihypertensive Therapy.Med Clin North Am. 2017;101:229–45. [DOI] [PubMed] [PMC]
Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences.Eur Heart J. 2013;34:2940–8. [DOI] [PubMed]
Elliott WJ. Improving outcomes in hypertensive patients: focus on adherence and persistence with antihypertensive therapy.J Clin Hypertens (Greenwich). 2009;11:376–82. [DOI] [PubMed] [PMC]
Rash JA, Lavoie KL, Feldman RD, Campbell TS. Adherence to antihypertensive medications: Current status and future directions.Curr Cardiovasc Risk Rep. 2014;8:1–13. [DOI]
Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, et al.; American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing, and Council on Clinical Cardiology. Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association.Hypertension. 2022;79:e1–4. [DOI] [PubMed] [PMC]
Bosworth HB, Granger BB, Mendys P, Brindis R, Burkholder R, Czajkowski SM, et al. Medication adherence: a call for action.Am Heart J. 2011;162:412–24. [DOI] [PubMed] [PMC]
Conn VS, Ruppar TM, Chase JA, Enriquez M, Cooper PS. Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis.Curr Hypertens Rep. 2015;17:94. [DOI] [PubMed] [PMC]
Ampofo AG, Khan E, Ibitoye MB. Understanding the role of educational interventions on medication adherence in hypertension: A systematic review and meta-analysis.Heart Lung. 2020;49:537–47. [DOI] [PubMed]
Kravitz RL, Duan N, Braslow J. Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages.Milbank Q. 2004;82:661–87. [DOI] [PubMed] [PMC]
Bryan CJ, Tipton E, Yeager DS. Behavioural science is unlikely to change the world without a heterogeneity revolution.Nat Hum Behav. 2021;5:980–9. [DOI] [PubMed] [PMC]
Bullock JG, Green DP, Ha SE. Yes, but what's the mechanism? (don’t expect an easy answer).J Pers Soc Psychol. 2010;98:550–8. [DOI] [PubMed]
Edmondson D, Falzon L, Sundquist KJ, Julian J, Meli L, Sumner JA, et al. A systematic review of the inclusion of mechanisms of action in NIH-funded intervention trials to improve medication adherence.Behav Res Ther. 2018;101:12–9. [DOI] [PubMed] [PMC]
Beran N, Abdallah R, Giacomoni L. The population health journey: A change framework and lessons learned in a large clinically integrated network.Manag Healthc. 2025;9:214–36. [DOI]
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009;42:377–81. [DOI] [PubMed] [PMC]
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners.J Biomed Inform. 2019;95:103208. [DOI] [PubMed] [PMC]
Kim MT, Hill MN, Bone LR, Levine DM. Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale.Prog Cardiovasc Nurs. 2000;15:90–6. [DOI] [PubMed]
Michie S, Carey RN, Johnston M, Rothman AJ, de Bruin M, Kelly MP, et al. From Theory-Inspired to Theory-Based Interventions: A Protocol for Developing and Testing a Methodology for Linking Behaviour Change Techniques to Theoretical Mechanisms of Action.Ann Behav Med. 2018;52:501–12. [DOI] [PubMed] [PMC]
Náfrádi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence.PLoS One. 2017;12:e0186458. [DOI] [PubMed] [PMC]
O’Leary A. Self-efficacy and health.Behav Res Ther. 1985;23:437–51. [DOI] [PubMed]
Ogedegbe G, Mancuso CA, Allegrante JP, Charlson ME. Development and evaluation of a medication adherence self-efficacy scale in hypertensive African-American patients.J Clin Epidemiol. 2003;56:520–9. [DOI] [PubMed]
Morrison VL, Holmes EA, Parveen S, Plumpton CO, Clyne W, De Geest S, et al. Predictors of self-reported adherence to antihypertensive medicines: a multinational, cross-sectional survey.Value Health. 2015;18:206–16. [DOI] [PubMed]
McClelland M, Geldhof J, Morrison F, Gestsdóttir S, Cameron C, Bowers E, et al. Self-regulation. Handbook of life course health development. 2017. pp. 275–98. [DOI]
Liddelow C, Mullan B, Boyes M. Understanding the predictors of medication adherence: applying temporal self-regulation theory.Psychol Health. 2021;36:529–48. [DOI] [PubMed]
Liddelow C, Mullan B, Boyes M, Ling M. Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis.Health Psychol Rev. 2023;17:578–613. [DOI] [PubMed]
de Bruijn GJ, Gardner B, van Osch L, Sniehotta FF. Predicting automaticity in exercise behaviour: the role of perceived behavioural control, affect, intention, action planning, and behaviour.Int J Behav Med. 2014;21:767–74. [DOI] [PubMed]
Gardner B, Abraham C, Lally P, de Bruijn GJ. Towards parsimony in habit measurement: testing the convergent and predictive validity of an automaticity subscale of the Self-Report Habit Index.Int J Behav Nutr Phys Act. 2012;9:102. [DOI] [PubMed] [PMC]
Badawy SM, Shah R, Beg U, Heneghan MB. Habit Strength, Medication Adherence, and Habit-Based Mobile Health Interventions Across Chronic Medical Conditions: Systematic Review.J Med Internet Res. 2020;22:e17883. [DOI] [PubMed] [PMC]
Jankowska-Polańska B, Uchmanowicz I, Dudek K, Mazur G. Relationship between patients’ knowledge and medication adherence among patients with hypertension.Patient Prefer Adher. 2016;10:2437–47. [DOI] [PubMed] [PMC]
Delavar F, Pashaeypoor S, Negarandeh R. The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial.Patient Educ Couns. 2020;103:336–42. [DOI] [PubMed]
Kini V, Ho PM. Interventions to Improve Medication Adherence: A Review.JAMA. 2018;320:2461–73. [DOI] [PubMed]
van der Bijl JJ, Shortridge-Baggett LM. The theory and measurement of the self-efficacy construct.Sch Inq Nurs Pract. 2001;15:189–207. [PubMed]
Carey RN, Connell LE, Johnston M, Rothman AJ, de Bruin M, Kelly MP, et al. Behavior Change Techniques and Their Mechanisms of Action: A Synthesis of Links Described in Published Intervention Literature.Ann Behav Med. 2019;53:693–707. [DOI] [PubMed] [PMC]
Fernandez S, Chaplin W, Schoenthaler AM, Ogedegbe G. Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans.J Behav Med. 2008;31:453–62. [DOI] [PubMed] [PMC]
Levesque CS, Williams GC, Elliot D, Pickering MA, Bodenhamer B, Finley PJ. Validating the theoretical structure of the Treatment Self-Regulation Questionnaire (TSRQ) across three different health behaviors.Health Educ Res. 2007;22:691–702. [DOI] [PubMed]
Chen J, Yang Y, Zhou ZY, Shan R, Luo JH, Liu JH, et al. The association between children’s motivation type and emotional overeating.Eur J Pediatr. 2025;184:266. [DOI] [PubMed]
Sanne S, Muntner P, Kawasaki L, Hyre A, DeSalvo KB. Hypertension knowledge among patients from an urban clinic.Ethn Dis. 2008;18:42–7. [PubMed]
Unni EJ, Olson JL, Farris KB. Revision and validation of Medication Adherence Reasons Scale (MAR-Scale).Curr Med Res Opin. 2014;30:211–21. [DOI] [PubMed]
R Core Team R. R: A language and environment for statistical computing. Version 4.6.0. 2026.
Michie S, Johnston M. Theories and techniques of behaviour change: Developing a cumulative science of behaviour change.Health Psychol Rev. 2012;6:1–6. [DOI]
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.Ann Behav Med. 2013;46:81–95. [DOI] [PubMed]
Michie S, Thomas J, Johnston M, Aonghusa PM, Shawe-Taylor J, Kelly MP, et al. The Human Behaviour-Change Project: harnessing the power of artificial intelligence and machine learning for evidence synthesis and interpretation.Implement Sci. 2017;12:121. [DOI] [PubMed] [PMC]
Krousel-Wood M, Holt E, Joyce C, Ruiz R, Dornelles A, Webber LS, et al. Differences in cardiovascular disease risk when antihypertensive medication adherence is assessed by pharmacy fill versus self-report: the Cohort Study of Medication Adherence among Older Adults (CoSMO).J Hypertens. 2015;33:412–20. [DOI] [PubMed] [PMC]
Butler MJ, Romain AN, Augustin R, Robles P, Friel CP, Chandereng T, et al. The effect of a multi-component behavior change technique intervention on medication adherence among individuals on primary prevention statin therapy: a dose-finding protocol.Trials. 2023;24:523. [DOI] [PubMed] [PMC]
Ren XS, Kazis LE, Lee A, Zhang H, Miller DR. Identifying patient and physician characteristics that affect compliance with antihypertensive medications.J Clin Pharm Ther. 2002;27:47–56. [DOI] [PubMed]
Choi HY, Oh IJ, Lee JA, Lim J, Kim YS, Jeon TH, et al. Factors Affecting Adherence to Antihypertensive Medication.Korean J Fam Med. 2018;39:325–32. [DOI] [PubMed] [PMC]
van der Laan DM, Elders PJM, Boons CCLM, Beckeringh JJ, Nijpels G, Hugtenburg JG. Factors associated with antihypertensive medication non-adherence: a systematic review.J Hum Hypertens. 2017;31:687–94. [DOI] [PubMed]
Biffi A, Rea F, Iannaccone T, Filippelli A, Mancia G, Corrao G. Sex differences in the adherence of antihypertensive drugs: a systematic review with meta-analyses.BMJ Open. 2020;10:e036418. [DOI] [PubMed] [PMC]
Venditti V, Bleve E, Morano S, Filardi T. Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health.Metabolites. 2023;13:1087. [DOI] [PubMed] [PMC]
Chen SL, Lee WL, Liang T, Liao IC. Factors associated with gender differences in medication adherence: a longitudinal study.J Adv Nurs. 2014;70:2031–40. [DOI] [PubMed]
Holt E, Joyce C, Dornelles A, Morisky D, Webber LS, Muntner P, et al. Sex differences in barriers to antihypertensive medication adherence: findings from the cohort study of medication adherence among older adults.J Am Geriatr Soc. 2013;61:558–64. [DOI] [PubMed] [PMC]
Bozionelos N, Simmering MJ. Methodological threat or myth? Evaluating the current state of evidence on common method variance in human resource management research.Hum Resour Manag J. 2022;32:194–215. [DOI]