Improving Medication Adherence Among Patients with Hypertension Through a Hybrid Health Educational Intervention Based on the Health Belief Model in Rural Indonesia: A Quasi-Experimental Difference-in-Differences Study

Abstract

Background: Hypertension remains a major global health challenge, particularly in low- and middle-income countries, where medication adherence is essential for blood pressure control. Hybrid educational approaches combining face-to-face and digital strategies offer practical solutions in resource-limited settings.

Objective: To evaluate the effectiveness of a Hybrid Health Education Intervention based on the Health Belief Model (HHEI-HBM) among patients with hypertension in rural Indonesia.

Methodology: A pre–post control-group quasi-experimental study was conducted in two randomly selected community health centres (CHCs) in Majalengka, Indonesia (one intervention and one control). Participants were recruited consecutively. Of 129 eligible individuals, 110 met the criteria and were analysed (51 in the intervention group; 59 in the control group). Behavioural outcomes were measured using validated questionnaires, and blood pressure was measured with a validated digital device. Baseline equivalence was tested using chi-square tests and independent t-tests. Intervention effects were estimated using a Difference-in-Differences (DiD) approach.

Results: A DiD analysis demonstrated that HHEI-HBM significantly improved knowledge (β = 1.72; 95% CI: 0.68–2.76; p = 0.001), self-efficacy (β = 6.16; 95% CI: 3.42–8.91; p < 0.001), and medication adherence (β = 1.28; 95% CI: 0.49–2.07; p = 0.002). Significant reductions were observed in systolic blood pressure (β = −9.67 mmHg; 95% CI: −12.42 to −6.91; p < 0.001) and diastolic blood pressure (β = −2.80 mmHg; 95% CI: −3.91 to −1.69; p < 0.001).

Conclusion: HHEI-HBM improved behavioural outcomes and reduced blood pressure among rural patients with hypertension.

Unique Contribution: This study demonstrates the effectiveness of a multimodal educational approach integrating complementary strategies in resource-limited CHCs, while reinforcing the HBM as a robust framework for behaviour change interventions.

Key Recommendation: Integration of HHEI-HBM into routine health promotion programmes in rural CHCs is recommended. Larger studies with longer follow-up are needed to confirm sustainability and support implementation.