Abstract: Background　Good medication adherence can significantly reduce the risk of recurrence in stroke patients and is crucial for the secondary prevention of stroke. However，existing research primarily focuses on short-term medication and adherence behaviors among rural stroke patients，while studies on the long-term medication adherence behaviors of patients with a history of stroke in rural areas are limited. Objective　To analyze attitude and long-term medication adherence behaviors of stroke survivors in rural China，and to identify factors related to medication behaviors. Methods　System-integrated technology-enabled intervention（SINEMA） study，a research project focusing on the management of stroke patients in rural areas，which was conducted in 60 villages across 5 towns of Nanhe County，Hebei Province in 2017—the subjects of this study were all stroke survivors who had previously participated in the 2017 SINEMA study，consented to participate in the follow-up survey conducted from May to July 2024，and completed the survey. The study investigated the medication use of the subjects，including antihypertensive drugs，statins，antiplatelet drugs，and hypoglycemic drugs. Meanwhile，the Maastricht Utrecht Adherence in Hypertension-16（MUAH-16） scale was employed to assess the subjects' medication adherence attitudes，specifically focusing on the dimensions of positive medical and medication attitudes. The Morisky Green Levine scale was used to measure the medication adherence behaviors of patients taking the above four categories of drugs，with a score of 0 defined as high adherence. Descriptive analysis was applied to present the basic characteristics of the patients，their medication adherence status，and the relevant factors identified through multivariate Logistic regression analysis. Results　A total of 912 participants were included in this study，with a mean age of（72.0±7.9） years. Among them，46.1%（420/912） were female. Regarding medication use，772 cases（84.6%） reported taking antihypertensive drugs，547 cases（59.9%） took antiplatelet drugs，427 cases（46.8%） used statins，and 203 cases（22.3%） took hypoglycemic drugs. Among patients currently taking these four types of drugs，the adherence rate to hypoglycemic drugs was 77.3%（157/203），to antihypertensive drugs was 71.5% （552/772），to antiplatelet drugs was 71.2%（392/547），and to statins was 71.2%（304/427）. The survey also showed that 49.2%（449/912） of the patients held a relatively positive attitude towards medication use. Results from multivariate Logistic regression analysis showed that among patients taking antihypertensive medications，those with higher educational attainment （secondary school or above：OR=1.87，95%CI=1.13-3.09） and positive attitudes toward medical care and medication use （OR=1.53，95%CI：1.08-2.17） had higher medication adherence，while patients capable of independently completing work tasks（OR=0.56，95%CI=0.32-0.99） and those visiting village clinics ≥ 1 time per month（OR=0.68，95%CI=0.53~0.88）had lower medication adherence（P<0.05）. For patients taking antiplatelet drugs，higher educational attainment（secondary school or above：OR=1.79，95%CI=1.09-2.96） was linked to better medication adherence，whereas patients with hemorrhagic stroke（OR=0.55，95%CI=0.31-0.98） had lower medication adherence（P<0.05）. Among patients on statins，those visiting village clinics ≥ 1 time per month（OR=0.67，95%CI=0.46-0.98） showed lower medication adherence（P<0.05）. As for patients taking antidiabetic medications，male patients（OR=0.21，95%CI=0.06-0.73），those enrolled in the chronic and major disease insurance program（OR=0.34，95%CI=0.15-0.79），and individuals visiting village clinics ≥ 1 time per month （OR=0.34，95%CI=0.13-0.89） all had significantly lower medication adherence（P<0.05）. Conclusion　Stroke survivors in rural areas with a longer disease history tend to exhibit relatively higher levels of medication adherence；however，nearly one-third of patients still fail to consistently follow treatment recommendations. The determinants of adherence vary across different types of medications，highlighting the need for tailored interventions to enhance medication adherence and secondary prevention behaviors in this population.

Key words: Stroke, Multiple medications, Medication Adherence, Rural

摘要： 背景　良好用药依从性可显著降低脑卒中患者复发风险，是脑卒中患者二级预防的关键。然而，已有研究多针对农村脑卒中患者的短期用药及依从行为，而对同类患者的长期用药依从行为的研究较为有限。目的　本研究旨在分析中国农村地区脑卒中幸存者的长期用药行为、依从态度与行为，并识别与用药行为相关的因素。方法　基于2017年在河北省南和县5个乡镇、60个村开展的农村地区脑卒中患者管理研究——中国农村地区脑卒中管理的系统整合技术辅助照护模式研究（SINEMA），本研究对象为曾参与过2017年SINEMA研究且同意参与2024年5—7月随访并完成调查的所有脑卒中幸存者。调查研究对象降压药、他汀类药、抗血小板药和降糖药的用药情况，并使用Maastricht Utrecht Adherence in Hypertension-16（MUAH-16）量表评估其用药依从态度（积极的医疗与药物态度维度）。采用Morisky Green Levine量表测量服用4类药物的患者的用药依从行为（得分为0分定义为依从性高）。使用描述性分析展示患者基本特征、用药依从性状况和多因素Logistic回归分析识别出的相关因素。结果　本研究共纳入912名研究对象，平均年龄为（72.0±7.9）岁，其中女性占46.1%（420/912）；在药物服用方面，有772例（84.6%）患者自报服用降压药，547例（59.9%）服用抗血小板药，427例（46.8%）服用他汀类药，以及203例（22.3%）服用降糖药。在正在服用4类药物的人群中，降糖药服用依从性为77.3%（157/203），降压药服用依从性为71.5%（552/772）、抗血小板药物服用依从性为71.2%（392/547），他汀类药服用依从性为71.2%（304/427）。调查结果显示49.2%（449/912）的患者具有积极的医疗与药物态度。多因素Logistic回归分析结果显示，在服用降压药的患者中，受教育程度较高（中学及以上：OR=1.87，95%CI=1.13~3.09）、具有积极的医疗与药物态度（OR=1.53，95%CI：1.08-2.17）的患者用药依从性高，可独立完成工作（OR=0.56，95%CI=0.32~0.99）、去村卫生所≥1次/月者（OR=0.68，95%CI=0.53~0.88）用药依从性较低（P<0.05）。在服用抗血小板药的患者中，受教育程度较高（中学及以：OR=1.79，95%CI=1.09~2.96）的患者用药依从性较高，出血性脑卒中患者（OR=0.55，95%CI=0.31~0.98）用药依从性较低（P<0.05）。在服用他汀类药的患者中，去村卫生所≥1次/月者（OR=0.67，95%CI=0.46~0.98）用药依从性较低（P<0.05）。在服用降糖药的患者中，男性（OR=0.21，95%CI=0.06~0.73）、注册慢性病重大疾病保险（OR=0.34，95%CI=0.15~0.79）、去村卫生所≥1次/月者（OR=0.34，95%CI=0.13~0.89）用药依从性较低（P<0.05）。结论　本研究结果显示，农村地区具有较长疾病史的脑卒中幸存者具有相对较高的用药依从性，但仍有近三成患者未能规律依从诊疗建议，不同药物类型依从行为的影响因素存在差异，应开展个性化的用药依从干预增加患者的用药依从及二级预防行为。

关键词: 脑卒中, 多重用药, 用药依从性, 农村