Social Support and Urban–Rural Disparities in Medication Adherence Among Hypertensive Patients in Southwestern Iran: A Cross-Sectional Study

Background Medication adherence among hypertensive patients remains a major challenge, especially in low-resource and rural areas. Perceived social support has been identified as a psychosocial determinant influencing adherence behaviors. This study aimed to examine factors related to treatment adherence and perceived social support among hypertensive patients in urban and rural areas of Izeh, Khuzestan, Iran. Methods A cross-sectional analytical study was conducted among 550 adults with hypertension (300 urban, 250 rural). Data were collected using the Morisky Medication Adherence Scale-8 (MMAS-8) and the Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive statistics, bivariate analyses, and multivariable logistic regression were applied. The multivariable model demonstrated acceptable goodness of fit. Results The mean age of participants was 60.2 ± 13.4 years; 60.9% were female. Only 30.4% had high medication adherence (MMAS-8 ≥ 6). Urban residence (AOR = 2.14, 95% CI: 1.37–3.34), family history of hypertension (AOR = 1.92, 95% CI: 1.25–2.95), use of liquid oil (AOR = 2.08, 95% CI: 1.28–3.37), relaxation exercises (AOR = 2.56, 95% CI: 1.30–5.05), and higher perceived social support (AOR = 1.07 per unit increase, 95% CI: 1.03–1.11) were significant predictors. Model fit was acceptable (Hosmer–Lemeshow p = 0.42; Nagelkerke R²=0.126). Conclusion Medication adherence among hypertensive patients in Izeh was suboptimal. Perceived social support modestly improved adherence, but the explained variance was limited. Strengthening social and family support, along with rural-focused interventions, may enhance adherence behaviors and hypertension control.