Objective To construct an index system for health management adherence among rural older adults aged 60 and above with cardiometabolic multimorbidity (CMM), thus providing a measurement tool for understanding the current situation of health management adherence among this population.

Methods The index system was initially determined by literature research and expert group discussion. Two rounds of Delphi expert consultation were conducted among 25 selected experts. The analytic hierarchy process was adopted to calculate the weights of indexes.

Results Experts in the two rounds of consultation showed the positive coefficients of 100.0% and 72.0%, the authority coefficients of 0.892 and 0.883, and the Kendall′s coefficients of concordance of 0.172 and 0.206 (all P < 0.001), which indicated good concordance of experts′ opinions. The finally established index system was composed of 6 first-level indexes and 38 second-level indexes. In the two rounds of consultation, the indexes showed the importance scores of 4.62 ± 0.23 and 4.64 ± 0.22 and the coefficients of variation within the ranges of 0.00–0.23 and 0.00–0.19. The weights of the first-level indexes and second-level indexes ranged from 0.106 6 to 0.270 0 and from 0.007 4 to 0.074 0, respectively.

Conclusions The index system for health management adherence among rural older adults with CMM is scientific and reliable, providing a measurement tool for evaluating health management adherence for rural older adults with CMM and a reference for related research.