Social Support and Self-Efficacy as Mediating Factors Affecting the Association Between Depression and Medication Adherence in Older Patients with Coronary Heart Disease: A Multiple Mediator Model with a Cross-Sectional Study

The role of depressive symptoms and self-efficacy in the relationship between activities of daily living and medication adherence among the elderly with chronic diseases: a serial mediation model

The current study aimed to test the effects of depressive symptoms and self-efficacy in the relationship between activities of daily living (ADLs) and medication adherence using a serial mediation model. This cohort study was conducted among 797 elderly with chronic diseases in Hunan Province of China. Their ADLs, medication adherence, self-efficacy, and depressive symptoms were assessed by the Barthel Index (BI), the Morisky Medication Adherence Scale (MMAS-8), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), respectively. The PROCESS SPSS Macro version 4.1, model 6, was used to test the serial mediation model of ADLs affecting medication adherence through self-efficacy and depressive symptoms. From baseline to follow-up, the elderly had a significant increase in depressive symptoms (from 15.3 ± 11.3 to 19.1 ± 13.1) and significant decreases in ADLs (from 71.4 ± 19.8 to 64.9 ± 17.61), self-efficacy (from 21.5 ± 5.4 to 20.4 ± 6.2), and medication adherence (from 6.7 ± 1.8 to 6.0 ± 1.5), all with p < 0.001. The serial mediation model demonstrated a robust association between ADLs and medication adherence, which was serially mediated by depressive symptoms and self-efficacy (total effect c = 0.499, 95% CI = 0.393 to 0.605; direct effect c' = 0.379, 95% CI = 0.281 to 0.477; total indirect effect ab = 0.120, 95% CI = 0.073 to 0.168). This study elucidates the association between ADL and medication adherence, clarifying the mediating roles of depressive symptoms and self-efficacy. Our findings suggest that future medication adherence intervention programs among the elderly with chronic illness may be effective by focusing on decreasing depressive symptoms and improving self-efficacy.

Tailored personas for self-management in home-based cardiac rehabilitation for patients with coronary heart disease: A qualitative study

BACKGROUND

Self-management is a key factor determining recovery outcomes in home-based cardiac rehabilitation. However, the impact of individual differences on self-management in patients with coronary heart disease is particularly significant, and standardised approaches often fail to fully meet the needs of this heterogeneous group.

OBJECTIVE

This study aimed to explore the heterogeneity of self-management among patients with coronary heart disease undergoing home-based cardiac rehabilitation and construct patient personas to address the unique challenges and needs of diverse patient groups.

METHODS

A qualitative descriptive study was conducted at a cardiac rehabilitation centre in mainland China from April to July 2024. Purposive sampling was used to select patients with coronary heart disease. Semi-structured interviews were conducted to capture their self-management experiences during home-based cardiac rehabilitation. Content analysis was used to extract factual labels and construct dimensional models. Patient personas were developed by categorising patients based on these dimensions, and their self-management personas were visualised using labelled personas.

RESULTS

A total of 28 eligible patients with coronary heart disease participated in the study. Three key dimensions were identified to construct the personas: descriptions, characteristics, and needs. Five distinct personas were developed based on individual attributes, highlighting the varying self-management behaviours and needs of patients with coronary heart disease. The personas were categorised as follows: patients who actively seek cooperation in health management, patients with limited knowledge and poor management behaviour, patients with management deficiencies under high work demands, patients with prominent symptoms but strong awareness, and patients with impaired motivation for self-management.

CONCLUSION

Precise interventions based on patient personas are essential for enhancing self-management behaviours during home-based cardiac rehabilitation among patients with coronary heart disease. This study developed five patient personas for self-management in home-based cardiac rehabilitation, providing a basis for precise interventions to address the heterogeneous needs of this patient group.

Self-Efficacy, Social Support, and Depression: Mediators of Medication Adherence in Dialysis Patients

Introduction: Healthcare providers' understanding of how self-efficacy and social support affect medication adherence and depression in dialysis patients can lead to holistic interventions and improve outcomes. This study aimed to investigate how self-efficacy and social support indirectly influence the relationship between medication adherence and depressive symptoms in patients with chronic kidney disease (CKD) undergoing dialysis. Methods: We employed a cross-sectional observational study design with 668 CKD patients from outpatient departments (OPDs) and dialysis centers in the Hail region of Saudi Arabia. The data were collected between April and May 2024. Results: The participants had a relatively high level of self-efficacy (median = 82.00/100) and greater perception of social support (median = 75.500/84) with minimal to mild depressive symptoms (median = 15.00/63); however, 50% of participants scored ≥ 5 (out of 10) on the level of adherence to their medication regimen. Depression was prevalent, with a mean score of 5.03 on the PHQ-9 scale, and was positively correlated with nonadherence. Social support and self-efficacy were negatively correlated with depression, and both partially mediated the link between depression and non-adherence. Conclusions: This study found that, despite high social support and self-efficacy, a significant number of patients with CKD on dialysis exhibited medication non-adherence. Depression has emerged as a key factor influencing adherence, even in the presence of social support and self-efficacy. These findings suggest that depression is crucial for CKD management. Healthcare providers, owing to their frequent interactions with patients with CKD, are ideally placed to screen for depression and incorporate management strategies into patient care plans. By addressing both the biological and psychological aspects of CKD, they can empower patients to take a more active role in their treatment, ultimately leading to improved health outcomes.

Relationship between social capital and medication adherence among frail and pre-frail older people: a cross-sectional study from China

BACKGROUND

The number of frail older people is increasing. To alleviate poor health and improve quality of life, pre-frail and frail older people need to adhere to their medication. Yet, studies examining the connection between social capital (including six dimensions) and medication adherence are currently scarce. Therefore, this study aims to examine their relationship in older individuals with pre-frailty and frailty, respectively.

METHODS

Information concerning the socio-demographics, frailty, social capital, and medication adherence of 4218 participants was collected through a structured questionnaire during November and December 2020. This study employed descriptive analysis and binary logistic regression to fit their relationship.

RESULTS

Among the pre-frail respondents, those with lower social participation (AOR 0.55 [95% CI 0.44-0.69]) had less risk of inadequate medication adherence; while lower social connection (AOR 1.91 [95% CI 1.54-2.36]), lower trust (AOR 2.80 [95% CI 2.25-3.47]), lower cohesion (AOR 2.04 [95% CI 1.65-2.53]), and lower reciprocity (AOR 2.32 [95% CI 1.87-2.88]) were all related to higher odds of inadequate medication adherence. Also, lower social participation (AOR 0.54 [95% CI 0.40-0.74]) was linked to less risk of inadequate medication adherence, while lower trust (AOR 1.89 [95% CI 1.41-2.54]), lower cohesion (AOR 1.68 [95% CI 1.24-2.26]), and lower reciprocity (AOR 1.52 [95% CI 1.14-2.04]) were all found to have a greater odds of inadequate medication adherence in frail respondents.

CONCLUSION

By enhancing the relationship between social capital and medication adherence in this challenging community and offering educational programs that promote medication adherence from the perspective of social capital, our findings emphasize the relevance of social capital in improving medication adherence in later life, especially for frail and pre-frail older adults.

Current Status and Factors Influencing Mental Health Literacy in Patients With Coronary Heart Disease: A Cross-Sectional Study

This study aimed to investigate the current status of mental health literacy and related influencing factors in patients with coronary heart disease. Four hundred and thirty-five patients with coronary heart disease were recruited in this survey. Data collection was conducted using the General Information Questionnaire, the Chinese version of the Mental Health Literacy Scale, Coronary Artery Disease Self-Management Scale, Social Support Rating Scale, and Coronary Heart Disease Self-Efficacy Scale. Descriptive methods, independent samples t-test or one-way ANOVA, Pearson's correlation analysis, and multiple linear regression were used for data analysis. The results showed that the mean total mental health literacy score of patients with coronary heart disease was 96.42 ± 8.40; gender, age, education level, monthly per capita family income, first diagnosed with coronary heart disease, cardiac function classification, self-management ability, social support, and self-efficacy were the factors influencing the level of mental health literacy in patients with coronary heart disease (all p < 0.05). The study suggests that mental health literacy can improve patients' self-management ability and self-efficacy, and healthcare professionals should emphasize the strengthening of this aspect of health education in order to better improve patient's prognosis.

From meta-analysis to Mendelian randomization: Unidirectional perspectives on the association of glaucoma with depression and anxiety

BACKGROUND

Glaucoma, a primary cause of blindness worldwide, has its association with depression and anxiety noted, yet the understanding of such association is still rudimentary. This study aims to provide the unidirectional perspectives on the association of glaucoma with depression and anxiety, informing public health strategies.

METHODS

The Meta-analysis screened observational studies from Medline, Embase, and Web of Science, using the modified Newcastle-Ottawa Scale for quality assessment. It employed R's 'meta' package to assess the association between glaucoma and depression or anxiety prevalence. The Mendelian Randomization (MR) analysis was conducted using R's 'TwoSampleMR' package, based on data from the IEU database data to explore the impact of glaucoma on depression and anxiety.

RESULTS

This Meta-analysis included 23 out of 379 studies involving 11,845 glaucoma patients. The combined prevalence of depression among glaucoma patients, derived from 18 cross-sectional studies, stood at 19.42%. Five case-control studies indicated that glaucoma patients had a 6.17-fold higher risk of depression compared to controls. Derived from 16 cross-sectional studies, the consolidated prevalence for anxiety was 19.07%. According to five case-control studies, glaucoma patients exhibited a 4.45-fold increased risk of anxiety compared to controls. MR analysis failed to uncover a causal effect of glaucoma on depression and anxiety.

CONCLUSION

This study suggests that glaucoma patients may experience higher prevalence of depression and anxiety than the general population, with no clear genetic links found. It suggests that environmental factors and non-genetic biological pathways, among others, may play significant roles in their association, though the role of genetic factors cannot be ruled out. These findings highlight the necessity of a comprehensive approach to study the complex factors influencing the association of glaucoma with depression or anxiety and underscore the importance of integrating mental health considerations into glaucoma management to improve medication adherence and disease progression.

Self-Care Practices and Perspectives in Managing Coronary Heart Disease Patients: A Qualitative Study

Background/Objectives: Self-care experiences and understanding of coronary heart disease (CHD) play a pivotal role in the management of CHD and can contribute to positive health outcomes. This qualitative study aimed to explore the views and experiences of CHD patients, their families, and Indigenous leaders about self-care practices of CHD. Methods: A qualitative design employing semi-structured interviews and a focus group discussion was used. Employing purposive sampling, 49 respondents, comprising 30 patients, 10 family members, and 9 Indigenous leaders, were recruited and interviewed from April to September 2022. The data were analyzed using content analysis. Results: Five major categories were constructed: (1) inadequate knowledge and early symptom identification; (2) self-care activities for physical, psychosocial, and spiritual needs; (3) family and kinship support for self-care efforts; (4) barriers to self-care including physical, psychological, and access issues; and (5) health improvement expectations based on culturally sensitive health education. Conclusions: The study reveals significant gaps in knowledge about CHD and the identification of early symptoms among patients, families, and Indigenous leaders. Despite efforts to meet physical, psychosocial, and spiritual needs, self-care is hindered by various barriers, including limited access to healthcare and entrenched habits. The support from family and kinship systems is crucial for self-care. Participants expressed a strong desire for culturally tailored health education and better health control to improve heart health outcomes.

Medication perceptions mediate the association between illness perceptions and adherence to oral anticancer agents among patients with gastrointestinal tract cancer: A cross-sectional study

PURPOSE

Patients with gastrointestinal tract cancer reported suboptimal adherence to oral anticancer agents, reducing the therapeutic benefit and increasing mortality risk. The Common-Sense Model of Self-Regulation highlights patients' perceptions of illness and treatment influence adherence. However, how these perceptions influence adherence remains unknown among this population. This study aimed to explore whether illness perceptions influence adherence via their effect on medication perceptions.

METHODS

A multi-center cross-sectional study design was conducted. Between July and August 2023, a questionnaire was administered to patients from four tertiary hospitals in Mainland China. Illness perceptions were assessed using the Brief Illness Perceptions Questionnaire. Medication perceptions were measured in medication belief and self-efficacy using the Belief about Medicines Questionnaire and Self-efficacy for Appropriate Medication Use Scale, respectively. Adherence was evaluated using the Morisky 4-item Medication Adherence Scale. Mediation analyses were conducted.

RESULTS

In total, 253 participants were recruited. Patients with worse negative illness perceptions reported higher concern, lower self-efficacy, and poorer adherence. Medication self-efficacy was positively associated with adherence, whereas the necessity and concern belief of taking oral anticancer agents were not. Illness perceptions, including the cognitive and emotional dimensions, had direct and indirect effects on adherence via its effects on medication self-efficacy. The indirect effect explained 26.63% of the total effect.

CONCLUSIONS

The association between illness perceptions and adherence is partially mediated by medication self-efficacy. Strategies to foster positive illness perceptions may contribute to better medication self-efficacy and adherence. Attention should be equally focused on both the emotional and cognitive dimensions of illness perceptions.

Understanding the Relationship Between Comorbidities, Medication Nonadherence, Activities of Daily Living, and Heart Condition Status Among Older Adults in the United States: A Regression Analysis and Machine Learning Approach

BACKGROUND

Nonadherence to medication among patients with heart disease poses serious risks, including worsened heart failure and increased mortality rates.

OBJECTIVE

This study aims to explore the complex interplay between comorbidities, medication nonadherence, activities of daily living, and heart condition status in older American adults, using both traditional statistical methods and machine learning.

METHODS

Data from 326 older adults with heart conditions, drawn from the Health and Retirement Study, were analyzed. Descriptive statistics characterized demographic profiles and comorbidities, whereas logistic regression, multiple regression analyses, and decision tree models were used to address our research inquiries. In addition, a machine learning approach, specifically decision tree models, was integrated to enhance predictive accuracy.

RESULTS

Our analysis showed that factors like age, gender, hypertension, and stroke history were significantly linked to worsening heart conditions. Notably, depression emerged as a robust predictor of medication nonadherence. Further adjusted analyses underscored significant correlations between stroke and challenges in basic activities such as dressing, bathing, and eating. Depression correlated significantly with difficulties in dressing, bed mobility, and toileting, whereas lung disease was associated with bathing hindrances. Intriguingly, our decision tree model revealed that patients experiencing dressing challenges, but not toileting difficulties, were more prone to report no improvement in heart condition status over the preceding 2 years.

CONCLUSIONS

Blending traditional statistics with machine learning in this study reveals significant implications for crafting personalized interventions to improve patients' depression, leading to increased activities of daily living, medication adherence, reduced severity of comorbidities, and ultimately better management of heart conditions.

Frailty in middle-aged and older adult postoperative patients with gynecological malignancies structural equation modeling

Background

Frailty and self-management are important determinants of quality of life in cancer patients. However, their synergistic effects and potential mechanisms on quality of life in middle-aged and older adult postoperative gynecologic malignancy patients have not been adequately studied.

Objective

This cross-sectional study aimed to explore the relationship between frailty, self-management, and quality of life in middle-aged and older adult postoperative gynecologic malignancy patients.

Methods

A cross-sectional study was conducted from January 2024 to April 2024 in three gynecological wards of a tertiary hospital in Wuxi. The study recruited 177 patients aged 45 years or older who underwent surgery for gynecologic malignancies (cervical, ovarian, and endometrial cancer). Data were collected using demographic and clinical characteristics, the Edmonton Frailty Scale, the Self-Management Competence Scale, and the EORTC Core Quality of Life Questionnaire. Structural equation modeling was used to explore the interactions between frailty, self-management, and quality of life.

Results

The prevalence of frailty in middle-aged and older adult postoperative gynecologic malignancy patients was 39.5%, with a mean total self-management score of 125.81 ± 13.21 and a mean total quality of life score of 69.26 ± 10.88. The fit indices of the model indicated a good fit, and that frailty had multiple effects on quality of life; specifically, frailty could affect the quality of life directly or through self-management, i.e., self-management partially mediated frailty and quality of life.

Conclusion

Self-management is a mediating variable between frailty and quality of life, suggesting that clinical workers can intervene in self-management skills to improve patient's quality of life and physical and mental health.

A predictive model for medication adherence in older adults with heart failure

AIMS

Although many studies have examined the predictors of medication adherence (MA), further empirical research is required to clarify the best model for predicting MA for older adults with heart failure (HF). Thus, we hypothesized a model in which information (knowledge), motivation (social support and depressive symptoms), and behavioural skills (barriers to self-efficacy) would be associated with MA in patients with HF.

METHODS AND RESULTS

Using a cross-sectional survey, 153 adults aged ≥ 65 years taking medication for HF were recruited from a university hospital in Korea. Data were collected based on the information-motivation-behavioural skills (IMB) model constructs and MA. In the hypothesized path model, self-efficacy was directly related to MA (β = -0.335, P = 0.006), whereas social support was indirectly related to MA through self-efficacy (β = -0.078, P = 0.027). Depressive symptoms were directly related to MA (β = 0.359, P = 0.004) and indirectly related to MA through self-efficacy (β = 0.141, P = 0.004). The hypothesized MA model showed a good fit for the data. Knowledge, social support, and depressive symptoms accounted for 44.3% of the variance in self-efficacy (P = 0.004). Left ventricular ejection fraction, knowledge, social support, depressive symptoms, and self-efficacy explained 64.4% of the variance in MA (P = 0.004).

CONCLUSION

These results confirmed the IMB model's suitability for predicting MA in older adults with HF. These findings may guide and inform intervention programmes designed to alleviate depressive symptoms in older adults with HF and enhance their HF knowledge, social support, and self-efficacy, with the ultimate goal of improving their MA.

Mediating effect of self-efficacy between social support and compassion fatigue among Geriatric Services and Management interns: A cross-sectional study

OBJECTIVES

To explore the impact of social support on CF and further clarify the mediating role of self-efficacy among Geriatric Services and Management interns.

METHODS

A cross-sectional survey study examined social support, self-efficacy and CF in 592 interns in Geriatric Services and Management from 46 institutions in China.

RESULT

The level of CF among Geriatric Services and Management interns is low but about one-third of the respondents is at high risk of CF. Social support was positively correlated with self-efficacy (β = 0.114, P < 0.01). Social support significantly reduced CF (β = -0.322, P < 0.01). Similarly, self-efficacy had significant direct effects on CF (β = -0.497, P < 0.01). Additionally, self-efficacy played a partial mediating role in the relationship between social support and CF.

CONCLUSION

Social support can directly affect the CF of Geriatric Services and Management interns and indirectly through self-efficacy. Accordingly, It is necessary to strengthen social support and self-efficacy to relieve CF among Geriatric Services and Management interns.

Impact of specialized nursing outpatient case management on post-coronary artery bypass grafting patients

BACKGROUND

Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events (MACE) and require readmission after Coronary Artery Bypass Grafting (CABG) surgery. This is often attributed to patients' unhealthy lifestyles and dietary habits, inadequate understanding of the disease, and poor disease management compliance. Thus, searching for more targeted nursing intervention models that can enhance patients' self-management abilities and reduce the risk of readmission after CABG surgery is significant.

AIM

To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.

METHODS

A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample. The patients were divided into two groups using an odd-even number grouping method. The control group received routine nursing care, while the case management group received specialized nursing outpatient case management. The differences in psychological status, adherence to medical treatment, self-care ability, knowledge mastery, quality of life scores, and the occurrence rate of MACE were compared between the two groups.

RESULTS

After the intervention, the case management group had lower scores on the self-rating depression scale and self-rating anxiety scale and lower MACE rate, as well as higher scores for adherence to a healthy diet, medication adherence, good lifestyle habits, regular exercise, and timely follow-up, higher scores on the Coronary Heart Disease Self-Management Scale, higher scores for managing adverse habits, symptoms, emotional cognition, emergency response, disease knowledge, general lifestyle, and treatment adherence, higher scores for understanding coronary heart disease, recognizing the importance of medication adherence, understanding self-care points after CABG surgery, and being aware of post-CABG precautions, higher scores for physical well-being, disease condition, general health, social-psychological well-being, and work-related aspects (P < 0.05).

CONCLUSION

Specialized nursing outpatient case management can enhance patient adherence to medical treatment, knowledge mastery, psychological well-being, and overall quality of life in patients after CABG surgery.

Burden and Predictors of Depression in Populations With Coronary Heart Disease

INTRODUCTION

Depression significantly impacts the quality of life and medical care in patients with coronary heart disease (CHD). This study assesses the burden of depression in adults aged 40 years and above with CHD and evaluates predictors of depression in this population. It has been reported that approximately 17-44% of persons with CHD have a major depression diagnosis and that nearly 27% of individuals undergoing coronary artery bypass graft operation suffer depression following the procedure.  Methods: Data from the 2022 National Health Interview Survey was used. The sample was made up of adults 40 years and above with CHD. A chi-square analysis was used to identify differences between those who were depressed and those who were not. Logistic and ordinal regression analyses were used to identify predictors of depression and severe depression, respectively.

RESULTS

The proportion of adults 40 years and above with CHD who reported having depression was 863/1700 (50.5%). Among those who were ≥65, the proportion of those who reported depression and those who did not were similar (49.3% vs. 50.7%). Most women reported having depression (57.4% vs. 42.6%), while fewer men reported having depression (46.3% vs. 53.7%). The positive predictors of depression include being insured (odds ratio (OR) 1.26 (1.05-1.53), p = 0.016), college degree (OR 1.09 (1.01-1.18), p = 0.040), diabetes mellitus (OR 1.28 (1.15-1.42), p < 0.001), and hypertension (OR 1.34 (1.24-1.44), p < 0.001). The negative predictors of being depressed were age ≥65 (OR 0.74 (0.69-0.80), p < 0.001), male sex (OR 0.54 (0.50-0.58), p < 0.001), and ratio of family income (RFI) ≥1 (OR 0.68 (0.61-0.77), p < 0.001). The positive predictors of severe depression include diabetes mellitus (OR 1.38 (1.06-1.81), p = 0.019) and current cigarette use (OR 2.10 (1.44-3.07), p < 0.001).

CONCLUSION

A significant proportion of adults 40 years and above with CHD have depression, and socioeconomic and cardiovascular risk factors are associated with a high likelihood of depression. Cardiovascular risk factors alone predict the likelihood of severe depression. Interventions to address depression in CHD should target specifically these high-risk individuals.

Perceived Determinants of Health-Related Behaviors Among Patients with Coronary Heart Disease After Percutaneous Coronary Intervention: A Longitudinal Qualitative Study

Purpose

Studies had reported some influencing factors of health behavior among patients with coronary heart disease(CHD) after percutaneous coronary intervention(PCI). However, considering that human perceptions are complex, unrestricted and dynamically changing. A longitudinal qualitative study was conducted to explore the determinants of health-related behaviors of patients after PCI and dynamic changes of these determinants at the 1st, 3rd, and 6th months.

Patients and Methods

Using purposive sampling, 18 patients undergoing PCI were interviewed. The conventional content analysis method was used to identify categories and subcategories. Semi-structured, face-to-face or telephone in-depth interviews were conducted at the cardiology unit of a tertiary referral hospital in Yunnan Province, China from March 2022 to January 2023.

Results

Seven categories with some subcategories were constructed from the data, categorized into three domains. Firstly, individual factors include (i) Personal coping with healthy lifestyle requirements (tried but failed; I can do it), (ii) individual perception and feeling toward disease (knowing about the disease; belief of cure; fears of relapse), and (iii) personal benefits (improved health; meaning of life). Secondly, social factors include (i) social facilitators (family resources; healthcare support), (ii) social barriers (inconvenient medical care service; conflicting information). Finally, cultural factors include (i) way of living (dietary habits; key roles of yan (cigarette) and jiu (alcohol) in Chinese society), (ii) way of thinking (fatalism and Confucian familism).

Conclusion

The determinants of health-related behaviors of patients after PCI are multifaceted and dynamic. Different interventions should be formulated to promote patients' adherence to health behaviors. Moreover, priority should be given to the impact of traditional Chinese philosophy on the health behaviors of patients after PCI, and the health promotion program for these patients should be culturally sensitive. In addition, future research should further explore the determinants of health behaviors among diverse ethnic minorities after PCI, which has not been fully inquired in this study.

Social Support and Adherence to Self-Care Behavior Among Patients With Coronary Heart Disease and Heart Failure: A Systematic Review

Cardiovascular diseases stand out as the foremost cause of mortality on a global scale and encompass conditions that require long term self-care. Coronary heart disease and heart failure are two cardiovascular conditions that require significant lifestyle modifications. Adherence to self-care is a multifaceted phenomenon, and is influenced by various factors that include social, economic, disease-related and healthcare system-related factors. A key factor in adherence to self-care in chronic illnesses is social support. To explore this relationship between social support and adherence to self-care, a systematic review was carried out across Scopus, EBSCO host and ProQuest from October 2022 to February 2023 using predefined search criteria. Studies from inception to February 2023 were considered for the review, ultimately incorporating a total of 11 studies. Six studies had an adult population with coronary heart disease while the remaining five had adults with heart failure. All the studies reported a significant positive correlation between social support and adherence to self-care. Our findings revealed that social support plays a significant role in promoting self-care, emphasizing the need for a holistic understanding of self-care to develop effective interventions. Along with self-report measures, objective measures should be used to assess adherence accurately. There is a need for scales that assess all aspects of self-care, as well as the development of new interventions and teaching strategies to facilitate the individual's self-care journey. In addition, family members and trusted resources should be involved in encouraging self-care, and interventions should target both patients and their family members.

Unraveling the mediation role of frailty and depression in the relationship between social support and self-management among Chinese elderly COPD patients: a cross-sectional study

BACKGROUND

Self-management (SM) is the key factor in controlling the progression of chronic obstructive pulmonary disease (COPD). Previous studies have reported that majority of COPD patients later presented with frailty and mental health diseases, which affect self-management. This study attempted to explore the mediation role of depression and frailty between social support and self-management in elderly COPD population.

METHODS

Six hundred twenty-seven stable elderly COPD patients admitted to 5 public hospitals in Ningxia, China were selected as study subjects by convenience sampling method. Self-management, frailty, depression and social support were assessed using the COPD Self-management Scale (COPD-SMS), Frail Scale (FS), 15-item Geriatric Depression Scale (GDS-15), and Social Support Rating Scale (SSRS) respectively. The Pearson correlation analysis was used to assess the correlation between variables. Additionally, SPSS25.0 PROCESS plugin Model 6 was used to explore the mediating effects of frailty and depression in the relationship between social support and self-management.

RESULTS

The mean participant age was 72.87 ± 7.03 years, 60.4% of participants were male. The mean total score of the COPD-SMS was 156.99 ± 25.15. Scores for the SSRS, FS, and GDS-15 were significantly correlated with COPD-SMS (p < 0.05). The analysis of the mediation effect demonstrated that social support has a direct predictive effect on self- management (β = 1.687, 95%CI: 1.359 to 2.318). Additionally, social support can also predict self- management indirectly through the mediation of depression (β = 0.290, 95%CI: 0.161 to 0.436) and frailty-depression (β = 0.040, 95%CI: 0.010 to 0.081). However, the mediation effect of frailty alone was not found to be statistically significant (β =-0.010, 95%CI: -0.061 to 0.036). The direct effect accounted for 84.06% of the total effect, while the indirect effect accounted for 15.94% of the total effect.

CONCLUSION

Self-management among elderly COPD patients was relatively moderate to low. Furthermore, frailty and depression were found to have a partially mediation role in the relationship between social support and self-management. Therefore, healthcare professionals need to comprehensively consider the frailty and depression status of patients, and implement targeted intervention measures as part of their care, which can improve the self-management of elderly COPD patients.

A Predictive Model for Identifying Low Medication Adherence Among Patients with Cirrhosis

Purpose

This study aims to identify the novel risk predictors of low medication adherence of cirrhosis patients in a large cohort and construct an applicable predictive model to provide clinicians with a simple and precise personalized prediction tool.

Patients and Methods

Patients with cirrhosis were recruited from the inpatient populations at the Department of Infectious Diseases of Tangdu Hospital. Patients who did not meet the inclusion criteria were excluded. The primary outcome was medication adherence, which was analyzed by the medication possession ratio (MPR). Potential predictive factors, including demographics, the severity of cirrhosis, knowledge of disease and medical treatment, social support, self-care agency and pill burdens, were collected by questionnaires. Predictive factors were selected by univariable and multivariable logistic regression analysis. Then, a nomogram was constructed. The decision curve analysis (DCA), clinical application curve analysis, ROC curve analysis, Brier score and mean squared error (MSE) score were utilized to assess the performance of the model. In addition, the bootstrapping method was used for internal validation.

Results

Among the enrolled patients (460), most had good or moderate (344, 74.78%) medical adherence. The main risk factors for non-adherence include young age (≤50 years), low education level, low income, short duration of disease (<10 years), low Child-Plush class, poor knowledge of disease and medical treatment, poor social support, low self-care agency and high pill burden. The nomogram comprised these factors showed good calibration and good discrimination (AUC = 0.938, 95% CI = 0.918-0.956; Brier score = 0.14). In addition, the MSE value was 0.03, indicating no overfitting.

Conclusion

This study identified predictive factors regarding low medication adherence among patients with cirrhosis, and a predictive nomogram was constructed. This model could help clinicians identify patients with a high risk of low medication adherence and intervention measures can be taken in time.

Mediating effects of general self-efficacy on social support and quality of life in patients after surgical aortic valve replacement

AIM

To explore whether general self-efficacy can mediate the relationship between social support and quality of life in patients after surgical aortic valve replacement.

DESIGN

A cross-sectional design.

METHODS

The final analysis included 283 patients who underwent surgical aortic valve replacement from May 2021 to September 2021. They completed a set of questionnaires, including the Chinese version of the General Self-Efficacy Scale, the Chinese Questionnaire of Quality of life in Patients with Cardiovascular Diseases and the Social Support Rating Scale. The PROCESS Macro in SPSS was used to analyse the mediating effect.

RESULTS

Quality of life and all of its dimensions were significantly related to social support and general self-efficacy. A significant indirect effect of social support existed through general self-efficacy in relation to quality of life with the mediation effect ratio of 32.82%.

Factors related to medication adherence in patients with hypertension in Iran: a systematic review study

OBJECTIVES

This study aimed to review the available studies of the factors in Iranian hypertensive patients' adherence to drug treatment.

METHODS

Four Persian databases and seven English databases were searched. The articles, which were published from 2000 to 2022 in Persian and English and examined the adherence to drug treatment in the Iranian population of adults with high blood pressure, were reviewed. Based on the primary examination, 31 of the initial 1062 articles met the inclusion criteria and were included in the analysis. The evidence, which was provided by the examined articles, was summarized and discussed using the 5-dimensional framework of adherence to long-term treatments, which was developed by WHO.

RESULTS

The factors that significantly correlated with adherence to drug treatment in the examined studies were: (1) factors that were related to the health team or the health system: patients' satisfaction with their doctor-patient relationship; (2) factors that were related to the conditions: the number of concomitant diseases, high quality of life and the implementation of effective interventions; (3) factors which were related to the treatment: long duration of illness, short intervals between the visits, duration of treatment, lower numbers of drugs, and the patient's blood pressure control; and (4) factors that were related to the patient: self-efficacy, health literacy, social support, locus of control, illness perception, beliefs, attitude, knowledge, and cues to action.

CONCLUSION

It is possible to draw definite conclusions about the factors which affect adherence to drug treatment in patients with high blood pressure because most of the relevant studies have been cross-sectional. Therefore, in the future, valuable results can be obtained by conducting more studies that preferably use objective instruments for assessing adherence to drug treatment.

Validation and adaption of an Information-Motivation-Behavioral Skills model of medication adherence in older patients with multimorbidity

OBJECTIVE

To test and adapt the Information-Motivation-Behavioral Skills (IMB) model in explaining medication adherence for older patients with multimorbidity.

METHODS

Older patients with at least three chronic conditions (N = 254) were recruited from community health centers in Changsha, China. All participants completed a self-administrated questionnaire assessing adherence information, personal motivation, social motivation, behavioral skills, medication adherence, depressive symptoms, medication treatment satisfaction, treatment burden, and disease burden. Structural equation modeling was used to examine the hypothesized models and relationships between variables.

RESULTS

The final extended IMB model could explain 52.0% of the variance in adherence. Personal motivation (β = 0.29, p < 0.001), behavioral skills (β = 0.36, p < 0.001), and medication treatment satisfaction (β = 0.23, p = 0.001) had a positive direct effect on adherence. Information, social motivation, personal motivation, medication treatment satisfaction, and treatment burden could also affect adherence indirectly through multiple pathways.

CONCLUSION

This study demonstrated that an extended IMB model could be used to conceptualize determinants of medication adherence among older patients with multimorbidity.

PRACTICAL IMPLICATIONS

Adherence improvement programs might be more effective if targeting psychosocial factors, including adherence information, motivation, behavioral skills, treatment burden, and medication treatment satisfaction.

Examining the relationship between depression and medication adherence among elderlies suffering from cardiovascular disease referring to the clinics affiliated with Kermanshah University of Medical Sciences: A cross-sectional study

Background

In recent years, around 30% of all mortalities worldwide has been related to cardiovascular disease (CVD). The most important predictor solution of cardiovascular events is enhancing medication adherence. Meanwhile, the main reason behind development of physical disorders among the elderly is depression. In this regard, the present research was performed to determine the relationship between depression and medication adherence among the elderly suffering from CVD.

Methods

A cross-sectional study was done via an analytical approach on 188 elderlies fulfilling the inclusion criteria. The participants were chosen through convenience nonrandomized sampling from March to July 2022. The data were collected through demographic and healthcare information form plus Madanloo chronic disease medication adherence and geriatric depression scale. The analysis of the data was done by SPSS 26 plus Stata 14.2.

Results

The mean depression score was 5.6(4.3) and the mean score of medication adherence in the elderlies was 168.03(23.85). The prevalence of depression was higher in women than in men (p = 0.015), and the elderlies differing from heart failure reported the minimum extent of medication adherence. The findings obtained from analysis of variance showed that age, level of education, and monthly level of income were among the effective demographic factors in the extent of depression and medication adherence (p < 0.05). Meanwhile, 26% of changes in medication adherence can be attributed to depression. Further, the results of the multiple linear regression model reported that depression, age, and polypharmacy are among the predictors of medication adherence.

Discussion and Conclusion

A weak to moderate relationship existed between depression and medication adherence among these elderlies. Given the growing elderly population, the importance of depression, and lack of medication adherence in incidence of CVD events, it is recommended to train the healthcare team to monitor the elderly regarding depression symptoms.

Prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer cycle: A cross-sectional study

Objective: This study aimed to explore the prevalence and associated factors of medication adherence among infertile women undergoing frozen-thawed embryo transfer (FET) cycle.

Methods: A cross-sectional study was conducted with 556 infertile women undergoing FET cycle in total. The Self-efficacy for Appropriate Medication Use Scale (SEAMS), Herth Hope Index (HHI) scale, and Social Support Rating Scale (SSRS) were used to evaluate the patients. Data were described by univariate and multivariate analyses. Logistic regression method was performed to analyse the factors potentially associated with medication adherence.

Results: The average score of Self-efficacy for Appropriate Medication Use Scale (SEAMS) was 30.38 ± 6.65, and 65.3% of participants showed non-adherence. Multiple regression analysis indicated that first-time FET cycle, treatment stage, methods of daily medication, social support and hope level were the main associated factors of the medication adherence among infertile women undergoing FET cycle (p &lt; 0.001).

Conclusion: This study revealed the medication adherence is at medium level among infertile women undergoing FET cycle, especially in patients with repeated FET cycles. The study also suggested that improving the hope level and social support of infertile women undergoing FET cycle may increase medication adherence.

Psychopathology, Personality and Depression after Acute Coronary Syndrome: A Network Analysis in an Italian Population

Several biopsychosocial factors are associated with the onset of a Major Depressive Episode (MDE) after cardiovascular events. However, little is known of the interaction between trait- and state-like symptoms and characteristics and their role in predisposing cardiac patients to MDEs. Three hundred and four subjects were selected among patients admitted for the first time at a Coronary Intensive Care Unit. Assessment comprised personality features, psychiatric symptoms and general psychological distress; the occurrences of MDEs and Major Adverse Cardiovascular Events (MACE) were recorded during a two-year follow-up period. Network analyses of state-like symptoms and trait-like features were compared between patients with and without MDEs and MACE during follow-up. Individuals with and without MDEs differed in sociodemographic characteristics and baseline depressive symptoms. Network comparison revealed significant differences in personality features, not state-like symptoms: the group with MDEs displayed greater Type D personality traits and alexithymia as well as stronger associations between alexithymia and negative affectivity (edge differences between negative affectivity and difficulty identifying feelings was 0.303, and difficulty describing feelings was 0.439). The vulnerability to depression in cardiac patients is associated with personality features but not with state-like symptoms. Personality evaluation at the first cardiac event may help identify individuals more vulnerable to development of an MDE, and they could be referred to specialist care in order to reduce their risk.

Pathways linking relative deprivation to blood pressure control: the mediating role of depression and medication adherence among Chinese middle-aged and older hypertensive patients

BACKGROUND

Studies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension.

METHODS

Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The "KHB-method" was used to perform mediation analysis.

RESULTS

Among 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78-7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control.

CONCLUSIONS

Individual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.

Relationship between self-efficacy and adherence to self-management and medication among patients with chronic diseases in China: A multicentre cross-sectional study

PURPOSE

This study aimed to explore the effects of self-efficacy on adherence to self-management and medication among patients with chronic diseases in China.

METHODS

A cross-sectional survey of 2047 patients with chronic diseases in 120 cities across China was conducted between May and September 2021 using a multi-stage sampling method. Self-efficacy was measured using the New General Self-Efficacy Scale. The adherence to self-management was measured using the item response theory based self-management adherence scale, and the medication adherence was assessed using the Medication Adherence Scale for the Chronically Ill. The adherence to self-management and medication were evaluated by linear regression and logistic regression models, respectively.

RESULTS

After adjusting for all covariates, self-efficacy was significantly associated with adherence to self-management (β =0.207, 95% CI =0.064-0.350, P = 0.005), but not with medication adherence (for[middle/low]: OR = 1.119, 95% CI =0.828-1.511, P = 0.47; for[high/low]: OR = 1.281, 95% CI =0.935-1.754, P = 0.12). In subgroup analysis, self-efficacy positively correlated with adherence to self-management in patients with multiple chronic diseases (β =0.286, 95% CI =0.037-0.535, P = 0.03), but not in those with only one chronic disease (P = 0.12). Self-efficacy was not significantly associated with medication adherence in any of the subgroups.

CONCLUSION

Self-efficacy was positively associated with adherence to self-management in patients with chronic diseases, but not with medication adherence. Enhanced health education in patients with one chronic disease alone may have an association with better adherence to self-management and medication in daily life.

Relationships among social support, self-efficacy, and patient activation in community-dwelling older adults living with coronary heart disease: A cross-sectional study

OBJECTIVES

To explore whether social support indirectly influences patient activation through self-efficacy in older adults living with coronary heart disease.

METHODS

A cross-sectional study was conducted. Older patients (n=451) from four communities in the city of Qingdao completed a questionnaire survey. We conducted multiple linear regression models and bootstrap testing to assess the relationships among social support, self-efficacy, and patient activation.

RESULTS

Patient activation was positively correlated with social support (r = 0.524, P < 0.01) and with self-efficacy (r = 0.740, P < 0.01). The of social support had indirect positive effect on patient activation through self-efficacy and the effect was 58.8%.

CONCLUSIONS

We identified the critical role of social support and self-efficacy for the activation of community-dwelling older patients living with coronary heart disease. Our findings provide essential knowledge for developing and evaluating effective interventions to promote patient activation and enhance self-management of coronary heart disease.

Mediating effect of self-efficacy on the relationship between social support and self-management behaviors among patients with knee osteoarthritis: a cross-sectional study

BACKGROUND

Good self-management behaviors in patients with knee osteoarthritis can improve disease awareness, treatment effectiveness, quality of life, and reduce medical costs. However, there is a paucity of studies focusing on patients with knee osteoarthritis. Therefore, the purpose of this study was to explore the mediating effect of self-efficacy on aspects of social support and self-management behaviors in this population.

METHODS

This study employed a cross-sectional design and convenience sampling to survey patients with knee osteoarthritis in an outpatient department of a regional hospital in northern Taiwan from February 22, 2021, to April 15, 2021. The inclusion criteria for patients were (1) those diagnosed by a physician with knee osteoarthritis and (2) who could communicate in Chinese or Taiwanese. Participants were asked to complete a demographic questionnaire, the Arthritis Self-Efficacy Scale (ASE), the Inventory of Socially Supportive Behavior (including enacted support and perceived social support), and the Arthritis Self-Management Assessment Tool (ASMAT). In addition, the Kellgren-Lawrence Grading Scale was obtained from a chart review. Data were analyzed with descriptive statistics, t-test, one-way analysis of variance, Pearson product-moment correlation, and mediation analysis.

RESULTS

A total of 140 patients met the inclusion criteria. The mean age of participants was 70.21 ± 10.84years; most (73.6%) were female. The mean total score of the ASMAT was 64.27 ± 14.84. Scores for the ASE, enacted support, and perceived social support were significantly positively correlated with ASMAT (all p < .001). The standardized coefficient for total effect and direct effect of perceived social support on ASMAT was 0.899 (p < .001) and 0.754 (p < .05), respectively. After introducing the ASE into the model, the indirect effect was 0.145 (p < .05), which indicated that ASE had a partial mediating effect on the relationship between perceived social support and ASMAT.

CONCLUSION

Our findings might suggest that perceived social support indirectly affected ASMAT through ASE. Therefore, interventions designed to increase self-efficacy and social support could enhance self-management behaviors for patients with knee osteoarthritis.