Liqing Liang,1,2,* Xiaomin Zhang,2,3,* Yinghua Pan,4 Lei Huang,4 Lei Jia,5 Peijun Xu,6 Kun Li2 

1Department of Preventive Treatment Center, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, People’s Republic of China; 2School of Nursing, Sun Yat-sen University, Guangzhou, People’s Republic of China; 3Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China; 4Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 5Department of Rheumatology and Immunology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 6Department of Rheumatology and Immunology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Kun Li, School of Nursing, Sun Yat-sen University, No. 74 Zhong Shan Second Road, Guangzhou, 510080, People’s Republic of China, Tel +8613822206519, Email likun22@mail.sysu.edu.cn

Background: Studies have shown that poor medication adherence is common in patients with rheumatoid arthritis (RA). However, the related factors and underlying mechanisms remain unclear. Through theory-based research, the mechanism of medication adherence in RA patients can be better explored and clarified, providing reference for clinical intervention.
Aim: To explore the mediating role of medication self-efficacy between perceived barriers, pharmacologic treatment expectations, social support and medication adherence in patients with RA based on the social cognitive theory.
Methods: A total of 232 participants diagnosed with RA were recruited from three general hospitals in Guangzhou, China. Participants’ sociodemographic, disease-, and medication-related information as well as data on their perceived barriers, pharmacologic treatment expectations, social support, medication self-efficacy, and adherence were collected. SPSS 25.0 software was used for univariate analysis of medication adherence and to explore the correlation between variables. Mplus 8.0 was used to build a parallel mediation model and perform path analysis.
Results: In addition to pharmacologic treatment expectations, perceived barriers, family support, and medication self-efficacy were associated with medication adherence. A mediating model with three independent variables showed that medication self-efficacy fully mediated the negative impact of perceived barriers on medication adherence. Family support had a positive effect on both medication adherence and self-efficacy, but it did not affect medication adherence through medication self-efficacy.
Conclusion: Medication self-efficacy, as a mediating factor, plays a key role in improving medication adherence of RA patients. In nursing practice, timely assessment of the actual or potential barriers on medication adherence of patients and implementation of targeted intervention measures such as health education, as well as giving full play to the positive role of the family support system to improve patients’ medication self-efficacy, will effectively enhance the medication adherence of patients with RA.

Keywords: rheumatoid arthritis, medication self-efficacy, perceived barriers, pharmacologic treatment expectations, social support, medication adherence