Psychosocial predictors of self-reported medical adherence in patients with heart failure over 6 months : an examination of the influences of depression, self-efficacy, social support, and their changes

Abstract

Background Poor adherence to medical regimens is a serious problem that interferes with heart failure (HF) patients’ disease management and contributes to poor clinical outcomes. Few prospective studies have examined the psychosocial predictors of adherence over time in HF patients.

Purpose This study examined the influences of depression, self-efficacy, social support, and their changes on self-reported medical adherence over 6 months in HF patients.

Methods Participants were 252 HF outpatients, among whom 168 completed follow-up assessments. Hierarchical multiple regression analyses were conducted to examine whether psychosocial variables and their changes prospectively predicted adherence at 6 months, after adjusting for baseline adherence, age, gender, ethnicity, marital status, education, HF severity, medical comorbidity, and mental health treatment.

Results Baseline self-efficacy (β = .22, p < .05), increase in self-efficacy (β = .34, p < .001), and decrease in depression (β = –.15, p = .05) predicted improved adherence over 6 months, but social support did not. In the combined model that included all significant psychosocial predictors from previous analyses, baseline self-efficacy (β = .37, p = .001) and its increase (β = .35, p < .001) emerged as independent predictors of improved adherence at 6 months.

Conclusions Promoting self-efficacy and reducing depressive symptoms may be promising targets of behavioral interventions to facilitate long-term disease management in HF patients.