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已发表论文
2 型糖尿病患者在医院至家庭过渡期间药物素养与依从性的中介模型
Authors Jiang S , Zeng K , Xie S, Huang Y , Li B, Zhang Y
Received 23 August 2025
Accepted for publication 6 December 2025
Published 27 December 2025 Volume 2025:19 Pages 4283—4297
DOI https://doi.org/10.2147/PPA.S556814
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 5
Editor who approved publication: Dr Ramón Morillo-Verdugo
Sifen Jiang,1,* Kun Zeng,2,* Sumei Xie,3,* Yanling Huang,4 Bing Li,4 Yihui Zhang1
1Stroke Rehabilitation Department, Guangdong Work Injury Rehabilitation Hospital, Guangzhou, People’s Republic of China; 2Science and Education Section, Dongguan Eighth People’s Hospital, Dongguan, People’s Republic of China; 3Nursing Department, Guangdong Work Injury Rehabilitation Hospital, Guangzhou, People’s Republic of China; 4School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yihui Zhang, Stroke Rehabilitation Department, Guangdong Work Injury Rehabilitation Hospital, No. 68 Qide Road, Baiyun District, Guangzhou City, Guangdong Province, 510440, People’s Republic of China, Tel +86 13802433815, Email 13802433815@163.com
Purpose: The hospital-home transition is a high-risk period for medication management in patients with type 2 diabetes mellitus (T2DM). While bivariate relationships among medication literacy, beliefs, self-efficacy, and adherence have been explored, the integrated mediating mechanisms during this phase remain unclear. This study examined these interrelationships, focusing on the serial mediation beliefs and self-efficacy between literacy and adherence.
Patients and Methods: A cross-sectional study enrolled 315 T2DM patients at discharge from a tertiary hospital in Dongguan, China, between August 2022 and October 2023. Data were collected using validated scales, including the Chinese version of the Medication Literacy Questionnaire, the Beliefs about Medicines Questionnaire-Specific, the Self-efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale-8. Data analysis was performed using SPSS 26.0 and the PROCESS macro. The study received ethical approval, and all participants provided informed consent.
Results: Patients demonstrated moderate medication literacy (4.05± 1.49) and medication adherence (6.35± 1.27), held stronger necessity beliefs, and reported high self-efficacy (31.19± 4.29). Significant correlations were observed between medication literacy, concern beliefs, self-efficacy, and medication adherence (all P < 0.01). Concern beliefs partially mediated the medication literacy - adherence relationship (indirect effect: 0.085, 28.43%), self-efficacy also served as a partial mediator (indirect effect: 0.128, 42.81%). Furthermore, concern beliefs and self-efficacy acted as serial mediators (total indirect effect: 0.168, 56.19%), revealing a clinical pathway where poor literacy increases concerns, which in turn reduces self-efficacy and medication adherence.
Conclusion: In conclusion, this study reveals that medication literacy influences adherence in T2DM patients through a sequential psychological pathway: by alleviating concern beliefs, which in turn strengthens self-efficacy. This serial mediation mechanism underscores that effective interventional strategies must extend beyond knowledge dissemination to concurrently address patients’ specific concerns and bolster their management confidence, thereby offering a multi-faceted approach to improve adherence during the vulnerable hospital-home transition.
Keywords: medication adherence, medication literacy, T2DM, mediation model, hospital-home transition
1Stroke Rehabilitation Department, Guangdong Work Injury Rehabilitation Hospital, Guangzhou, People’s Republic of China; 2Science and Education Section, Dongguan Eighth People’s Hospital, Dongguan, People’s Republic of China; 3Nursing Department, Guangdong Work Injury Rehabilitation Hospital, Guangzhou, People’s Republic of China; 4School of Nursing, Guangdong Pharmaceutical University, Guangzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yihui Zhang, Stroke Rehabilitation Department, Guangdong Work Injury Rehabilitation Hospital, No. 68 Qide Road, Baiyun District, Guangzhou City, Guangdong Province, 510440, People’s Republic of China, Tel +86 13802433815, Email 13802433815@163.com
Purpose: The hospital-home transition is a high-risk period for medication management in patients with type 2 diabetes mellitus (T2DM). While bivariate relationships among medication literacy, beliefs, self-efficacy, and adherence have been explored, the integrated mediating mechanisms during this phase remain unclear. This study examined these interrelationships, focusing on the serial mediation beliefs and self-efficacy between literacy and adherence.
Patients and Methods: A cross-sectional study enrolled 315 T2DM patients at discharge from a tertiary hospital in Dongguan, China, between August 2022 and October 2023. Data were collected using validated scales, including the Chinese version of the Medication Literacy Questionnaire, the Beliefs about Medicines Questionnaire-Specific, the Self-efficacy for Appropriate Medication Use Scale, and the Morisky Medication Adherence Scale-8. Data analysis was performed using SPSS 26.0 and the PROCESS macro. The study received ethical approval, and all participants provided informed consent.
Results: Patients demonstrated moderate medication literacy (4.05± 1.49) and medication adherence (6.35± 1.27), held stronger necessity beliefs, and reported high self-efficacy (31.19± 4.29). Significant correlations were observed between medication literacy, concern beliefs, self-efficacy, and medication adherence (all P < 0.01). Concern beliefs partially mediated the medication literacy - adherence relationship (indirect effect: 0.085, 28.43%), self-efficacy also served as a partial mediator (indirect effect: 0.128, 42.81%). Furthermore, concern beliefs and self-efficacy acted as serial mediators (total indirect effect: 0.168, 56.19%), revealing a clinical pathway where poor literacy increases concerns, which in turn reduces self-efficacy and medication adherence.
Conclusion: In conclusion, this study reveals that medication literacy influences adherence in T2DM patients through a sequential psychological pathway: by alleviating concern beliefs, which in turn strengthens self-efficacy. This serial mediation mechanism underscores that effective interventional strategies must extend beyond knowledge dissemination to concurrently address patients’ specific concerns and bolster their management confidence, thereby offering a multi-faceted approach to improve adherence during the vulnerable hospital-home transition.
Keywords: medication adherence, medication literacy, T2DM, mediation model, hospital-home transition