Community Efficacy for Non-Communicable Disease Management and Medication Adherence: The Sequential Mediating Role of Self-Efficacy and Depressive Symptoms

Gangjiao Zhu; Rahul Malhotra; Shangzhi Xiong; Xinyue Chen; Mingyang Zhang; You Wu; Enying Gong; Zhan Wang; Xiangyang Tian; Weixia Peng; Truls Østbye; Lijing L Yan

doi:10.2147/PPA.S436419

Community Efficacy for Non-Communicable Disease Management and Medication Adherence: The Sequential Mediating Role of Self-Efficacy and Depressive Symptoms

Patient Prefer Adherence. 2023 Dec 14:17:3421-3433. doi: 10.2147/PPA.S436419. eCollection 2023.

Authors

Gangjiao Zhu^{1

2}, Rahul Malhotra^{3

4

5}, Shangzhi Xiong⁶, Xinyue Chen⁷, Mingyang Zhang², You Wu², Enying Gong⁸, Zhan Wang⁹, Xiangyang Tian¹⁰, Weixia Peng¹¹, Truls Østbye^{2

3

12}, Lijing L Yan^{1

2

12}

Affiliations

¹ School of Public Health, Wuhan University, Wuhan, People's Republic of China.
² Global Health Research Center, Duke Kunshan University, Kunshan, People's Republic of China.
³ Health Services and Systems Research, Duke-NUS Medical School, Singapore.
⁴ Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore.
⁵ Singhealth, Duke-NUS Global Health Institute Medical School, Singapore.
⁶ The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
⁷ Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁸ School of Population Medicine and Public Health, China Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China.
⁹ Department of Agricultural Economics, College of Agriculture, Purdue University, West Lafayette, IN, USA.
¹⁰ Chinese Health Education Center, Beijing, People's Republic of China.
¹¹ School of Public Health, Fudan University, Shanghai, People's Republic of China.
¹² Duke Global Health Institute, Duke University, Durham, NC, USA.

Abstract

Purpose: We assess whether the sequential mediating effects of self-efficacy and depressive symptoms on the relationship between community efficacy for non-communicable disease management (COEN) and medication adherence and whether these relationships differed by sex and age.

Patients and methods: Overall, 662 individuals from 12 communities in China were interviewed twice 1 year apart. Serial mediation analysis examined whether the relationship between COEN and medication adherence was mediated by self-efficacy and depressive symptoms. Model invariance across sex and age groups was assessed using multi-group analysis.

Results: Serial mediation analysis indicated that self-efficacy and depressive symptoms sequentially mediated relationship between COEN and medication adherence. Multi-group analysis by sex showed that the path from self-efficacy to medication adherence was significant only for females and from depressive symptoms to medication adherence was significant only for males.

Conclusion: Interventions that enhance individual self-efficacy may be beneficial in decreasing depressive symptoms and improving medication adherence.

Keywords: China; community; depressive symptoms; medication adherence; neighborhood; non-communicable chronic diseases; self-efficacy; social cognitive theory.

Grants and funding

This study was supported by the National Natural Science Foundation of China (Grant number: 71774075).