{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:38:18Z","timestamp":1791823098423,"version":"4.3.4"},"reference-count":75,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Treatment adherence in patients with chronic obstructive pulmonary disease (COPD) is a critical factor influencing disease prognosis and quality of life. Health literacy, defined as patients\u2019 ability to acquire and apply health information, may indirectly modulate adherence behaviors through psychological mechanisms. However, prior research has seldom examined the relationship between health literacy and treatment adherence, along with its underlying mechanisms. To bridge this gap, the present study, grounded in protection motivation theory and self-efficacy theory, investigates the mediating roles of perceived disease threat and self-efficacy in the association between health literacy and treatment adherence among COPD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This study utilized a cross-sectional design and employed convenience sampling to recruit 456 COPD patients from four tertiary Grade A hospitals in Beijing, China. All participants completed the Health Literacy Scale, Perceived Disease Threat Scale, Self-Efficacy Scale, Treatment Adherence Scale, and provided essential demographic information.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Health literacy showed a significant positive correlation with treatment adherence, whereas perceived disease threat exhibited a significant negative correlation with self-efficacy. Perceived disease threat and self-efficacy demonstrated significant chain mediation in the relationship between health literacy and treatment adherence. Specifically, higher health literacy enhances patients\u2019 confidence in implementing treatment regimens by fostering an understanding of treatment efficacy, enabling accurate perceptions of disease severity and personal susceptibility. This cognition translates into motivational urgency for action, thereby driving patients to engage in long-term and proactive adherence to various treatment behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study confirms that health literacy promotes treatment adherence in COPD patients via a chain mediation mechanism involving enhanced self-efficacy and reduced perceived disease threat. These findings offer a foundation for clinical interventions, such as elevating literacy through health education to optimize psychological pathways and improve patient management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1741304","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T06:47:53Z","timestamp":1767768473000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The impact of health literacy on treatment adherence in COPD patients: chain mediation roles of self-efficacy and perceived disease threat"],"prefix":"10.3389","volume":"13","author":[{"given":"Fang","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limin","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaoyao","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s00391-025-02409-5","article-title":"Diagnosis of chronic obstructive pulmonary disease (COPD) in older patients: consensus statement of the working group on pneumology in older patients","volume":"58","author":"Stenmanns","year":"2025","journal-title":"Z Gerontol Geriatr"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s13668-025-00613-8","article-title":"The role of nutrition and nutritional supplements in the prevention and treatment of malnutrition in chronic obstructive pulmonary disease: current approaches in nutrition therapy","volume":"14","author":"Tuna","year":"2025","journal-title":"Curr Nutr Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1164\/rccm.202204-0671PP","article-title":"Definition and nomenclature of chronic obstructive pulmonary disease: time for its revision","volume":"206","author":"Celli","year":"2022","journal-title":"Am J Respir Crit Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1136\/thoraxjnl-2020-216037","article-title":"Small airway determinants of airflow limitation in chronic obstructive pulmonary disease","volume":"76","author":"Polosukhin","year":"2021","journal-title":"Thorax"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/s2213-2600(24)00339-4","article-title":"The global burden of COPD: epidemiology and effect of prevention strategies","volume":"13","author":"de Oca","year":"2025","journal-title":"Lancet Respir Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e069679","DOI":"10.1136\/bmj-2021-069679","article-title":"Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the global burden of disease study 2019","volume":"378","author":"Safiri","year":"2022","journal-title":"BMJ"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/17476348.2021.2011722","article-title":"Occupational chronic obstructive pulmonary disorder: prevalence and prevention","volume":"16","author":"Minov","year":"2022","journal-title":"Expert Rev Respir Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2400516","DOI":"10.1183\/13993003.00516-2024","article-title":"20-year trends in excess costs of COPD","volume":"65","author":"Amegadzie","year":"2025","journal-title":"Eur Respir J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1112072","DOI":"10.3389\/fpubh.2023.1112072","article-title":"Patient experience with chronic obstructive pulmonary disease: a nationally representative demonstration study on quality and cost of healthcare services","volume":"11","author":"Ghamari","year":"2023","journal-title":"Front Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"200213","DOI":"10.1183\/16000617.0213-2020","article-title":"Chronic lung diseases: prospects for regeneration and repair","volume":"30","author":"Barnes","year":"2021","journal-title":"Eur Respir Rev"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1644607","DOI":"10.3389\/fpubh.2025.1644607","article-title":"Factors influencing the benefits of pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: a prospective study","volume":"13","author":"Feng","year":"2025","journal-title":"Front Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"998","DOI":"10.4187\/respcare.10876","article-title":"Oxygen therapy in COPD","volume":"68","author":"Hess","year":"2023","journal-title":"Respir Care"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.pulmoe.2020.01.005","article-title":"Is adherence to treatment influenced by the ability to use inhaled devices in patients with COPD correctly?","volume":"26","author":"Latorre","year":"2020","journal-title":"Pulmonology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2887","DOI":"10.2147\/copd.S431829","article-title":"Inhaler adherence in COPD: a crucial step towards the correct treatment","volume":"18","author":"Tur\u00e9gano-Yedro","year":"2023","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"E18","DOI":"10.1097\/jcn.0000000000001214","article-title":"The status of medication literacy in young patients with hypertension and its relationship with medication adherence","volume":"41","author":"Ming","year":"2025","journal-title":"J Cardiovasc Nurs"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1046\/j.1365-2710.2001.00363.x","article-title":"Patient adherence to treatment: three decades of research. A comprehensive review","volume":"26","author":"Vermeire","year":"2001","journal-title":"J Clin Pharm Ther"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"34","DOI":"10.3390\/jcm14176034","article-title":"Understanding treatment adherence in chronic diseases: challenges, consequences, and strategies for improvement","volume":"14","author":"Patel","year":"2025","journal-title":"J Clin Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1111\/jocn.15976","article-title":"Multidimensional factors affecting medication adherence among patients with chronic obstructive pulmonary disease","volume":"31","author":"Aldan","year":"2022","journal-title":"J Clin Nurs"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.2147\/ppa.S412136","article-title":"Illness perceptions, cognitions, and beliefs on COPD patients' adherence to treatment - a systematic review","volume":"17","author":"Poletti","year":"2023","journal-title":"Patient Prefer Adherence"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"151368","DOI":"10.1016\/j.apnr.2020.151368","article-title":"Associated factors with treatment adherence of patients diagnosed with chronic disease: relationship with health literacy","volume":"57","author":"Coskun","year":"2021","journal-title":"Appl Nurs Res"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"107829","DOI":"10.1016\/j.pec.2023.107829","article-title":"Health literacy interventions among patients with chronic diseases: a meta-analysis of randomized controlled trials","volume":"114","author":"Shao","year":"2023","journal-title":"Patient Educ Couns"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1111\/j.1525-1497.2006.00540.x","article-title":"The meaning and the measure of health literacy","volume":"21","author":"Baker","year":"2006","journal-title":"J Gen Intern Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e20457","DOI":"10.2196\/20457","article-title":"Effects of objective and subjective health literacy on patients' accurate judgment of health information and decision-making ability: survey study","volume":"23","author":"Schulz","year":"2021","journal-title":"J Med Internet Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.pec.2014.10.006","article-title":"Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management","volume":"98","author":"Heijmans","year":"2015","journal-title":"Patient Educ Couns"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1177\/17423953211035472","article-title":"The importance of health literacy for self-management: a scoping review of reviews","volume":"18","author":"van der Gaag","year":"2022","journal-title":"Chronic Illn"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e0299971","DOI":"10.1371\/journal.pone.0299971","article-title":"Pathways linking health literacy to self-care in diabetic patients with physical disabilities: a moderated mediation model","volume":"19","author":"Nam","year":"2024","journal-title":"PLoS One"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.2147\/ppa.S513375","article-title":"Mediating effects of health literacy, self-efficacy, and social support on the relationship between disease knowledge and patient participation behavior among chronic ill patients: a cross-sectional study based on the capability-opportunity-motivation and behavior (COM-B) model","volume":"19","author":"Wu","year":"2025","journal-title":"Patient Prefer Adherence"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1186\/1471-2458-12-130","article-title":"The development of health literacy in patients with a long-term health condition: the health literacy pathway model","volume":"12","author":"Edwards","year":"2012","journal-title":"BMC Public Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1016\/j.pec.2016.01.020","article-title":"Health literacy and adherence to medical treatment in chronic and acute illness: a meta-analysis","volume":"99","author":"Miller","year":"2016","journal-title":"Patient Educ Couns"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"61","DOI":"10.2147\/rmhp.S7500","article-title":"Improving health outcomes with better patient understanding and education","volume":"3","author":"Adams","year":"2010","journal-title":"Risk Manag Healthc Policy"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1037\/0022-3514.45.2.464","article-title":"Self-efficacy determinants of anticipated fears and calamities","volume":"45","author":"Bandura","year":"1983","journal-title":"J Pers Soc Psychol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1002\/pits.22201","article-title":"The relationship between vicarious experience, social persuasion, physiological state, and chemistry self-efficacy: the role of mastery experience as a mediator","volume":"55","author":"Capa-Aydin","year":"2018","journal-title":"Psychol Sch"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"105660","DOI":"10.1016\/j.actpsy.2025.105660","article-title":"The impact of perceived stigma on appearance anxiety in postoperative rhinoplasty patients: a variable-centered and person-centered perspective","volume":"260","author":"Yang","year":"2025","journal-title":"Acta Psychol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1186\/s12890-023-02796-8","article-title":"The patient journey in chronic obstructive pulmonary disease (COPD): a human factors qualitative international study to understand the needs of people living with COPD","volume":"23","author":"Scichilone","year":"2023","journal-title":"BMC Pulm Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.jpainsymman.2006.01.012","article-title":"Effects of treatment on two types of self-efficacy in people with chronic obstructive pulmonary disease","volume":"32","author":"Davis","year":"2006","journal-title":"J Pain Symptom Manag"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1007\/s11764-013-0298-2","article-title":"Why do some patients prefer to leave decisions up to the doctor: lack of self-efficacy or a matter of trust?","volume":"7","author":"Chawla","year":"2013","journal-title":"J Cancer Surviv"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e099666","DOI":"10.1136\/bmjopen-2025-099666","article-title":"Patient perceptions of primary care rapid respiratory microbiological point-of-care testing: a qualitative study","volume":"15","author":"Clarke","year":"2025","journal-title":"BMJ Open"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1430202","DOI":"10.3389\/fpubh.2024.1430202","article-title":"The relationship between self-efficacy, health literacy, and quality of life in patients with chronic diseases: a cross-sectional study in China","volume":"12","author":"Gao","year":"2024","journal-title":"Front Public Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1080\/15412555.2021.1872061","article-title":"Effectiveness of health literacy interventions on COPD self-management outcomes in outpatient settings: a systematic review","volume":"18","author":"Shnaigat","year":"2021","journal-title":"COPD"},{"key":"ref40","first-page":"201","article-title":"Efficiency of two constructs called \u201cfear of disease\u201d and \u201cperceived severity of disease\u201d on the prevention of gastric cancer: application of protection motivation theory","volume":"6","author":"Baghiani-Moghadam","year":"2015","journal-title":"Caspian J Intern Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.copsyc.2015.03.012","article-title":"Risk perceptions and health behavior","volume":"5","author":"Ferrer","year":"2015","journal-title":"Curr Opin Psychol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1201789","DOI":"10.3389\/fcvm.2023.1201789","article-title":"Associations among risk perception, health efficacy, and health behaviors for cardiovascular disease: an application of risk perception attitude framework","volume":"10","author":"Guo","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1574726","DOI":"10.3389\/fnut.2025.1574726","article-title":"How disease threat affects the purchase intention of ultra-processed foods among high-pressure workers","volume":"12","author":"He","year":"2025","journal-title":"Front Nutr"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1007\/s00520-025-09513-7","article-title":"Illness perception, cognitive emotion regulation strategies and psychological distress in breast cancer patients and spouses: an actor-partner interdependence mediation model","volume":"33","author":"Zheng","year":"2025","journal-title":"Support Care Cancer"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1007\/s11606-020-06447-0","article-title":"The impact of social determinants of health on medication adherence: a systematic review and Meta-analysis","volume":"36","author":"Wilder","year":"2021","journal-title":"J Gen Intern Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"339","DOI":"10.15326\/jcopdf.2024.0597","article-title":"Challenges and opportunities for the management of COPD: a narrative review of patient and health care professional perspectives","volume":"12","author":"Anzueto","year":"2025","journal-title":"Chronic Obstr Pulm Dis"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1111\/resp.14032","article-title":"Contemporary perspectives in COPD: patient burden, the role of gender and trajectories of multimorbidity","volume":"26","author":"Buttery","year":"2021","journal-title":"Respirology"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1097\/j.pain.0000000000000872","article-title":"Pain and cancer survival: a cognitive-affective model of symptom appraisal and the uncertain threat of disease recurrence","volume":"158","author":"Heathcote","year":"2017","journal-title":"Pain"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1186\/s40359-024-01946-9","article-title":"The links between symptom burden, illness perception, psychological resilience, social support, coping modes, and cancer-related worry in Chinese early-stage lung cancer patients after surgery: a cross-sectional study","volume":"12","author":"Yang","year":"2024","journal-title":"BMC Psychol"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"3398","DOI":"10.1186\/s12889-024-20906-x","article-title":"The influence of family health on self-efficacy in patients with chronic diseases: the mediating role of perceived social support and the moderating role of health literacy","volume":"24","author":"Luo","year":"2024","journal-title":"BMC Public Health"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"657","DOI":"10.2147\/ppa.S447320","article-title":"The effect of health literacy on disease management self-efficacy in chronic disease patients: the mediating effects of social support and the moderating effects of illness perception","volume":"18","author":"Zou","year":"2024","journal-title":"Patient Prefer Adherence"},{"key":"ref52","first-page":"22","article-title":"Spirometry in chronic obstructive lung disease (COPD)","volume":"60","author":"Karkhanis","year":"2012","journal-title":"J Assoc Physicians India"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.1183\/13993003.01603-2024","article-title":"GOLD science committee recommendations for the use of pre- and post-bronchodilator spirometry for the diagnosis of COPD","volume":"65","author":"Singh","year":"2025","journal-title":"Eur Respir J"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1111\/j.1532-5415.1992.tb01992.x","article-title":"The mini-mental state examination: a comprehensive review","volume":"40","author":"Tombaugh","year":"1992","journal-title":"J Am Geriatr Soc"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1038\/s41533-023-00347-6","article-title":"Rational use of inhaled corticosteroids for the treatment of COPD","volume":"33","author":"Quint","year":"2023","journal-title":"NPJ Prim Care Respir Med"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s12931-022-02037-2","article-title":"Impact of switching from triple therapy to dual bronchodilation in COPD: the DACCORD 'real world' study","volume":"23","author":"Vogelmeier","year":"2022","journal-title":"Respir Res"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"e01894","DOI":"10.1002\/brb3.1894","article-title":"Psychometric properties of structured clinical interview for DSM-5 disorders-clinician version (SCID-5-CV)","volume":"11","author":"Shabani","year":"2021","journal-title":"Brain Behav"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.2147\/rmhp.S419879","article-title":"The use of multidimensional Nomial logistic model and structural equation model in the validation of the 14-item health-literacy scale in Chinese patients living with type 2 diabetes","volume":"16","author":"Wu","year":"2023","journal-title":"Risk Manag Healthc Policy"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/j.jpsychores.2005.10.020","article-title":"The brief illness perception questionnaire","volume":"60","author":"Broadbent","year":"2006","journal-title":"J Psychosom Res"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"e0174093","DOI":"10.1371\/journal.pone.0174093","article-title":"Psychometric assessment of the Chinese version of the brief illness perception questionnaire in breast cancer survivors","volume":"12","author":"Zhang","year":"2017","journal-title":"PLoS One"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1111\/j.1365-2648.2008.04808.x","article-title":"Psychometric validation of the Chinese version of the illness perception questionnaire-revised for patients with hypertension","volume":"64","author":"Chen","year":"2008","journal-title":"J Adv Nurs"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"e13278","DOI":"10.1111\/ijn.13278","article-title":"A Chinese version of the stroke illness perception questionnaire-revised: reliability and validity assessment in stroke patients","volume":"30","author":"Lei","year":"2024","journal-title":"Int J Nurs Pract"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1177\/109442810141004","article-title":"Validation of a new general self-efficacy scale","volume":"4","author":"Chen","year":"2001","journal-title":"Organ Res Methods"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"111105","DOI":"10.1016\/j.jpsychores.2022.111105","article-title":"Relationship between self-efficacy and adherence to self-management and medication among patients with chronic diseases in China: a multicentre cross-sectional study","volume":"164","author":"Chen","year":"2023","journal-title":"J Psychosom Res"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"7","DOI":"10.31234\/osf.io\/r7aj3","article-title":"Reliability and validity analysis and Mokken model of new general self-efficacy scale-short form (NGSES-SF)","volume":"2022","author":"Wang","year":"2022","journal-title":"PsyArXiv"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"333","DOI":"10.2147\/ppa.S150435","article-title":"Adherence to treatment assessed with the adherence in chronic diseases scale in patients after myocardial infarction","volume":"12","author":"Kosobucka","year":"2018","journal-title":"Patient Prefer Adherence"},{"key":"ref67","volume-title":"Principles and practice of structural equation modeling","author":"Kline","year":"2023"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/0277-9536(91)90109-p","article-title":"Prediction of motivation and behavior change following health promotion: role of health beliefs, social support, and self-efficacy","volume":"32","author":"Kelly","year":"1991","journal-title":"Soc Sci Med"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"1627422","DOI":"10.3389\/fpsyt.2025.1627422","article-title":"Psychological capital and death anxiety in pancreatic Cancer patients: a latent profile analysis","volume":"16","author":"Yang","year":"2025","journal-title":"Front Psych"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1038\/s41533-025-00443-9","article-title":"Self-management and COPD: a qualitative study to explore the perceived barriers and recommendations to improve COPD management using the information-motivation-Behavioral skills model","volume":"35","author":"Chen","year":"2025","journal-title":"NPJ Prim Care Respir Med"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"e09716","DOI":"10.1016\/j.heliyon.2022.e09716","article-title":"Factors influencing poor medication adherence amongst patients with chronic disease in low-and-middle-income countries: a systematic scoping review","volume":"8","author":"Chauke","year":"2022","journal-title":"Heliyon"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1186\/s12889-024-20734-z","article-title":"Health literacy and medication adherence in adults from ethnic minority backgrounds with type 2 diabetes mellitus: a systematic review","volume":"25","author":"Parmar","year":"2025","journal-title":"BMC Public Health"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1093\/eurjpc\/zwaf237","article-title":"Review of strategies to improve adherence to lipid lowering therapy in the primary prevention of cardiovascular disease","volume":"22","author":"Whitmore","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"ref74","doi-asserted-by":"crossref","first-page":"7067","DOI":"10.1038\/s41598-023-34393-4","article-title":"Factors predicting medication adherence among Omani patients with chronic diseases through a multicenter cross-sectional study","volume":"13","author":"Al-Noumani","year":"2023","journal-title":"Sci Rep"},{"key":"ref75","doi-asserted-by":"crossref","first-page":"12028","DOI":"10.1038\/s41598-020-68915-1","article-title":"Medication adherence and its determinants in patients after myocardial infarction","volume":"10","author":"Pietrzykowski","year":"2020","journal-title":"Sci Rep"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1741304\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T06:47:55Z","timestamp":1767768475000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1741304\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,7]]},"references-count":75,"alternative-id":["10.3389\/fpubh.2025.1741304"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1741304","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,7]]},"article-number":"1741304"}}