{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:50Z","timestamp":1783491530439,"version":"3.55.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"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>Objective<\/jats:title>\n                    <jats:p>Medication adherence is critical for effective blood glucose control and reducing complication risks in patients with Type 2 Diabetes Mellitus (T2DM). However, improving it remains challenging in clinical practice and disease management. This study examined the relationships among social support, empowerment, health literacy, and medication adherence in T2DM patients to explore the multi-path associations underlying medication adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Social support, empowerment, health literacy, and medication adherence constituted the theoretical model. A cross-sectional survey was conducted using convenience sampling at a Grade III Class A hospital in Guiyang City, China. Univariate analyses were performed using nonparametric rank-sum tests. Structural equation modeling (SEM) was applied to test the hypothesized model, and a bootstrap was performed to examine mediation effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 261 T2DM patients were included, with a median medication adherence score of 6.75 (IQR 4.50, 7.63), indicating moderate adherence on the MMAS-8. In univariate analysis, educational level showed the strongest association with medication adherence (H\u202f=\u202f67.452,\n                      <jats:italic>p\u202f&amp;lt;<\/jats:italic>\n                      \u202f0.001). Social support was positively associated with medication adherence through both direct (53.5%) and indirect (46.5%) pathways. The indicators for affectionate support (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      =\u202f0.77) and emotional information support (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      =\u202f0.72) had the highest standardized factor loadings. Health literacy acted as a significant mediator (effect\u202f=\u202f0.256, 95% CI: 0.133\u20130.460, 31.7%), and a small but significant sequential mediation pathway was observed (effect\u202f=\u202f0.062, 95% CI: 0.018\u20130.147, 7.7%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this hospitalized sample of Chinese T2DM patients, empowerment and health literacy sequentially mediated the association between social support and medication adherence. These findings suggest that social support and health literacy may be relevant targets for future intervention research, although longitudinal studies are needed to establish their temporal and causal roles.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1783412","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:57:38Z","timestamp":1783490258000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Social support and medication adherence in type 2 diabetes: unraveling the sequential mediating pathways of empowerment and health literacy"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiaoxia","family":"Meng","sequence":"first","affiliation":[{"name":"School of Medicine and Health Management, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, The Affiliated Hospital of Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianfeng","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Management, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Pharmaceutical Science, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Medicine and Health Management, Guizhou Medical University","place":["Guiyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref1","volume-title":"Diabetes Atlas","year":"2025"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e1089","DOI":"10.1016\/S2468-2667(24)00250-0","article-title":"Diabetes in China part 1: epidemiology and risk factors","volume":"9","author":"Xu","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1038\/s42255-024-01190-w","article-title":"Diabetes in China: epidemiology, pathophysiology and multi-omics","volume":"7","author":"Jia","year":"2025","journal-title":"Nat Metab"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3561","DOI":"10.3390\/ijerph16193561","article-title":"Quality of life and associated factors among primary care Asian patients with type 2 diabetes mellitus","volume":"16","author":"Dhillon","year":"2019","journal-title":"Int J 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