{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T13:13:51Z","timestamp":1788527631832,"version":"build-2803163510"},"reference-count":53,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behav. Sci.","Behavioral Sciences"],"abstract":"<jats:p>Adolescence is a critical developmental period in which epilepsy can affect both health behaviors and psychological well-being. However, clinical indicators alone do not fully capture adolescents\u2019 lived experience. Grounded in Self-Determination Theory, this study examined the cross-sectional associations among autonomy-supportive healthcare (ASH) environments, medication adherence, and life satisfaction in adolescents with epilepsy. A cross-sectional design was used with 1219 Italian adolescents with epilepsy (M age = 15.58, SD = 1.72), recruited through pediatric neurology clinics and national patient support organizations. Participants completed validated self-report measures: the Health Care Climate Questionnaire (HCCQ) for ASH, the Medication Adherence Report Scale (MARS) for medication adherence, and the Satisfaction With Life Scale (SWLS) for life satisfaction. A mediation model was tested to evaluate the indirectly associated paths among the variables. The mediation model showed a good fit to the data (\u03c72\/df = 2.45, CFI = 0.994, RMSEA = 0.034, SRMR = 0.029). ASH was positively associated with both medication adherence (\u03b2 = 0.40, p &lt; 0.001) and life satisfaction (\u03b2 = 0.23, p &lt; 0.001), while medication adherence was positively associated with life satisfaction (\u03b2 = 0.35, p &lt; 0.001). The indirect statistical path from ASH to life satisfaction through medication adherence was also significant (\u03b2 = 0.08, p &lt; 0.001), indicating partial mediation. Overall, these findings highlight positive cross-sectional links between ASH environments, medication adherence, and psychological well-being in adolescents with epilepsy, underscoring the potential relevance of relational aspects of care in chronic disease management.<\/jats:p>","DOI":"10.3390\/bs16091569","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T12:20:46Z","timestamp":1788524446000},"page":"1569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Autonomy-Supportive Healthcare, Medication Adherence, and Life Satisfaction in Adolescents with Epilepsy: A Cross-Sectional Association"],"prefix":"10.3390","volume":"16","author":[{"given":"Valeria","family":"Verrastro","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5659-1036","authenticated-orcid":false,"given":"Valeria","family":"Saladino","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0038-6895","authenticated-orcid":false,"given":"Andrea","family":"Sgroi","sequence":"additional","affiliation":[{"name":"Department of Humanistic Research and Innovation, University of Bari Aldo Moro, 70121 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9447-2433","authenticated-orcid":false,"given":"Danilo","family":"Calaresi","sequence":"additional","affiliation":[{"name":"Faculty of Communication, Culture and Society, University of Italian Switzerland, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/nuf.12207","article-title":"Healthcare quality: A concept analysis","volume":"52","author":"Robinson","year":"2017","journal-title":"Nursing Forum"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1007\/s12187-021-09846-9","article-title":"The evolution of life satisfaction throughout childhood and adolescence: Differences in young people\u2019s evaluations according to age and gender","volume":"14","author":"Aymerich","year":"2021","journal-title":"Child Indicators Research"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Barello, S., Palamenghi, L., and Graffigna, G. (2020). The mediating role of the patient health engagement model on the relationship between patient perceived autonomy supportive healthcare climate and health literacy skills. International Journal of Environmental Research and Public Health, 17, (5).","DOI":"10.3390\/ijerph17051741"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1111\/jora.12678","article-title":"Dynamics of identity development in adolescence: A decade in review","volume":"31","author":"Branje","year":"2021","journal-title":"Journal of Research on Adolescence"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s10389-021-01632-9","article-title":"The relationship between life satisfaction, personal health, quality of life, and medication adherence among adolescents living with HIV in southwestern Uganda","volume":"31","author":"Byansi","year":"2023","journal-title":"Journal of Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1177\/0044118X241273407","article-title":"The relationship between trait emotional intelligence and problematic social media use","volume":"57","author":"Calaresi","year":"2024","journal-title":"Youth & Society"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1111\/bjc.12549","article-title":"Understanding adolescent suicide risk through alexithymia and hikikomori behaviours: A three-wave study","volume":"64","author":"Calaresi","year":"2025","journal-title":"British Journal of Clinical Psychology"},{"key":"ref_8","first-page":"e130650","article-title":"Medication adherence and perception of satisfaction in the healthcare of children with mental disorders","volume":"20","author":"Castro","year":"2023","journal-title":"Modern Care Journal"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"14129","DOI":"10.1038\/s41598-022-18596-9","article-title":"The association between healthcare needs, socioeconomic status, and life satisfaction from a Chinese rural population cohort, 2012\u20132018","volume":"12","author":"Chen","year":"2022","journal-title":"Scientific Reports"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Chen, C., Zhang, T., Gu, X., Lee, J., Ren, S., and Wang, H. (2019). Understanding adolescents\u2019 need support, need satisfaction, and health-related outcomes: A self-determination health behavior perspective. International Journal of Environmental Research and Public Health, 17, (1).","DOI":"10.3390\/ijerph17010104"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1097\/IJG.0000000000002228","article-title":"Patient-centered outcomes after a medication adherence intervention: A pilot study","volume":"32","author":"Cho","year":"2023","journal-title":"Journal of Glaucoma"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1111\/ijcp.12632","article-title":"Healthcare provider targeted interventions to improve medication adherence: Systematic review and meta-analysis","volume":"69","author":"Conn","year":"2015","journal-title":"International Journal of Clinical Practice"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1002\/jad.12037","article-title":"Cross-national and longitudinal evidence for a rapid decline in life satisfaction in adolescence","volume":"94","author":"Daly","year":"2022","journal-title":"Journal of Adolescence"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1207\/s15327752jpa4901_13","article-title":"The satisfaction with life scale","volume":"49","author":"Diener","year":"1985","journal-title":"Journal of Personality Assessment"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1177\/0734282915621223","article-title":"Measuring adolescent life satisfaction: Psychometric properties of the satisfaction with life scale in a sample of Italian adolescents and young adults","volume":"34","author":"Gori","year":"2016","journal-title":"Journal of Psychoeducational Assessment"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e200403","DOI":"10.1212\/CPJ.0000000000200403","article-title":"Barriers to medication adherence in people living with epilepsy","volume":"15","author":"Donahue","year":"2025","journal-title":"Neurology Clinical Practice"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1080\/21642850.2020.1794879","article-title":"\u2018It is like learning how to live all over again\u2019 A systematic review of people\u2019s experiences of living with a chronic illness from a self-determination theory perspective","volume":"8","author":"Eassey","year":"2020","journal-title":"Health Psychology and Behavioral Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Giordano, F., Calaresi, D., Saladino, V., and Verrastro, V. (2025). Perception of loneliness in adolescence: Role of maladaptive personality traits and trauma-related symptomatology. Brain Sciences, 15, (1).","DOI":"10.3390\/brainsci15010086"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.amepre.2018.04.004","article-title":"The relationship between life satisfaction and healthcare utilization: A longitudinal study","volume":"55","author":"Goel","year":"2018","journal-title":"American Journal of Preventive Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"108153","DOI":"10.1016\/j.diabres.2020.108153","article-title":"Communication matters: The role of autonomy-supportive communication by health care providers and parents in adolescents with type 1 diabetes","volume":"163","author":"Goethals","year":"2020","journal-title":"Diabetes Research and Clinical Practice"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Graffigna, G., Barello, S., and Bonanomi, A. (2017). The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model. PLoS ONE, 12, (6).","DOI":"10.1371\/journal.pone.0179865"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1002\/dev.22009","article-title":"Culture and stress biology in immigrant youth from the prenatal period to adolescence: A systematic review","volume":"63","author":"Haft","year":"2021","journal-title":"Developmental Psychobiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ejpn.2024.11.009","article-title":"Exploring the psychosocial and educational needs of young people with epilepsy and their parents: A systematic review","volume":"54","author":"Hyland","year":"2025","journal-title":"European Journal of Paediatric Neurology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"100496","DOI":"10.1016\/j.rcsop.2024.100496","article-title":"Exploring the impact of subjective well-being on medication adherence: A cross-sectional study among individuals with multiple chronic diseases","volume":"15","author":"Ismail","year":"2024","journal-title":"Exploratory Research in Clinical and Social Pharmacy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1016\/j.pec.2018.06.006","article-title":"What adolescents living with long-term conditions say about being involved in decision-making about their healthcare: A systematic review and narrative synthesis of preferences and experiences","volume":"101","author":"Jordan","year":"2018","journal-title":"Patient Education and Counseling"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kang, W. (2023). People with epilepsy have poor life satisfaction and self-rated health: Findings from the United Kingdom. Frontiers in Psychology, 13.","DOI":"10.3389\/fpsyg.2022.986520"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1038\/s41582-021-00464-1","article-title":"Cycles in epilepsy","volume":"17","author":"Karoly","year":"2021","journal-title":"Nature Reviews Neurology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1027\/2512-8442\/a000054","article-title":"Autonomy support, life satisfaction, and quality of life of cancer patients: Psychometric properties of the Turkish version of the health care climate questionnaire","volume":"27","author":"Kaya","year":"2020","journal-title":"European Journal of Health Psychology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1177\/0049124114543236","article-title":"The performance of RMSEA in models with small degrees of freedom","volume":"44","author":"Kenny","year":"2015","journal-title":"Sociological Methods & Research"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.rmed.2019.02.009","article-title":"Effect of a mHealth intervention on adherence in adolescents with asthma: A randomized controlled trial","volume":"149","author":"Kosse","year":"2019","journal-title":"Respiratory Medicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"431","DOI":"10.3109\/02770903.2014.979366","article-title":"Adolescents\u2019 inhaled corticosteroid adherence: The importance of treatment perceptions and medication knowledge","volume":"52","author":"Koster","year":"2015","journal-title":"Journal of Asthma"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4760624","DOI":"10.1155\/2020\/4760624","article-title":"The association between diabetes-related distress and medication adherence in adult patients with type 2 diabetes mellitus: A cross-sectional study","volume":"2020","author":"Kretchy","year":"2020","journal-title":"Journal of Diabetes Research"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kvarnstr\u00f6m, K., Westerholm, A., Airaksinen, M., and Liira, H. (2021). Factors contributing to medication adherence in patients with a chronic condition: A scoping review of qualitative research. Pharmaceutics, 13, (7).","DOI":"10.3390\/pharmaceutics13071100"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3055","DOI":"10.1038\/s41380-025-02912-6","article-title":"Cognitive predictors of mental health trajectories are mediated by inferior frontal and occipital development during adolescence","volume":"30","author":"Li","year":"2025","journal-title":"Molecular Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Liquori, G., De Leo, A., Di Simone, E., Dionisi, S., Giannetta, N., Ganci, E., Trainito, S. P., Orsi, G. B., Di Muzio, M., and Napoli, C. (2022). Medication adherence in chronic older patients: An Italian observational study using Medication Adherence Report Scale (MARS-5I). International Journal of Environmental Research and Public Health, 19, (9).","DOI":"10.3390\/ijerph19095190"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1093\/abm\/kaaa037","article-title":"Motivation for physical activity among U.S. adolescents: A self-determination theory perspective","volume":"55","author":"Nogg","year":"2021","journal-title":"Annals of Behavioral Medicine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.seizure.2025.08.025","article-title":"Transition from paediatric healthcare to adult healthcare for young people with epilepsy in the UK: A scoping review","volume":"132","author":"Paternoster","year":"2025","journal-title":"Seizure: European Journal of Epilepsy"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.pec.2014.06.016","article-title":"Mastery and perceived autonomy support are correlates of Dutch diabetes patients\u2019 self-management and quality of life","volume":"97","author":"Raaijmakers","year":"2014","journal-title":"Patient Education and Counseling"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1002\/epi4.70225","article-title":"Stigma, attitude, and knowledge of epilepsy in Italy: A survey on 1159 subjects","volume":"11","author":"Romozzi","year":"2026","journal-title":"Epilepsia Open"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Maggino, F. (2023). Self-determination theory. Encyclopedia of quality of life and well-being research, Springer International Publishing.","DOI":"10.1007\/978-3-031-17299-1"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Saedi, F., Dehghan, M., Mohammadrafie, N., Xu, X., Hermis, A. H., and Zakeri, M. A. (2024). Predictive role of spiritual health, resilience, and mental well-being in treatment adherence among hemodialysis patients. BMC Nephrology, 25, (1).","DOI":"10.1186\/s12882-024-03768-8"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Saladino, V., Calaresi, D., Cuzzocrea, F., and Verrastro, V. (2024). The interplay between binge watching and suicide risk: Daytime sleepiness and maladaptive daydreaming as mediators. Social Sciences, 13, (6).","DOI":"10.3390\/socsci13060283"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1080\/1068316X.2024.2303496","article-title":"Aggressive behavior among Italian justice-involved juveniles: The impact of attachment, discipline, and moral disengagement","volume":"31","author":"Saladino","year":"2025","journal-title":"Psychology, Crime & Law"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.copsyc.2021.09.023","article-title":"Adolescence as a pivotal period for emotion regulation development","volume":"44","author":"Silvers","year":"2022","journal-title":"Current Opinion in Psychology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/pchj.293","article-title":"A systematic review and meta-analysis on basic psychological need satisfaction, motivation, and well-being in later life: Contributions of self-determination theory","volume":"9","author":"Tang","year":"2020","journal-title":"PsyCh Journal"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1177\/1060028014522982","article-title":"Accuracy of the Medication Adherence Report Scale (MARS-5) as a quantitative measure of adherence to inhalation medication in patients with COPD","volume":"48","author":"Tommelein","year":"2014","journal-title":"Annals of Pharmacotherapy"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1177\/0972063418822583","article-title":"A review of healthcare service quality dimensions and their measurement","volume":"21","author":"Upadhyai","year":"2019","journal-title":"Journal of Health Management"},{"key":"ref_48","first-page":"3","article-title":"Natural language processing and String Metric-assisted Assessment of Semantic Heterogeneity method for capturing and standardizing unstructured nursing activities in a hospital setting: A retrospective study","volume":"35","author":"Vanalli","year":"2023","journal-title":"Annali Di Igiene: Medicina Preventiva E Di Comunita"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.3390\/ejihpe14100173","article-title":"Vulnerable narcissism and emotion dysregulation as mediators in the link between childhood emotional abuse and binge watching","volume":"14","author":"Verrastro","year":"2024","journal-title":"European Journal of Investigation in Health, Psychology and Education"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"152569","DOI":"10.1016\/j.comppsych.2024.152569","article-title":"Longitudinal pathways from emotional abuse to problematic gaming in adolescents: The role of psychoticism","volume":"137","author":"Verrastro","year":"2025","journal-title":"Comprehensive Psychiatry"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1002\/epd2.70239","article-title":"Transition from adolescence to adulthood: Dedicated health services for young people with epilepsy in Italy","volume":"28","author":"Venezia","year":"2026","journal-title":"Epileptic Disorders"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Williams, G. C., Grow, V. M., Freedman, Z. R., Ryan, R. M., and Deci, E. L. (1996). Health Care Climate Questionnaire (HCCQ) [Database record], APA PsycTests.","DOI":"10.1037\/t68628-000"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"108680","DOI":"10.1016\/j.yebeh.2022.108680","article-title":"Age and sex differences in social support among children and adolescents with epilepsy","volume":"130","author":"Yang","year":"2022","journal-title":"Epilepsy & Behavior"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/9\/1569\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T12:22:56Z","timestamp":1788524576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/9\/1569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":53,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["bs16091569"],"URL":"https:\/\/doi.org\/10.3390\/bs16091569","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]}}}