Abstract
Social support is necessary for patients with heart failure (HF) to take medication, which can lead to decreased hospitalization and mortality rates. However, the effect of patient health literacy on this relationship remains unclear. This study aimed to evaluate the mediating effect of health literacy on the relationship between social support and medication adherence among patients with HF. A cross-sectional correlational design was used between August and October 2024 for 249 patients with HF. Data were collected using patients’ sociodemographic and health status, the Arabic version of the General Medication Adherence Scale (GMAS), BRIEF Health Literacy Screening Tool, and Oslo Social Support Scale (OSSS-3). Hayes’ Process Macro program, version 4.2, Model 4, was used to assess the possible interaction effects. Statistical significance was set at p less than .05. There was a weak positive correlation between patients’ medication adherence and health literacy (r = .247, p < .001) and social support (r = .204, p < .001). In addition, there was a significant correlation between HL status and social support (r = .314, p < .001). Factors that increased medication adherence included older age (B = 0.06, p = .027), not smoking (B = 2.21, p < .001), other chronic diseases (B = 1.23, p = .005), higher health literacy (B = 0.30, p = .002), and social support (B = 0.33, p = .044). The model indicated an indirect positive effect of social support on medication adherence through health literacy (β = 0.064, p = .007). Social support had a positive direct effect on health literacy (β = 0.314, p < .001) and a positive effect of health literacy on medication adherence (β = 0.203, p = .002). Social support had a significant positive direct effect on medication adherence (β = 0.140, p = .031), with a total effect of β = 0.204, p = .001. Health literacy showed a statistically significant indirect association in the mediation model. This study revealed that patients with higher health literacy are better equipped to manage complex treatment regimens and engage in self-care. This effect was further amplified by social support, which both directly and indirectly enhanced adherence.
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Data availability
The data are available at request from the corresponding author.
Abbreviations
- HF:
-
Heart failure
- GMAS:
-
General Medication Adherence Scale
- OSSS-3:
-
Oslo Social Support Scale
- IMBS:
-
Information-motivation-behavioral skills model
- CI:
-
Confidence interval
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We would like to thank all patients who participated in this study
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Sameer A. Alkubati: Conceptualization, data curation, formal analysis, investigation, methodology, resources, validation, visualization, writing—original draft, writing—review, and editing. Homoud Khaled Aleyadah; Data curation, investigation, methodology. Habib Alrasashedi: Writing-original draft, writing-review, and editing. Awatif M. Alrasheeday; Writing—original draft; writing—review and editing. Abdulhafith Alharbi: Writing—original draft; writing—review and editing. Bandar Alsaif, Writing—original draft; Writing—review and editing, Joseph U Almazan; Writing—original draft, writing—review, and editing. Aziza Z. Ali; Writing—original draft, writing—review and editing, Bushra Alshammari; Conceptualization, data curation, and investigation.
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The Research Ethics Committee of Ha’ il’s Cluster of Health (2024/13) and the Research Ethics Committee of the University of Ha’il (H/2024/085). This study was conducted in accordance with the principles of the Declaration of Helsinki. Before starting the survey, all participants were requested to read the description on the first page of the online survey link. The purpose and extent of the study, their consent to participate, confidentiality, anonymity, the option to withdraw from research engagement, and the fact that no personal identifying information was collected were covered in this explanation. The purpose of the study was explained to the participants, who were assured that any data collected would only be used for research.
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Alkubati, S.A., Aleyadah, H.K., Alrashedi, H. et al. The impact of social support on medication adherence among patients with heart failure: health literacy as a mediator. Sci Rep (2026). https://doi.org/10.1038/s41598-026-40360-6
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DOI: https://doi.org/10.1038/s41598-026-40360-6
