| Nonadherence to medical recommendations is a leading preventable cause of rehospitalization and premature mortality in chronic heart failure (HF) patients. This study examined the contribution of functional and structural social support to general and specific adherence, and whether self-efficacy and gender mediated and moderated these relationships, respectively. Participants consisted of 252 HF patients (31% women) with a mean age of 54 years. All analyses controlled for age, gender, marital status, education, ethnicity, New York Heart Association (NYHA) class, and comorbidity. Structural support was significantly associated with both general (beta=.156, p<.05) and specific adherence (beta=.165, p<.05). Similarly, functional support was significantly associated with both general (beta=.275, p<.001) and specific (beta=.274, p<.001) adherence. The tangible, emotional/informational, affectionate, and positive social interaction subtypes of functional support were highly intercorrelated (Pearson's r=.77 - .88, ps <.001) and not differentially associated with adherence. Self-efficacy significantly mediated the effects of structural support on general (Sobel Z = 2.71, p=.007) and specific adherence (Sobel Z = 3.09, p=.002), as well as the effects of functional support on general (Sobel Z = 3.13, p=.002) and specific adherence (Sobel Z = 4.18, p=.000). Gender did not appear to moderate any of these relationships (ps>.05). These results suggest that both the quality and quantity of social support are important predictors of both global and domain-specific adherence, and that this positive influence occurs indirectly via self-efficacy. Implications and future directions for HF interventions are discussed. |
