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Self-Efficacy Mediates the Associations of Social Support and Depression with Treatment Adherence in Heart Failure Patients



Nonadherence to treatment recommendations is a leading preventable cause of rehospitalization and premature mortality in chronic heart failure (HF) patients.


This study examined whether self-efficacy mediates the contributions of social support and depression to treatment adherence.


A sample of 252 HF outpatients with a mean age of 54 years completed self-report questionnaires assessing depression, perceived social support, self-efficacy, and treatment adherence.


Self-efficacy mediated the associations of social support and depression with treatment adherence after adjusting for demographic (age, gender, marital status, education, and ethnicity) and medical (New York Heart Association Classification and comorbidity) covariates.


Self-efficacy explains the influence of social support and depression on treatment adherence and may be a key target for interventions to improve disease management and self-care behaviors in HF patients.

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This research was supported by a grant from the American Heart Association.

Author information

Correspondence to Biing-Jiun Shen.

Appendix 1: Heart Failure Self-Efficacy Scale

Appendix 1: Heart Failure Self-Efficacy Scale


Below is a list of things your doctor, a nurse, or other health care professional may have recommended that you do as a part of your treatment. If these things do not apply to you, circle N/A. Please indicate how confident you were that you know or can do these things in the past 2 weeks. Circle one number on each line.

NA = Does not apply

1 = Not at all

2 = A little

3 = Somewhat

4 = A good bit of the time

5 = Most of the time

6 = All of the time

How confident I was in my ability to:
1. Take my medication
2. Stop or cut down on smoking
3. Cut down on alcohol I drink
4. Do appropriate exercise regularly (not too much and not too little)
5. Cut down water or other fluids (e.g., soft drink) that I drink
6. Follow a low salt diet (avoid food with a lot of salt, e.g., bacon, canned soup, crackers, etc.)
7. Follow a low fat or weight loss or healthy diet
8. Maintain a healthy weight
9. Cut down the stress in my life
10. Maintain my usual social activities
11. Maintain my usual activities at home with my family
12. Maintain my usual activities at work
13. Control my chest discomfort
14. Control my shortness of breath
15. When I should call or visit my doctor about my heart disease
16. Make my doctor understand my concerns about my heart
17. Use relaxation techniques to relax (breathing, biofeedback, yoga, etc.)

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Maeda, U., Shen, B., Schwarz, E.R. et al. Self-Efficacy Mediates the Associations of Social Support and Depression with Treatment Adherence in Heart Failure Patients. Int.J. Behav. Med. 20, 88–96 (2013). https://doi.org/10.1007/s12529-011-9215-0

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  • Heart failure
  • Social support
  • Depression
  • Self-efficacy
  • Adherence