Background: Long-term immunosuppressive medication adherence is critical for survival after liver transplantation, yet poor adherence among adolescents remains a significant clinical challenge. Prior studies have primarily examined isolated factors, with limited integrative analyses grounded in theoretical frameworks. This study integrates the Health Belief Model (HBM) and Social Cognitive Theory (SCT) to explore the mechanism by which perceived knowledge of immunosuppressive medications influences adherence in adolescent liver transplant recipients, testing the parallel mediating roles of medication necessity beliefs and chronic disease self-efficacy.
Methods: A cross-sectional study enrolled 612 Chinese adolescent liver transplant recipients (M age = 13.0, SD = 4.7; 307 males, 305 females; mean post-transplant duration = 7.5 years). Adherence was assessed using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS). Predictors included the Specific-Necessity subscale of the Beliefs about Medication Questionnaire (BMQ), the Chronic Disease Self-Efficacy Scale (CDSES), and the Patient-perceived Medication Knowledge in Medication Use Scale. Parallel mediation was analyzed via structural equation modeling (SEM), with bootstrap testing for indirect effects.
Results: The total effect of perceived medication knowledge on adherence was significant (β = 0.08, p < 0.05). Parallel mediation analysis revealed full mediation through both necessity beliefs (β = 0.08, 95% CI [0.03, 0.14]) and self-efficacy (β = 0.17, 95% CI [0.06, 0.29]), accounting for 100% of the effect. The direct effect was nonsignificant (β = 0.04, p = 0.24), confirming complete mediation. Model fit was excellent (CFI = 0.98, RMSEA = 0.00).
Conclusion: Key psychological mechanisms driving adherence in adolescent liver transplant recipients were identified: perceived medication knowledge enhances adherence by strengthening necessity beliefs and self-management efficacy. Clinically, interventions should integrate medication education, necessity belief reinforcement, and self-efficacy building to improve long-term outcomes. Future longitudinal and intervention studies are warranted to validate causal pathways and refine theoretical applications.