Exploring medication adherence and risk factors in elderly patients with hepatocellular carcinoma undergoing oral...

Oral targeted therapy is now integral to the management of older adults with hepatocellular carcinoma (HCC), yet suboptimal adherence persistently undermines its real-world effectiveness. Although the Health Belief Model (HBM) is widely applied to explain health behaviors, its integration with self-efficacy theory-particularly in the HCC context, where the volitional gap between belief and action frequently dictates clinical outcomes-remains inadequately characterized.

To elucidate factors associated with oral targeted therapy adherence in elderly HCC patients and to evaluate the explanatory utility of an integrated HBM-self-efficacy framework for medication-taking behavior.

In this cross-sectional study, 653 older HCC patients on oral targeted agents were recruited via convenience sampling. Data were collected using demographic questionnaires, validated HBM and self-efficacy scales, and the Morisky Medication Adherence Scale (MMAS-8). Binary logistic regression and mediation analyses were performed.

The mean MMAS-8 score was 6.08 ± 1.37, with 29.10% of patients classified as having poor adherence. Independent risk factors included moderate-to-severe adverse reactions, high concern beliefs, and living alone, whereas high necessity beliefs and high self-efficacy emerged as protective factors. Notably, self-efficacy partially mediated the relationship between medication beliefs and adherence.

The combined Health Belief Model and self-efficacy framework showed notable ability to explain inter-individual differences in medication adherence within this sample. Medication beliefs and self-efficacy correlated significantly with adherence, while self-efficacy carried a detectable partial indirect association between medication beliefs and adherence.

Adherence optimization extends beyond initial patient education. Nurses should implement periodic, structured assessments and tailored behavioral interventions-prioritizing the reinforcement of perceived necessity, mitigation of unwarranted concerns, and cultivation of self-efficacy to sustain long-term therapeutic compliance.