Clarifying the Causal Effect of Coping Strategies on Treatment Adherence in Coronary Heart Patients: The Mediating Role of Psychological Distress and Self-Efficacy

Abstract

Background: In this research, the researcher aims to model the adherence of patients with coronary heart disease (CHD) based on coping strategies and disease perception with the mediation of self-efficacy and psychological distress. Methods: This cross-sectional study was conducted on patients with CHD. The statistical population included patients with CHD in Isfahan Province, Iran, with the sample consisting of patients referred to Shahid Chamran Hospital in Isfahan City which were selected using purposeful sampling method. Data collection was done through the Adherence in Chronic Diseases Scale (ACDS), the Billings and Moss Coping Strategies Questionnaire, the Lovibond and Lovibond Psychological Distress Questionnaire, and the Cardiovascular Management Self-Efficacy Questionnaire developed by Steca et al. Comparative tests, correlation analysis methods, and structural equation modeling (SEM) were used to investigate the relationships between different factors. Findings: Coping strategies affected the adherence to treatment of patients with CHD, both directly and through the mediation of self-efficacy and psychological distress. The SEM method was used to test the mentioned model. The results of the analysis indicated that all the fit indices obtained from the analysis supported the fit of SEM with the compiled data [χ2 (degree of freedom or df = 94) = 157.54, χ2/df = 168, comparative fit index (CFI) = 0.959, goodness of fit index (GFI) = 0.915, adjusted GFI (AGFI) = 0.877, and root mean square error of approximation (RMSEA) = 0.056]. Conclusion: It can be concluded that coping strategies have a causal effect on adherence to treatment in patients with CHD with the mediating role of psychological distress and self-efficacy. The model has a good fit. © 2024, Isfahan University of Medical Sciences(IUMS). All rights reserved.