Medication literacy and treatment adherence in people living with human immunodeficiency virus: Mediating effects of psychosocial factors

Table 2 Key psychosocial mediating variables influencing treatment adherence in people living with human immunodeficiency virus

Mediating variable	Definition	Mediating mechanism	Key findings	Ref.
Stigma	Social stigma and self-stigmatization related to HIV	Affects access to health information and self-efficacy through external and internal stigma pathways	Stigma leads to avoidance of medication information and increased risk of dosage errors; internalized stigma is significantly associated with psychological inflexibility	[21,22]
Self-efficacy	Patients’ belief in their ability to successfully perform treatment behaviors	Promotes translation of health knowledge into treatment behaviors via the self-regulatory system in social cognitive theory	Higher self-efficacy is significantly associated with better adherence; treatment success reinforces efficacy, forming a positive feedback loop	[31,32]
Social support	Support from peers, family, and healthcare providers	Provides emotional and informational support, buffers stigma, and enhances self-efficacy	Peer support is strongly linked to long-term retention, adherence, and viral suppression; family support buffers the negative impact of low medication literacy on adherence	[52,53]
Depression/anxiety	Mental health problems associated with HIV	Alters cognitive processing through functional decoupling of the prefrontal–limbic system	Depression reduces glucose metabolism in the prefrontal cortex, impairing working memory and executive function; anxiety heightens amygdala–insula reactivity, leading to cognitive overload	[58-61]
Patient–provider trust	Degree of trust patients have in healthcare providers	Enhances the therapeutic alliance and reduces suspicion and fear of the medical system	Lower levels of trust are linked to poorer adherence and outcomes; especially relevant among minority populations	[89]

HIV: Human immunodeficiency virus.