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

Table 3 Mechanisms through which self-efficacy mediates the relationship between medication literacy and treatment adherence

Pathway of action	Neural mechanism	Psychological and behavioral manifestations	Influencing factors	Ref.
Medication literacy → self-efficacy → adherence	Functional coupling between the prefrontal cortex and striatum enhances executive control network efficiency	Patients accurately interpret medication instructions and anticipate side effects, strengthening their sense of agency in disease management	Culturally adapted health education integrates traditional medical beliefs with modern biomedical knowledge, enhancing confidence in medication use	[33-35]
Treatment success → reinforced self-efficacy → literacy improvement	Activation of D2 receptors in the striatum enhances neural markers of positive behavioral reinforcement	Patients consistently achieve micro-level treatment goals, forming a feedback loop of "successful experience → efficacy gain → knowledge deepening"	Peer support networks reshape patients’ self-narratives in virtual spaces; trust in healthcare providers modulates dopaminergic projections from the ventral tegmental area to the prefrontal cortex	[43-47]
Psychodynamic system of behavioral reinforcement	Positive feedback in the dopaminergic reward system drives the acquisition and maintenance of treatment-adherent behavior	High-efficacy patients exhibit a 40% increase in behavioral reinforcement learning rate, especially in managing side effects	Urban living environments offer real-time medical feedback channels; economic empowerment frees cognitive resources for health management	[59,72]
Dynamic evolution of self-efficacy	Stage-based construction of efficacy across theoretical models	In the initiation phase, trust in healthcare providers plays a central role; in the maintenance phase, the influence of peer support networks increases	Digital interventions using virtual reality simulate medication-taking scenarios, overcoming spatial and temporal limitations of traditional interventions	[61]