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

Table 5 Research limitations and future directions

Limitation	Specific issues	Future research directions	Suggestions for innovative methods	Ref.
Lack of longitudinal data	Existing studies predominantly adopt cross-sectional designs, limiting the ability to capture dynamic relationships between psychosocial factors and treatment adherence	Establish longitudinal cohorts integrating biomarkers with behavioral monitoring	Use mobile health technologies for real-time data collection; adopt mixed-method approaches to capture dynamic fluctuations of mediating variables	[100,101]
Methodological constraints in quantifying mediation effects	The complexity of multiple mediation models challenges traditional statistical methods; failure to account for intergroup heterogeneity may bias effect estimates	Develop hybrid models integrating computational psychiatry and structural equation modeling	Use bias-corrected bootstrap methods to relax normality assumptions in mediation testing; apply Bayesian approaches to improve the accuracy of multilevel mediation models	[102-106]
Blind spots in evaluating long-term effects of digital interventions	Current digital health studies mainly focus on short-term adherence improvements, lacking exploration of behavior maintenance mechanisms	Construct a "digital intervention life-cycle" evaluation framework	Leverage blockchain technology for decentralized data tracking; include neuroplasticity markers as biomarkers of long-term intervention efficacy	[107-108]
Insufficient comparative research on cross-cultural interventions	Lack of systematic comparisons of intervention effectiveness across different cultural contexts	Develop a three-dimensional evaluation framework for cross-cultural intervention outcomes	Compare prefrontal–limbic system responses to intervention stimuli across cultural groups; analyze the impact of geographic patterns of community-level stigma on delivery efficiency; evaluate the transferability of cultural archetypes in virtual health communities	—