Family Functioning and Medication Self‐Management in Rural Older Adults With Chronic Comorbidities: The Mediating Role of Self‐Efficacy

AIMS: To examine the mediating role of self-efficacy for appropriate medication use in the relationship between family functioning and medication self-management among rural older adults with chronic comorbidities. BACKGROUND: Effective medication self-management is vital for rural older adults with chronic comorbidities. However, despite the recognized clinical importance of family functioning, self-efficacy for appropriate medication use and medication self-management, the relationships among these factors in this population remain underexplored. DESIGN: A cross-sectional design. METHODS: Between June and July 2025, 539 rural older adults with chronic comorbidities were recruited from a county-level hospital in Henan Province, China using a convenience sampling method. Standardized instruments assessed demographic characteristics, family functioning, self-efficacy for appropriate medication use and medication self-management. PROCESS Model 4 tested the mediation effect. RESULTS: The median score for medication self-management was 61.0 (54.0, 70.0), and significant positive correlations were found among all three variables. Path analysis revealed that self-efficacy for appropriate medication use partially mediated the relationship between family functioning and medication self-management, with the direct and indirect effects accounting for 52.46% and 47.54% of the total effect, respectively. CONCLUSIONS: Medication self-management requires further improvement among rural older adults with chronic comorbidities. Self-efficacy for appropriate medication use serves as a partial mediator between family functioning and medication self-management. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: These findings support family-integrated nursing interventions, including family-centred education and collaborative medication planning, to strengthen family functioning, enhance patients' self-efficacy and improve medication self-management in rural older adults. IMPACT: This study clarifies the mechanism linking family functioning to medication self-management in rural older adults, identifying self-efficacy as a mediator. This evidence supports interventions that enhance family support and patient confidence. PATIENT OR PUBLIC CONTRIBUTION: Rural older adults with chronic comorbidities participated voluntarily in this study.