Cardiac Self‐Efficacy Mediates the Relationship Between Patient Empowerment and Medication Adherence: A Path Analysis in Patients With Coronary Artery Disease ‐ Empirical Research Quantitative

AIM: To examine the mediating role of cardiac self-efficacy in the relationship between patient empowerment and medication adherence among patients with coronary artery disease (CAD) and to identify which empowerment sub-dimensions are most prominent. DESIGN: A cross-sectional correlational study. METHODS: A convenience sample of adults attending a cardiology clinic completed validated versions of the Coronary Artery Disease Empowerment Scale (CADES), Cardiac Self-Efficacy Scale and Morisky Medication Adherence Scale. Data were analysed using Spearman's correlations, ordinal logistic regression and path analysis with bootstrap mediation testing. RESULTS: Positive correlations were found among empowerment, self-efficacy and adherence. Regression analysis showed that cardiac self-efficacy predicted adherence, while empowerment did not directly predict adherence. Path analysis confirmed that self-efficacy mediates the empowerment-adherence relationship. The self-determination subscale of empowerment was the strongest predictor of self-efficacy, whereas personal competence was not significant. CONCLUSION: Patient empowerment enhances medication adherence indirectly by building cardiac self-efficacy, primarily through fostering patient autonomy rather than merely providing knowledge. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurse-led strategies should target cardiac self-efficacy. Motivational interviewing and autonomy-supportive interventions may be more effective than traditional education. IMPACT: What problem did the study address? The study addressed the gap in understanding the nurse-led interventions that translate patient empowerment into actual medication adherence behaviours. What were the main findings? Self-efficacy acts as the essential bridge between empowerment and adherence and this bridge is built most effectively through self-determination rather than personal competence. Where and on whom will the research have an impact? These results will impact clinical nurses, nurse educators and healthcare professionals involved in cardiac care by highlighting that nurse-led counselling strategies and autonomy-supportive interventions may be more effective for improving medication. REPORTING METHOD: We adhered to the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.