Understanding Medication Adherence in Patients With Primary Osteoporosis in China: A Qualitative Study Guided by the Integrated Theory of Health Behavior Change.

Introduction

Primary osteoporosis (PO) is a systemic skeletal disease characterized by diminished bone mass, microarchitectural deterioration of bone tissue and a consequent increase in bone fragility and susceptibility to fracture (Nutrition and Bone Health Committee et al. 2020 ). As the global population ages, the prevalence of PO continues to rise, positioning it as a significant public health challenge, particularly for middle‐aged and older adults (Morin et al. 2025 ). In China, a 2018 epidemiological survey revealed that the prevalence of PO was 3.2% among individuals aged 40–49, rising sharply to 19.2% in those aged 50 and above. These epidemiological data indicate a steep increase in prevalence with age, highlighting the scale of the issue within an aging society (Wang et al. 2021 ). The impact of PO extends beyond individual suffering from fractures; it imposes a substantial economic burden on healthcare systems and society at large. A 2022 report in The Lancet indicated that approximately 2.33 million fragility fractures in China were attributable to PO, with associated annual medical expenditures reaching 174.5 billion RMB (Chen et al. 2022 ). This context underscores PO as a critical and costly chronic condition demanding effective long‐term management strategies.

Pharmacological therapy is fundamental to managing PO, aimed at slowing bone loss, reducing fracture risk and preserving patients' quality of life (Yu et al. 2024 ). However, achieving optimal therapeutic outcomes is consistently undermined by the widespread problem of suboptimal medication adherence. Studies report alarmingly high discontinuation rates among patients receiving osteoporosis medications, often exceeding 50% within the first year (Modi et al. 2017 ; Yeam et al. 2018 ). This nonadherence is multifactorial, influenced by treatment‐related concerns (e.g., cost, side effects and complex regimens), patient‐related factors (e.g., knowledge, beliefs and routines) and systemic issues (e.g., follow‐up support) (Yuanhua 2021 ). The consequences are severe: poor adherence is strongly linked to worse clinical outcomes, including attenuated gains in bone mineral density, higher fracture rates and increased mortality (Koller et al. 2020 ; Bjørnerem et al. 2025 ). Furthermore, it leads to increased healthcare utilization and costs (Yu et al. 2023 ). Therefore, improving and sustaining medication adherence is a paramount nursing and public health objective for enhancing PO management.

Understanding the determinants of adherence behaviour is a crucial first step. Existing research identifies a complex interplay of factors spanning intrapersonal, interpersonal, and systemic levels (Yuanhua 2021 ; Yeam et al. 2018 ). A deeper, nuanced exploration of these factors from the patient's perspective is essential. Qualitative inquiry is particularly valuable in uncovering the lived experiences, beliefs and decision‐making processes of individuals managing PO with home‐based medication. To systematically organize and understand these influences, a theoretical framework is indispensable. The Integrated Theory of Health Behavior Change (ITHBC) provides a comprehensive lens, focusing on how patient‐centered factors like knowledge, self‐efficacy and social support interact to influence self‐management behaviours over time. This study, therefore, employs a qualitative research design guided by the ITHBC to explore the facilitators and barriers to medication adherence among patients with Primary Osteoporosis in a home setting, aiming to inform the development of targeted, theory‐driven nursing interventions.

Background

Extensive research has identified multiple factors influencing medication adherence across patient, family and healthcare‐system levels. However, the development of effective interventions is constrained by two predominant limitations in the existing literature. Firstly, while quantitative studies have established valuable statistical associations, they often fail to elucidate the subjective psychological and experiential pathways—such as profound fears of medication side effects or fragmented understanding of one's illness—that underlie these trends (Mays and Pope 2000 ). Understanding these lived experiences is crucial for nursing practice, which emphasizes holistic patient care. Secondly, particularly within China's family‐oriented cultural context, there is an absence of a cohesive theoretical framework that explains how intrinsic patient factors (e.g., health beliefs, knowledge and self‐regulation capabilities) interact dynamically with extrinsic family support systems to either enable or impede sustained adherence behaviour (Zhao et al. 2025 ). This conceptual gap has resulted in interventions that are frequently siloed, focusing either on unidirectional patient education to improve knowledge or on simplistic external reminders—a limited form of social support (Haynes et al. 2008 ). Such approaches often neglect to intentionally foster patients' self‐regulatory skills or to strategically engage the family ecosystem to reinforce these internal processes, thereby limiting the precision and sustained impact of nursing‐led interventions.

To address these gaps, this study employs the Integrated Theory of Health Behavior Change (ITHBC) as its theoretical framework (Ryan 2009 ). This patient‐centered model is well‐suited for nursing research, as it posits that health behaviour change emerges from the dynamic interaction of three core constructs: ‘knowledge and beliefs,’ ‘self‐regulation skills and abilities’ and ‘social facilitation’ (Jiang et al. 2025 ). It offers a valuable lens for exploring the under‐examined interplay between patients' internal cognitive‐affective processes and the external facilitation provided within the Chinese family unit.

A qualitative research design is essential to achieve these aims. This methodology is uniquely positioned to explore the ‘why’ behind adherence challenges, to give voice to the subjective experiences behind quantitative data (e.g., how patients perceive familial support or economic barriers), and to map the complex interactive mechanisms proposed by the ITHBC in real‐world contexts (Britten 1994 ). By generating rich, contextual insights, this study seeks to bridge the explanatory gap between isolated ‘influencing factors’ and observed ‘behavioural outcomes.’ The ultimate objective is to inform the development of integrated, culturally sensitive nursing interventions that concurrently strengthen patients' self‐management capabilities and leverage family support to promote sustained medication adherence in chronic illness care (Widayanti et al. 2020 ).

In summary, grounded in the ITHBC, this qualitative study aims to conduct an in‐depth exploration of medication adherence among patients with PO in China. It seeks to uncover patients' specific needs, their behavioural patterns in medication management, and the interaction mechanisms between patients, families and the healthcare system. This research intends to provide a theoretical foundation for developing tailored, family‐engaged interventions and to offer practical insights for nurses to improve adherence support in chronic disease management.

Aim

This study aimed to conduct an in‐depth qualitative analysis of medication adherence among Chinese patients with PO, providing a theoretical basis for culturally tailored interventions and practical insights to improve adherence.

Methods

Design

This qualitative study employed Giorgi's phenomenological approach. Semi‐structured interviews were used for data collection, and the study was reported following the COREQ checklist (Tong et al. 2007 ).

Sampling and Recruitment

This study was conducted at a national medical center in China from November 2023 to June 2024. A purposive sampling strategy ensured diversity across gender, age, residence, education, marital status, treatment type and disease course. Potential participants were identified from the hospital's outpatient PO registries and initially contacted by telephone. During this contact, the researcher explained the study aims, procedures and confidentiality, and conducted a preliminary screening using predefined inclusion/exclusion criteria. Interested candidates meeting the criteria were scheduled for a formal eligibility assessment (in‐person or by phone). Final enrollment occurred after written informed consent was obtained. Sample size was guided by data saturation, defined as the point when no new themes emerged. Saturation was achieved after 16 interviews.

Inclusion and Exclusion Criteria

Inclusion Criteria

Participants were included if they: (i) had a confirmed diagnosis of primary osteoporosis (PO) via Dual‐energy X‐ray Absorptiometry (DXA), defined as a T‐score ≤ −2.5 at the lumbar spine, hip or distal third of the radius (Nutrition and Bone Health Committee et al. 2020 ); (ii) were able to clearly articulate their experiences and thoughts; and (iii) provided written informed consent.

Exclusion Criteria

Participants were excluded if they had: (i) secondary osteoporosis or comorbidities known to affect bone metabolism (e.g., rheumatoid arthritis and endocrine disorders); (ii) immunological diseases (e.g., multiple myeloma), a history of long‐term glucocorticoid use, or were taking other medications significantly impacting bone metabolism; (iii) communication barriers impairing their ability to express themselves; or (iv) withdrawn mid‐interview, experienced two or more major interruptions during the interview, or provided predominantly perfunctory responses.

Data Collection

Individual semi‐structured interviews were conducted by two authors using an interview guide featuring open‐ended questions. The interviews commenced with a broad opening question: ‘Could you please describe your experience with your disease and its treatment?’. Follow‐up probes, such as ‘Could you elaborate on what you mean by…?’ or ‘Please tell me more about that,’ were used to clarify participant responses and explore topics in depth. The development of the interview themes was informed by a comprehensive literature review and expert panel discussions. This process led to the creation of a preliminary interview guide, structured around the three core components of the ITHBC (see Table 1 ). This guide was subsequently refined following two pilot interviews with patients diagnosed with PO.

Potential participants were contacted via telephone and text message. The text message contained a link to the study information letter and the consent form. Those who agreed to participate scheduled an interview at a mutually convenient time. While a face‐to‐face interview was initially offered to all participants, the option of a telephone interview was provided based on participant preference. Written informed consent was obtained from every participant, either electronically or on paper.

Data Analysis

Each interview lasted between 30 and 60 min and was digitally recorded. Within 24 h of completing each interview, the audio recordings were transcribed verbatim by the researcher, resulting in approximately 160 single‐spaced pages. The analysis was theoretically guided by the core constructs of the ITHBC. A directed thematic analysis approach (Braun and Clarke 2006 ) was employed to identify, organize, and offer insight into patterns of meaning (themes) across the dataset. NVivo Version 14 was used to facilitate data management. The analysis proceeded through the following steps: (i) Initial coding and theme identification: The smallest units of analysis were sentences that reflected factors influencing patients' medication adherence. The classification framework was guided by the ITHBC, ensuring that the analysis remained theoretically grounded. Open coding was conducted to generate initial codes, which were then grouped into broader categories. These categories were further refined into themes and sub‐themes, capturing the essence of the participants' experiences. (ii) Representative data extraction: To support the identified themes, representative verbatim excerpts were extracted from the original transcripts. These excerpts provide context and depth, illustrating the key insights derived from the data. (iii) Ensuring analytical validity: To ensure the validity and reliability of the analysis, two researchers independently analysed the entire dataset. They then convened to compare their findings, discuss any discrepancies and reach a consensus on the final themes and sub‐themes. This collaborative approach minimized bias and enhanced the robustness of the analysis.

Ethical Considerations

Ethical approval was granted by the Ethics Committee for Clinical Research. In accordance with the Declaration of Helsinki, all participants gave written informed consent. Data were anonymized with unique identifiers; paper records were locked, and electronic data were password‐protected.

Rigour and Trustworthiness

To minimize bias, two researchers independently analysed the dataset, then compared findings, discussed discrepancies and reached consensus on final themes. Credibility was enhanced through peer debriefing with two senior qualitative researchers and member checking with three participants. Dependability and confirmability were supported by an audit trail (transcripts, coding records, analytic memos and decision logs). Transferability was facilitated by thick descriptions of participant characteristics and study context.

Findings

Participants

Demographic characteristics of the participants ( N = 16) are presented in Table 2 . The majority were female (87.5%) and married (68.8%), with a mean age of 73 years. Educational attainment was generally low, with half (50%) having no formal education or only primary‐level schooling. Most participants resided in urban areas (68.8%), and half (50%) reported their spouse as their primary caregiver. On average, participants had been diagnosed with PO for 1.6 years, and the majority (87.5%) were prescribed a combination of oral and injectable medications.

Qualitative Findings

Guided by the ITHBC, medication adherence among patients with PO was conceptualized as a dynamic, self‐regulatory process. This process was shaped by three interconnected core components: (i) The Cognitive and Motivational Foundation: Illness Perceptions, Beliefs and Knowledge; (ii) Family Support as a Multidimensional External Scaffold; and (iii) Systemic and Environmental Barriers: Depleting Self‐Regulatory Resources. The interplay of these components informed the fourth, resultant theme: (iv) Emergent Patterns of Medication Management Behaviour. This thematic structure is illustrated in Figure 1 .

Theme 1: The Cognitive and Motivational Foundation: Illness Perceptions, Beliefs and Knowledge as Intrinsic Drivers

Consistent with the ITHBC framework, interview data indicate that patients' illness perceptions, treatment beliefs and level of knowledge serve as intrinsic drivers of medication adherence. Accurate perceptions and positive beliefs promote adherence, while knowledge facilitates the translation of cognitive understanding into practical self‐management skills, thereby sustaining adherence behaviours. The interplay of these factors is detailed in the following sub‐themes.

Sub‐Theme 1.1: Illness Perceptions and Beliefs: The Motivational Core of Adherence

Patients' foundational motivation for adherence stems from their understanding of osteoporosis and their beliefs regarding its treatment. Inaccurate beliefs—such as underestimating the necessity of treatment due to the asymptomatic nature of the condition—can undermine initial motivation. The test says I have osteoporosis, but I don't feel any symptoms. Missing some doses probably does not matter (laughs). (P3) After using [medications] for a while without seeing immediate results, I felt I was just spending money on them… I don't feel any impact. (P16) Conversely, an accurate assessment of fracture risk and recognition of the long‐term therapeutic value of treatment provide strong motivational support, reinforcing commitment to adherence. Learning about the risks of fractures changed my perspective. Now I view my weekly injection as being just as important as managing my diabetes. (P8) Since my last fracture… I have been consistent with medication and regular bone density tests. (P16)

Sub‐Theme 1.2: Medication Knowledge: Translating Cognition Into Practical Self‐Management Skills

Within the ITHBC framework, knowledge directly enables medication adherence. The data reveal a continuum of medication literacy, which correspondingly facilitates or constrains patients' ability to manage their treatment effectively. Foundational misunderstandings, such as equating short‐term biomarker improvement with a ‘complete cure,’ lead to premature therapy discontinuation, representing a critical failure in self‐regulation. After two zoledronate infusions, my T‐score improved. I thought I was fully cured. (P5) I've been getting injections for a year… I think I'm getting better, so I haven't gotten injections. (P6) Patients with higher medication literacy actively sought and applied information to optimize self‐management, translating it into precise skills such as mastering dosing schedules and implementing preventive precautions. My doctor advised me to use anti‐osteoporosis medication… to reduce fracture risk, so I've been sticking to the regimen. (P12) I learned to take calcium supplements 2 hours after breakfast for optimal absorption, while maintaining adequate hydration to prevent kidney stones. (P13)

Theme 2: Family Support as a Multidimensional External Scaffold

Aligned with the ITHBC model, family support emerged as a key external facilitator of medication adherence. Through instrumental aid, emotional encouragement, informational guidance and financial assistance, family support enhanced patients' motivation while reducing practical barriers, thereby optimizing the medication management process.

Sub‐Theme 2.1: Instrumental Support: Simplifying Management Tasks

Families provided practical tools that externalized and simplified self‐regulatory tasks, reducing cognitive load and environmental barriers. The three‐compartment smart dispenser… visualizes dosing schedules, syncs with family members' smartphones, and generates weekly adherence reports…. (P5) My husband bought me a smart reminder robot that reminds me when it's time to take my medicine. (P14)

Sub‐Theme 2.2: Emotional Support: Regulating Negative Emotions

Emotional encouragement and companionship helped patients regulate the negative affect associated with chronic disease management, strengthening treatment confidence and adherence. My husband always accompanies me to my injections. He knows I'm afraid of injections. (P10) My daughter and son‐in‐law… always accompany me to the hospital for bone density scans and injections. (P11)

Sub‐Theme 2.3: Informational Support: Constructing Actionable Plans

Families acted as co‐managers by organizing and clarifying medical information, transforming complex regimens into actionable plans and enhancing patients' self‐monitoring ability. My daughter labels each pill with the corresponding number, so I can instantly tell how many to take…. (P1) My husband carefully labels each pill in the medicine box [with sun/moon symbols for timing]. (P7) …my husband developed color‐coded labels: green (alendronate), yellow (calcium), red (vitamin D3). (P14)

Sub‐Theme 2.4: Financial Support: Alleviating Economic Barriers

By covering treatment costs, families removed a critical structural barrier, allowing patients to focus cognitive and emotional resources on adherence rather than financial concerns. My son covers all treatment costs… he insists I continue. (P4) With limited rural medical insurance coverage, my husband covers all out‐of‐pocket expenses. (P3)

Theme 3: Systemic and Environmental Barriers: Depleting Self‐Regulatory Resources

Consistent with the ITHBC model, systemic and environmental factors significantly challenge medication adherence. Inefficiencies within the healthcare system and disruptions to daily routines deplete patients' self‐regulatory capacity, hindering consistent medication management.

Sub‐Theme 3.1: Healthcare System Barriers: Eroding Foundational Support

Systemic inefficiencies directly undermine the external support crucial for effective self‐regulation. Cumbersome procedures and navigation difficulties consume excessive time and emotional energy before care can even be initiated. Coming to the hospital is overwhelming—confusing procedures and difficulty navigating. (P4) There's a huge patient backlog, long waiting times, and the examination rooms… take a long time to locate. (P16) When bureaucratic processes overshadow patient‐provider communication, patients lack the tailored information necessary for informed self‐management. I want to consult the doctor who treated me, but it's really difficult. The general staff… don't even know my condition…. (P2) I received a call… asking me many questions that weren't relevant to me. I just wanted to know what to do if I finish the medication…. (P7)

Sub‐Theme 3.2: Routine Disruptions: Challenging Habit Formation

Disruptions to daily life interfere with the habit formation that supports long‐term adherence, forcing reliance on conscious recall, which is often fallible.

Environmental changes, such as travel, remove established contextual cues (e.g., a home medicine cabinet), increasing the risk of missed doses. On my most recent business trip, I completely forgot to bring my medication. (P13) Everyday tasks can consume attentional resources, diverting focus from planned self‐care. When I take my grandson out to play… I'm in a rush to prepare lunch, and often forget to take my medicine. (P14)

Theme 4: Emergent Patterns of Medication Management Behaviour

The interaction between personal motivation, family support and external barriers resulted in three distinct patterns of medication management behaviour.

Sub‐Theme 4.1: Passive Compliance: Mechanistic Execution

Patients followed instructions mechanically, without internalized understanding, proactive planning or control over their management environment. Whether I know it or not doesn't matter. The doctor told me to take it, so I'll take it. (P1) I just follow the doctor's prescription without understanding the treatment goals. (P2)

Sub‐Theme 4.2: Active Engagement: Multidimensional Supported Self‐Management

Patients proactively developed personalized management systems, utilizing tools (e.g., calendars, reminders and journals) to plan, monitor and adapt their regimen. Whenever I experience any adverse reactions… my daughter will document them… and inform the doctor…. (P1) I've strategically attached a conspicuous red label to the bottle to remind myself to report [side effects]…. (P8) My medication dashboard includes: Google Calendar alerts… Smartphone reminders… Medication journal…. (P13)

Sub‐Theme 4.3: Experiential Learning: Adaptation Through Consequence and Reflection

Patients engaged in a cycle of experiential learning—trial, consequence and adaptation—significantly modifying their adherence based on personal or observed outcomes. After getting the injections, my recent bone density tests showed normal results. (P8) I followed [my relative's] advice… and ended up fracturing my leg… I'm definitely going to follow the doctor's advice now. (P11)

Discussion

This study utilized the ITHBC framework to qualitatively explore factors influencing medication adherence among patients with osteoporosis (PO) in China. The findings indicate that adherence is a complex outcome shaped by the dynamic interaction of individual beliefs, family support networks and systemic environmental factors (Guo and Su 2025 ). This integrated perspective addresses a key practical challenge in resource‐constrained settings: improving long‐term medication management requires simultaneously addressing internal perceptions, mobilizing culturally relevant social resources and reducing systemic barriers.

Key Findings and Implications for Nursing Practice

A primary finding was the common cognitive bias among patients, who often viewed PO as an inevitable aspect of aging rather than a manageable chronic condition. This misconception directly reduces treatment motivation and impedes the development of essential self‐management behaviours. This aligns with cognitive‐behavioural models like the Health Belief Model, which emphasize the role of perceived necessity and self‐efficacy in health behaviours (Shen et al. 2020 ; Wang et al. 2024 ). Our data further reveal that the often asymptomatic nature of PO exacerbates this bias, making the abstract long‐term risk of fracture less motivating than the immediate daily task of medication‐taking (Bonds et al. 2004 ; Lau et al. 2008 ). For nursing practice, this underscores the need for interventions that move beyond basic education. Nurses should employ structured communication strategies to make the benefits of adherence and risks of non‐adherence more tangible, thereby fostering a genuine, internalized understanding of treatment value.

Consistent with the ITHBC's focus on social context, our study identifies the family as a cornerstone of disease management in the Chinese setting. Family members act as both practical facilitators (managing logistics and providing reminders) and emotional supporters. Cultural norms of filial piety strengthen this role, creating an informal support system that can mitigate some healthcare resource limitations (Guo and Su 2025 ; Pei and Wang 2022 ). However, a critical insight from our analysis is the dual potential of family support. While instrumental, overly intensive involvement may inadvertently foster patient dependency and undermine their autonomous self‐efficacy (Hu and Jin 2023 ). Well‐intentioned reminders can be perceived as controlling, and deep emotional investment may become a source of guilt or burden (Wei and Liu 2024 ). This finding adds nuance to the typically positive portrayal of family support in collectivist cultures (Zhang and Li 2025 ). Consequently, nursing interventions should guide families toward ‘autonomy‐supportive’ communication strategies. Nurses can train family members to collaborate as partners in care, empowering patients rather than controlling them, thus preserving patient self‐efficacy while leveraging family strengths.

Participants consistently highlighted systemic barriers—such as complex clinic procedures, fragmented follow‐up, insufficient patient‐provider communication and treatment disrupting daily life—which collectively create significant ‘system friction’. This friction increases the perceived behavioural cost of adherence. Our findings support health services research emphasizing the importance of accessibility and convenience (Liu and Lu 2025 ). Telemedicine and digital health platforms show promise for streamlining processes and integrating care into patients' lives. However, our data also reveal a key limitation of standardized technological solutions: they may not adequately address the personalized, emotional and cognitive fluctuations patients experience (Al‐Arkee et al. 2021 ; Pouls et al. 2021 ). Therefore, technology should be viewed not as a standalone solution, but as a tool to enable more human‐centered care. Nurses can advocate for and utilize digital platforms in a way that frees up time for more profound, personalized consultations and facilitates better connections between the patient, their family and community resources.

The primary theoretical contribution of this study is the empirical demonstration of how the ITHBC dimensions interact synergistically. For example, an engaged family can help a patient reframe their understanding of the disease, while a patient‐centered system (e.g., with nurse‐ or pharmacist‐led counselling) can empower both the patient and family with effective management strategies. This interdependence underscores that adherence is a property of the entire care ecosystem (Wei and Liu 2024 ). Isolated interventions targeting only one level (e.g., only patient education) are therefore likely to have limited and unsustainable impact (Shen et al. 2020 ). The ITHBC framework reinforces the necessity for multi‐level, integrated interventions that create a coherent support system (Zhang and Li 2025 ). For nursing, this translates to designing and participating in coordinated strategies that simultaneously address individual cognitive barriers, optimize family support dynamics and work to reduce systemic obstacles within the healthcare environment.

Recommendations for Practice and Further Research

Based on this analysis, we recommend that strategies to improve medication adherence in PO patients in China prioritize the following directions. First, structured health communication led by nursing and clinical staff, coupled with tangible feedback on treatment outcomes, can strengthen patients' trust in disease management and activate their intrinsic motivation. For instance, Zhu ( 2025 ) implemented knowledge‐ and belief‐based interventions for patients with Parkinson's disease using face‐to‐face interactions and visual aids. This approach fostered positive outcome expectations, strengthened self‐efficacy and improved patients' cognitive state and social participation. By setting short‐term goals and encouraging patients to report progress to providers, the intervention enhanced their sense of engagement in self‐management. Second, families should be systematically integrated into medication education and support systems. Nurses can guide family members to develop scientifically sound supportive behaviours, transforming emotional support into sustainable assistance for patient self‐management (Long et al. 2026 ). Finally, healthcare systems should implement digital tools (e.g., appointment reminders, medication trackers and simplified tele‐consultations) not as replacements for human care, but as components of a blended care model (Long et al. 2026 ). These tools should be designed to facilitate easier connection with healthcare providers for personalized feedback and to support information sharing within the family unit.

Limitations

While this study provides rich insights into the medication self‐management experiences of patients with PO, its generalizability may be limited by recruiting participants primarily from a single hospital in Zhejiang Province. Future research should involve larger, more diverse cohorts. Furthermore, medication self‐management in PO is a complex, multi‐stakeholder process. This study focused primarily on the patient perspective. A more comprehensive understanding requires incorporating the views of other key stakeholders, including family caregivers, physicians, nurses, community health workers and policymakers. A multi‐stakeholder approach will yield a more holistic view of the medication adherence ecosystem and stronger evidence for developing integrated strategies.

Conclusion

Medication adherence among Chinese patients with PO is a complex behaviour sustained by the interaction of individual beliefs, family dynamics and systemic environments. The ITHBC provides a valuable framework for understanding these interconnected influences. To achieve meaningful and lasting improvements, a shift toward integrated, multi‐stakeholder strategies is essential. Effective medication self‐management will depend on interventions that simultaneously cultivate informed self‐efficacy, wisely guide family support and redesign healthcare systems—particularly nursing and patient‐facing workflows—to reduce friction and foster sustained engagement.

Author Contributions

Donghua Ma: Conceptualization, methodology, investigation, formal analysis, supervision and writing – original draft. Ming Cheng: Formal analysis, supervision and writing – review and editing. Huan Liu: Supervision. All authors have reviewed and approved the final manuscript.

Funding

This study was supported by the Nursing Discipline Construction Research Project of the First Affiliated Hospital, Zhejiang University School of Medicine (Grant No: 2023ZYHL14).

Disclosure

Statistical requirements: (a) The authors confirm that the submission adheres to the journal's statistical guidelines. (b) A statistician (Ming Cheng) is included in the author team. (c) The authors affirm that the analytical methods were appropriately applied within the study context, and statistical findings were correctly implemented and interpreted. (d) The authors take responsibility for the choice, execution, and interpretation of statistical analyses.

Ethics Statement

The study was approved by the Ethics Committee for Clinical Research of The First Affiliated Hospital, College of Medicine, Zhejiang University ([2025B]ǁT Ethics Approval No. 0039). Informed consent was obtained from all participants. Data were collected and used in accordance with the Nagoya Protocol and relevant ethical guidelines. Participants consented to data publication.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgements

The authors thank all study participants for their cooperation and support. This work was supported by the Nursing Scientific Research Project of The First Affiliated Hospital, College of Medicine, Zhejiang University (Grant No. 2023ZYHL14). The funder had no role in study design, data collection, analysis, or manuscript preparation.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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