| Summary: | Gangjiao Zhu,1,2 Rahul Malhotra,3– 5 Shangzhi Xiong,6 Xinyue Chen,7 Mingyang Zhang,2 You Wu,2 Enying Gong,8 Zhan Wang,9 Xiangyang Tian,10 Weixia Peng,11 Truls Østbye,2,3,12 Lijing L Yan1,2,12 1School of Public Health, Wuhan University, Wuhan, People’s Republic of China; 2Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China; 3Health Services and Systems Research, Duke-NUS Medical School, Singapore; 4Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore; 5Singhealth, Duke-NUS Global Health Institute Medical School, Singapore; 6The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; 7Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 8School of Population Medicine and Public Health, China Academy of Medical Science & Peking Union Medical College, Beijing, People’s Republic of China; 9Department of Agricultural Economics, College of Agriculture, Purdue University, West Lafayette, IN, USA; 10Chinese Health Education Center, Beijing, People’s Republic of China; 11School of Public Health, Fudan University, Shanghai, People’s Republic of China; 12Duke Global Health Institute, Duke University, Durham, NC, USACorrespondence: Lijing L Yan, School of Public Health, Wuhan University, Wuhan, People’s Republic of China, Email lijing.yan@duke.eduPurpose: We assess whether the sequential mediating effects of self-efficacy and depressive symptoms on the relationship between community efficacy for non-communicable disease management (COEN) and medication adherence and whether these relationships differed by sex and age.Patients and Methods: Overall, 662 individuals from 12 communities in China were interviewed twice 1 year apart. Serial mediation analysis examined whether the relationship between COEN and medication adherence was mediated by self-efficacy and depressive symptoms. Model invariance across sex and age groups was assessed using multi-group analysis.Results: Serial mediation analysis indicated that self-efficacy and depressive symptoms sequentially mediated relationship between COEN and medication adherence. Multi-group analysis by sex showed that the path from self-efficacy to medication adherence was significant only for females and from depressive symptoms to medication adherence was significant only for males.Conclusion: Interventions that enhance individual self-efficacy may be beneficial in decreasing depressive symptoms and improving medication adherence.Keywords: medication adherence, neighborhood, community, self-efficacy, depressive symptoms, non-communicable chronic diseases, social cognitive theory, China
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