Self-Efficacy as a Mediator Between Medication Adherence and Self-Care in Inflammatory Bowel Disease: A Multicenter Cross-Sectional Study

Aims: To examine the role of self-efficacy in the relationship between medication adherence and self-care behaviours in patients with Inflammatory Bowel Disease by describing their levels and exploring the interconnections among these variables. Design: Multicenter, cross-sectional. Methods: A total of 452 patients were recruited through consecutive non-probabilistic sampling across nine Italian outpatient Inflammatory Bowel Disease Units. Data were collected using validated tools: the Morisky Medication Adherence Scale-8, the Self-Care Self-Efficacy Scale, and the Self-Care of Chronic Illness Inventory. Descriptive statistics, Pearson correlations, and mediation analyses were performed to explore associations and the mediating role of self-efficacy between medication adherence and self-care behaviours. Results: Participants had a mean age of 43.49 years; 50.9% were male, 49.2% had Crohn's disease, and 50.8% had ulcerative colitis. Only 10.2% reported high medication adherence, while most showed medium or low adherence. The mean self-efficacy score was 74.82. Medication adherence was positively associated with self-care maintenance, and self-efficacy statistically accounted for part of this association. Lower levels were observed in self-care monitoring and management behaviours. Conclusions: Medication adherence was positively associated with self-care maintenance, and self-efficacy partially explained this relationship. Implications for clinical practice: Routine assessment of medication adherence and self-efficacy may help identify patients at risk of poor self-care. Interventions aimed at strengthening self-efficacy, such as motivational interviewing, nurse-led counselling, and digital monitoring tools, may improve adherence and self-care maintenance. Impact: The study addressed low medication adherence and suboptimal self-care in patients with IBD. Findings support integrating self-efficacy-enhancing strategies into multidisciplinary care to improve adherence and self-care behaviours. Patient or public contribution: Patients completed validated self-report questionnaires; however, they were not involved in the study design, conduct, analysis, or manuscript preparation.