Medication Adherence in Stroke Patients: The Role of Social Support, Social Health, Self-Esteem, and Leisure Time.

Background: Medication adherence in stroke patients remains a significant challenge, impacting treatment efficacy and patient outcomes. This study aimed to model the structural relationships predicting medication adherence based on social support and social health in stroke patients, focusing on the mediating roles of self-esteem and leisure time in Tehran.

Methods: This correlational study used structural equation modeling. The statistical population included all stroke patients referred to the Neurology Clinic of Firoozgar Hospital in Tehran in 2021. A sample of 255 participants was selected through a convenience sampling method. Participants completed questionnaires on medication adherence (Lin & et al, 2018), social support (Wax and Reader, 1986), self-esteem(Rosenberg, 1965), social health (Keyes, C. L., & Shapiro, A. D, 2004), and leisure time (Wang, 2019 ). Data were analyzed using Pearson correlation and structural equation modeling methods.

Results: The results indicate that SEM analysis demonstrated excellent model fit (χ²/df=2.91, CFI=0.97, RMSEA=0.062). Significant direct effects were found: social support → self-esteem (β=0.34, *P*<0.001), social health → medication adherence (β=0.45, *P*<0.001). Key indirect effects via mediators: social health → leisure time → adherence (β=0.15, *P*=0.001) and social support → self-esteem → adherence (β=0.15, *P*=0.001). All standardized coefficients (*P*<0.05) confirmed the hypothesized pathways.

Conclusion: The findings demonstrate that psychological factors significantly influence medication adherence and, ultimately, patient recovery. Strengthening social support, self-esteem, social health, and leisure time can enhance treatment outcomes and facilitate better management of stroke patients.