Exploring medication adherence and risk factors in elderly patients with hepatocellular carcinoma undergoing oral targeted therapy: a cross-sectional observational study

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Background: Oral targeted therapy is now integral to the management of older adults with hepatocellular carcinoma (HCC), yet suboptimal adherence persistently undermines its real-world effectiveness. Although the Health Belief Model (HBM) is widely applied to explain health behaviors, its integration with self-efficacy theory-particularly in the HCC context, where the volitional gap between belief and action frequently dictates clinical outcomes-remains inadequately characterized. Objectives: To elucidate factors associated with oral targeted therapy adherence in elderly HCC patients and to evaluate the explanatory utility of an integrated HBM-self-efficacy framework for medication-taking behavior. Methods: In this cross-sectional study, 653 older HCC patients on oral targeted agents were recruited via convenience sampling. Data were collected using demographic questionnaires, validated HBM and self-efficacy scales, and the Morisky Medication Adherence Scale (MMAS-8). Binary logistic regression and mediation analyses were performed. Results: The mean MMAS-8 score was 6.08 ± 1.37, with 29.10% of patients classified as having poor adherence. Independent risk factors included moderate-to-severe adverse reactions, high concern beliefs, and living alone, whereas high necessity beliefs and high self-efficacy emerged as protective factors. Notably, self-efficacy partially mediated the relationship between medication beliefs and adherence. Conclusion: The combined Health Belief Model and self-efficacy framework showed notable ability to explain inter-individual differences in medication adherence within this sample. Medication beliefs and self-efficacy correlated significantly with adherence, while self-efficacy carried a detectable partial indirect association between medication beliefs and adherence. Implications for oncology nursing practice: Adherence optimization extends beyond initial patient education. Nurses should implement periodic, structured assessments and tailored behavioral interventions-prioritizing the reinforcement of perceived necessity, mitigation of unwarranted concerns, and cultivation of self-efficacy to sustain long-term therapeutic compliance.

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