Structural equation modeling of the proximal–distal continuum of adherence drivers

Figures & data

Figure 1 The proximal–distal continuum of adherence drivers.

Table 2 Standardized path loadings of path model in predicting proximal beliefs

Independent variables	Proximal beliefs
	Perceived need for medications		Perceived medication concerns		Perceived medication affordability
	Standardized β	SE	Standardized β	SE	Standardized β	SE
Perceived disease severity	0.480‡	0.021	−0.078±	0.026	−0.233‡	0.030
Patient knowledge	0.244‡	0.031	0.164‡	0.032	0.082±	0.029
Perceived side-effect immunity	0.119‡	0.023	0.353‡	0.024	NS	NS
Perceived value of nutraceuticals	−0.249‡	0.025	−0.318‡	0.030	−0.222‡	0.029
Patient engagement	0.137‡	0.027	0.125‡	0.032	NS	NS
Information seeking	−0.090‡	0.021	−0.084±	0.027	NS	NS
Internal health locus of control	NS	NS	−0.051*	0.021	NS	NS
Self-rated health	NS	NS	NS	NS	0.136‡	0.032
Mental health	NS	NS	NS	NS	0.101±	0.031
Age	0.065‡	0.018	0.094‡	0.023	0.166‡	0.026
Female	NS	NS	NS	NS	−0.072±	0.026
White race	NS	NS	NS	NS	NS	NS
Education	NS	NS	NS	NS	0.057*	0.028
Income	NS	NS	NS	NS	0.231‡	0.031
Asthma	NS	NS	NS	NS	NS	NS
Diabetes	NS	NS	NS	NS	NS	NS
Lipid	−0.059‡	0.018	−0.053*	0.022	NS	NS
Osteoporosis	−0.081‡	0.020	−0.059±	0.022	NS	NS
Other CVD	−0.045±	0.017	NS	NS	NS	NS
R-square of model	0.683	0.016	0.509	0.023	0.340	0.023

Notes:

‡ P < 0.001;

± P < 0.01;

* P < 0.05; goodness of model fit: P-values listed in parentheses; estimator = MLR; 127 free parameters; Chi-square = 248.122 (df = 121) with P-value < 0.0001; CFI = 0.973; RMSEA = 0.031; 90% CI = (0.026, 0.037); SRMR = 0.032.

Abbreviations: CVD, cardiovascular disease; NS, nonsignificant; SE, standard error; MLR, maximum likelihood with robust standard errors; CFI, comparative fit index; RMSEA, root mean square error of approximation; SRMR, standardized root mean square residual.

Table 4 Standardized path loadings of path model in predicting distal beliefs

Independent variables	Distal beliefs
	Patient engagement		Health information seeking		Internal health locus of control		Self-rated health		Mental health
	Standardized β	SE	Standardized β	SE	Standardized β	SE	Standardized β	SE	Standardized β	SE
Age	0.169‡	0.027	0.070*	0.030	NS	NS	0.147‡	0.026	0.308‡	0.025
Female	NS	NS	0.218‡	0.030	NS	NS	NS	NS	NS	NS
White race	NS	NS	NS	NS	−0.069*	0.027	NS	NS	NS	NS
Education	NS	NS	0.127‡	0.029	−0.098‡	0.030	NS	NS	NS	NS
Income	NS	NS	NS	NS	NS	NS	0.245‡	0.027	0.121‡	0.029
Asthma	0.089‡	0.026	0.065*	0.026	NS	NS	NS	NS	NS	NS
Diabetes	NS	NS	NS	NS	NS	NS	−0.121‡	0.026	NS	NS
Lipid	NS	NS	NS	NS	NS	NS	NS	NS	NS	NS
Osteoporosis	NS	NS	NS	NS	NS	NS	NS	NS	NS	NS
Other CVD	NS	NS	0.096‡	0.027	NS	NS	−0.180‡	0.025	NS	NS
R square for model	0.037	0.010	0.077	0.016	0.014*	0.007	0.121	0.018	0.107	0.016

Notes:

‡ P < 0.001;

± P < 0.01;

* P < 0.05; goodness of model fit: P-values listed in parentheses; estimator = MLR; 127 free parameters; Chi-square = 248.122 (df = 121) with P-value < 0.0001; CFI = 0.973; RMSEA = 0.031; 90% CI = (0.026, 0.037); SRMR = 0.032.

Abbreviations: CVD, cardiovascular disease; NS, nonsignificant; SE, standard error; MLR, maximum likelihood with robust standard errors; CFI, comparative fit index; RMSEA, root mean square error of approximation; SRMR, standardized root mean square residual.

Table 1 Sociodemographic characteristics

Sociodemographic characteristic	N = 1072
	N	%
Mean age (±SD)		58.3 (10.4)
Median age (±IQR)		58.0 (17.0)
Age 65+	325	30.30%
Female	695	64.80%
White	928	89.40%
Black	56	5.40%
Hispanic	30	2.90%
Other race	24	2.30%
Less than high school	12	1.10%
High school graduate	167	15.60%
Some college but no degree	450	42.00%
Bachelor’s degree	177	16.50%
Some graduate school but no degree	88	8.20%
Graduate or professional degree	178	16.60%
Income < $15,000	62	6.80%
Income $15,000–$24,999	130	14.20%
Income $25,000–$34,999	149	16.30%
Income $35,000–$49,999	160	17.50%
Income $50,000–$74,999	177	19.40%
Income $75,000–$99,999	117	12.80%
Income $100,000–$124,999	49	5.40%
Income $125,000–$149,999	27	2.90%
Income $150,000–$199,999	22	2.40%
Income $200,000–$249,999	10	1.10%
Income > $250,000	11	1.20%
Asthma	144	13.40%
Diabetes	157	14.70%
Hyperlipidemia	249	23.20%
Hypertension	257	24.00%
Osteoporosis	180	16.80%
Other cardiovascular disease	85	7.90%
Self-rated health
Excellent	20	1.90%
Very good	219	20.40%
Good	419	39.10%
Fair	309	28.80%
Poor	105	9.80%

Abbreviations: SD, standard deviation; IQR, interquartile range.

Table 3 Standardized path loadings of path model in predicting intermediate beliefs

Independent variables	Intermediate beliefs
	Perceived disease severity		Patient knowledge		Perceived side-effect immunity		Perceived value of nutraceuticals
	Standardized β	SE	Standardized β	SE	Standardized β	SE	Standardized β	SE
Patient engagement	0.254‡	0.029	0.521‡	0.023	0.259‡	0.030	−0.415‡	0.026
Health information seeking	0.122‡	0.028	0.325‡	0.026	−0.242‡	0.030	0.126‡	0.029
Internal health locus of control	NS	NS	0.062±	0.024	NS	NS	0.209‡	0.026
Self-rated health	−0.262‡	0.030	NS	NS	NS	NS	0.100‡	0.028
Mental health	−0.112‡	0.030	0.047*	0.021	0.119‡	0.029	NS	NS
Age	NS	NS	NS	NS	NS	NS	−0.084±	0.025
Female	NS	NS	NS	NS	−0.111‡	0.027	NS	NS
White race	NS	NS	NS	NS	NS	NS	−0.053*	0.025
Education	−0.105‡	0.027	NS	NS	0.126‡	0.028	−0.083±	0.028
Income	NS	NS	NS	NS	NS	NS	−0.122‡	0.029
Asthma	−0.074*	0.031	NS	NS	NS	NS	0.060*	0.026
Diabetes	0.130‡	0.026	NS	NS	NS	NS	NS	NS
Lipid	NS	NS	NS	NS	NS	NS	NS	NS
Osteoporosis	−0.103‡	0.029	NS	NS	NS	NS	0.128‡	0.025
Other CVD	0.094‡	0.026	NS	NS	NS	NS	NS	NS
R square for model	0.251	0.023	0.477	0.025	0.151	0.020	0.286	0.024

Notes:

‡ P < 0.001;

± P < 0.01;

* P < 0.05; goodness of model fit: P-values listed in parentheses; estimator = MLR; 127 free parameters; Chi-square = 248.122 (df = 121) with P-value < 0.0001; CFI = 0.973; RMSEA = 0.031; 90% CI = (0.026, 0.037); SRMR = 0.032.

Abbreviations: CVD, cardiovascular disease; NS, nonsignificant; SE, standard error; MLR, maximum likelihood with robust standard errors; CFI, comparative fit index; RMSEA, root mean square error of approximation; SRMR, standardized root mean square residual.