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Background:  Studies have reported that medication literacy had a positive effect on medication adherence in patients with hypertension. However, little is known about the mechanism underlying this relationship in patients with hypertension.    Objective:  The purpose of this study was to investigate the mediating effect of self-efficacy between medication literacy and medication adherence.    Methods:  A total of 790 patients with hypertension were investigated using the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP), the Morisky Medication Adherence Scale-8 (MMAS-8) and the Medication Adherence Self-efficacy Scale-Revision (MASES-R). Hierarchical regression and the bootstrap approach were used to analyze the mediating effect of self-efficacy on the relationship between medication literacy and medication adherence.    Results:  A total of 60.9% of hypertensive patients were low adherent to their antihypertensive drug regimens. Self‐efficacy had a significant positive correlation with medication literacy ( r = 0.408,  p  < 0.001) and medication adherence ( r  = 0.591,  p  < 0.001). Self-efficacy accounts for 28.7% of the total mediating effect on the relationship between medication literacy and adherence to antihypertensive regimens for hypertensive patients.    Conclusion:  More than half of the hypertensive patients in the study were low adherent to antihypertensive regimens. Self-efficacy had a partial significant mediating effect on the relationship between medication literacy and medication adherence. Therefore, it was suggested that hypertensive patients’ medication adherence might be improved and driven by increasing self-efficacy. Targeted interventions to improve patients’ self-efficacy should be developed and implemented. In addition, health care providers should also be aware of the importance of medication literacy assessment and promotion in patients with hypertension.

Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension