Mediating Effect of Perceived Health Competence on the Association Between Mindfulness and Adherence to Health Behaviors in Patients with Acute Coronary Syndrome: A Cross-Sectional Study

Purpose: Given the importance of adherence to health behaviors in patients with acute coronary syndrome (ACS) and the potential influence of mindfulness, it is important to determine the association between mindfulness and adherence to health behaviors and its potential mechanisms in this population. Perceived health competence is a person's confidence in his/her ability to achieve health goals successfully and may explain how mindfulness influences adherence to health behaviors. This study aimed to examine the association between mindfulness and adherence to health behaviors and whether this association was mediated by perceived health competence.

Methods: A cross-sectional study (N = 555) was conducted at the First Affiliated Hospital of Soochow University from September 2022 to January 2024. Patients' sociodemographic and clinical data, mindfulness (Mindful Attention Awareness Scale [MAAS]), and perceived health competence (Perceived Health Competence Scale [PHCS]) were assessed one-two days before discharge, and adherence to health behaviors (Medical Outcomes Study Specific Adherence Scale [MOSSAS]) was assessed one month after discharge. Good adherence to health behaviors was defined as achieving a cumulative score of ≥ 80%. A mediating effect model was used to analyze data.

Results: The mean score of adherence to health behaviors was 42.58 ± 7.13 and only 27.39% (152/555) of the patients had good adherence. Mindfulness positively predicted adherence to health behaviors (β = 0.13, P < 0.01). Perceived health competence partially mediated the association between mindfulness and adherence to health behaviors, with the mediating effect accounting for 7.00% of the total effect (P = 0.03).

Conclusion: The adherence to health behaviors in patients with ACS was very low. Mindfulness positively predicted adherence to health behaviors, and perceived health competence partially mediated the association between mindfulness and adherence to health behaviors. Healthcare providers could intervene patients' mindfulness or perceived health competence to improve adherence to health behaviors.