The Mediating Roles of Self-Efficacy, Resilience, and Social Support in the Relationship Between Clinical Factors and Adaptation to Chronic Disease

Purpose: Psychosocial adaptation to chronic disease plays a central role in determining quality of life. Yet the mechanisms linking clinical factors to adaptation remain insufficiently understood, especially in Eastern European contexts and across different chronic conditions. This study tested whether self-efficacy mediates the relationship between comorbidities and number of medications on adaptation to chronic disease (as indicators of clinical burden and treatment complexity) and examined perceived social support and resilience as alternative mediators. Patients and Methods: Participants were 263 adults with chronic diseases recruited from public hospitals in Romania. Measures included the SEMCD (self-efficacy), CIAS (adaptation; total and the compliant behavior [CIAS-f2] and emotional support [CIAS-f4] subscales), BRS (resilience), and MOS-SSS (social support), with higher scores indicating higher levels. A cross-sectional design was used, and four simple mediation models were estimated, each with one mediator, using bootstrapping with 5000 resamples (95% bias-corrected CIs) in JASP 0.19. Results: Using unstandardized coefficients, the indirect effect of comorbidities on adaptation through self-efficacy was significant (a×b = -0.17, 95% CI -0.29 to -0.09), while the direct path was not, indicating complete mediation. For the number of medications, the indirect effect through self-efficacy was -0.02 (95% CI -0.04 to -0.01), with a nonsignificant direct effect. Mediation emerged for CIAS-f2 (compliant behavior) but not for CIAS-f4 (emotional support needs). Social support showed a direct positive association with adaptation (b = 0.45, P < 0.001) without mediation, whereas resilience showed no significant effects. Conclusion: The findings indicate a significant indirect pathway through which comorbidities and complex medication regimens are associated with adaptation via self-efficacy. Social support showed a direct, rather than mediating, association with adaptation, whereas resilience appeared to have a limited role. These results suggest that clinical practice may benefit from focusing on simplifying treatment regimens, enhancing self-management efficacy through personalized education, and mobilizing social support.