The impact of social support on medication adherence among patients with heart failure: health literacy as a mediator

Why this matters for everyday life

For people living with a weak heart, taking the right medicines every day can mean the difference between staying at home and landing back in the hospital. Yet many patients struggle to keep up with their prescriptions. This study from Saudi Arabia asks a simple but powerful question: how much do caring relationships and the ability to understand health information help people with heart failure stick to their medicines?

Heart trouble and the challenge of daily pills

Heart failure happens when the heart cannot pump blood well enough to meet the body’s needs. It is common, costly, and often deadly. One of the most important ways to control it is by taking several medicines exactly as prescribed, often for life. Around the world, however, many patients miss doses or stop drugs early. Earlier studies show that better adherence lowers hospital readmissions and deaths, but they also reveal that only about half of patients with heart failure take their medicines consistently. This new study focuses on patients in Hail City, Saudi Arabia, to understand what helps or hinders their daily pill-taking.

Support from others and the power to understand

The researchers focused on two human factors that might shape medication habits. The first is social support: having people—family, neighbors, or health professionals—who offer emotional comfort, practical help, and encouragement. The second is health literacy: how well a person can obtain, understand, and use health information, such as why a pill is needed, how often to take it, and what side effects to watch for. Theory suggests these pieces work together: strong support can motivate someone to learn, while better understanding can turn that motivation into steady action.

How the study was done

Between August and October 2024, the team surveyed 249 adults with heart failure receiving care at a specialized hospital. Participants filled out short, validated questionnaires that rated how closely they followed their medication plans, how well they understood health information, and how much social support they felt they had. The researchers also collected basic details such as age, income, smoking status, and other illnesses. Using statistical models, they tested not only whether support and understanding were linked to medication habits, but also whether health literacy acted as a bridge between social support and adherence.

What the researchers discovered

Most patients in this study did not have ideal medication habits: about half showed only partial adherence, and nearly 40% had low adherence. Health literacy was also strikingly low—more than seven in ten patients scored in the lowest category. Social support tended to be moderate but was weak for many. Even so, clear patterns emerged. Patients who were older, did not smoke, and who had other chronic illnesses tended to take their medicines more reliably. Most importantly, those with higher health literacy and stronger social support were more likely to follow their medication plans. The links were modest but consistent: patients with more support also tended to have better understanding of their health, and that understanding in turn was tied to better adherence.

How support and understanding work together

When the researchers looked closer, they found that health literacy partly explained how social support improved medication habits. In other words, support helped directly—for example, when a family member reminded a patient to take pills—but it also helped indirectly by boosting the patient’s grasp of their disease and treatments. Even a small improvement in understanding made it easier to manage complex pill schedules and daily self-care. While the effect was not huge, it is meaningful at the population level, where even slight gains in adherence can translate into fewer hospital stays and better survival for people with heart failure.

What this means for patients and families

For a layperson, the takeaway is straightforward: heart failure care is not only about the right drugs, but also about the right help and clear explanations. Patients who are surrounded by supportive people and who truly understand their medicines are more likely to take them as prescribed. The study suggests that clinics should involve family members, simplify instructions, use plain language and visual aids, and check that patients really understand what they are being told. By strengthening both social support and health literacy, health systems may give heart failure patients a better chance to stay on their medications—and out of the hospital.

Citation: Alkubati, S.A., Aleyadah, H.K., Alrashedi, H. et al. The impact of social support on medication adherence among patients with heart failure: health literacy as a mediator. Sci Rep 16, 9981 (2026). https://doi.org/10.1038/s41598-026-40360-6

Keywords: heart failure, medication adherence, social support, health literacy, chronic disease self-care