Elliott V, Morgan S, Day S, Mollerup L S, Wang W
Division of Behavioral Medicine, St Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
J Pediatr Hematol Oncol. 2001 Feb;23(2):112-6. doi: 10.1097/00043426-200102000-00009.
Prophylactic penicillin is effective in preventing severe invasive pneumococcal infection in children with sickle cell disease. In some families, compliance has been problematic. The aims of this study were to monitor compliance and to assess the efficacy of the Health Belief Model (HBM) in predicting compliance.
Fifty mothers of children with sickle cell disease, ages 6 to 60 months, participated in the study. On enrollment, mothers completed surveys assessing their health beliefs regarding sickle cell disease and infections. Compliance was assessed through self-reporting by the mothers and through review of local pharmacy records of penicillin refills.
Sixty percent of the mothers reported that they were highly compliant with obtaining the prescribed 14-day refills. Pharmacy records indicated that only 12% actually adhered to this schedule. The self-reports were significantly related to compliance ratings; mothers who admitted less than optimal compliance averaged 42 days between refills, compared with 19 days for mothers who reported good compliance. Varying perceptions identified through the HBM accounted for approximately 30% of the variance in compliance rates. The perceived burdens of picking up the refills and remembering to administer the medication were the most significant factors.
Educational efforts alone are not sufficient to ensure compliance with penicillin prophylaxis. Routinely monitoring compliance through pharmacy records, reviewing parental beliefs about sickle cell disease and infections, and exploring barriers to treatment will promote dialogue about the importance of strict compliance with this relatively simple yet life-saving prophylaxis.
预防性使用青霉素可有效预防镰状细胞病患儿发生严重的侵袭性肺炎球菌感染。在一些家庭中，服药依从性存在问题。本研究的目的是监测依从性，并评估健康信念模型（HBM）在预测依从性方面的有效性。
50名年龄在6至60个月的镰状细胞病患儿的母亲参与了该研究。在登记时，母亲们完成了调查，评估她们对镰状细胞病和感染的健康信念。通过母亲的自我报告以及查阅当地药房青霉素 refill 的记录来评估依从性。
60%的母亲报告称她们高度依从获取规定的14天 refill。药房记录显示只有12%的人实际遵守了这个时间表。自我报告与依从性评级显著相关；承认依从性欠佳的母亲 refill 之间的平均间隔为42天，而报告依从性良好的母亲为19天。通过HBM识别出的不同认知约占依从率差异的30%。取 refill 和记住服药的感知负担是最显著的因素。
仅靠教育努力不足以确保对青霉素预防治疗的依从性。通过药房记录定期监测依从性、审查父母对镰状细胞病和感染的信念以及探索治疗障碍，将促进关于严格遵守这种相对简单但能救命的预防措施重要性的对话。
