Scotto Carrie J
Duquesne University, Pittsburgh, PA, USA.
J Cardiopulm Rehabil. 2005 May-Jun;25(3):158-63. doi: 10.1097/00008483-200505000-00006.
Nonadherence is the primary cause of hospital readmission for patients with heart failure. While some demographic and social variables are associated with adherence, the identification of these variables does not address the complex problem of adherence. This study explored the lived experience of patients with heart failure as they attempt to adhere to a prescribed regimen of care.
Fourteen patients attending an outpatient heart failure clinic after hospital readmission for exacerbation of heart failure symptoms were interviewed. Transcription of the interviews provided data for phenomenological analysis and interpretation.
Data analysis indicated that within the experience of attempting to adhere to prescribed care regimens, participants' initial acceptance of their diagnosis resulted in a changed self-image. Behaviors appropriate to the new self-image were integrated into the former lifestyle by means of planning and setting routine. Identified themes that influence adherence to the new behaviors included personal beliefs and values, support from significant others and healthcare professionals, unusual circumstances, and temptation overcoming motivation.
Adherence is primary to the effectiveness of any health regimen. Assessment of personal and circumstantial elements that affect adherence can be useful in developing more effective individualized treatment plans for this population. A closer look at discrete events of nonadherent decision making may indicate effective ways to promote adherence.
不依从是心力衰竭患者再次入院的主要原因。虽然一些人口统计学和社会变量与依从性有关，但识别这些变量并不能解决依从性这一复杂问题。本研究探讨了心力衰竭患者在尝试遵循规定的护理方案时的生活经历。
对14名因心力衰竭症状加重再次入院后在门诊心力衰竭诊所就诊的患者进行了访谈。访谈记录为现象学分析和解释提供了数据。
数据分析表明，在尝试遵循规定护理方案的过程中，参与者对诊断的最初接受导致了自我形象的改变。通过规划和设定日常安排，与新自我形象相符的行为被融入到以前的生活方式中。确定的影响对新行为依从性的主题包括个人信念和价值观、重要他人和医护人员的支持、特殊情况以及克服动机的诱惑。
依从性是任何健康方案有效性的关键。评估影响依从性的个人和环境因素可能有助于为该人群制定更有效的个性化治疗方案。仔细研究不依从决策的离散事件可能会揭示促进依从性的有效方法。
