University Drive, Callaghan, NSW, AustraliaUniversity Drive, Callaghan, NSW, Australia.
Int J Older People Nurs. 2007 Dec;2(4):250-62. doi: 10.1111/j.1748-3743.2007.00082.x.
Aim. To examine relationships between psycho-social and patho-physiological measures in explaining medication compliance in older heart failure (HF) patients. Background. Self-efficacy is a predictor not only of medication compliance, but also health recovery. How older HF patients conceptualize and manage this life-threatening event is central to ongoing rehabilitation. Regulating ongoing medical and lifestyle changes in the rehabilitation process requires that any underlying negative affect be productively managed by the use of appropriate coping strategies. Method. Using an exploratory correlational design, 51 older HF patients were asked to complete the Beck Depression Inventory, Beliefs about Medication and Diet Questionnaire, Reactions to Daily Events Questionnaire and Self-regulation scale. A self-report measure of medication compliance was obtained as part of a semi-structured interview. The study was conducted in 2003-2004. Results. Using descriptive statistics, patho-physiological and psychosocial characteristics were given. Independent t-tests were used to assess the gender effects. Pairwise correlations were used to examine the relationships between presenting circumstances, psychosocial characteristics, medication compliance beliefs and self-reported medication compliance behaviours. All positive coping strategies and self-regulation were associated with positive intentions in medication compliance. Males were more inclined towards proactive coping and self-regulatory strategies than were females. Increased depressive symptoms were linked to carelessness in compliance. A belief in medication compliance was associated with a reduced likelihood of carelessness Conclusion. Bandura's three conditions for agency in rehabilitation, self-efficacy and goal-directed intention appeared to be important even in the early phase of the programme. Positive coping strategies and self-regulation suggests a positive basis for medication compliance and more successful ongoing rehabilitation for older HF patients. We identify a significantly enhanced educative role for nurses in this context. Relevance to clinical practice. We suggest that nurses dealing with compliance issues among older patients need to monitor behaviour through addressing both the quality of affect during the patient's response to HF (self-concept, -esteem and -efficacy) as well as the quality of health-related metacognitive knowledge underlying the self-regulatory decisions (such as the patients conceptions of 'wellness' and the strategic knowledge underpinning its achievement and maintenance).
目的。探讨心理社会和病理生理因素在解释老年心力衰竭（HF）患者药物依从性方面的关系。背景。自我效能不仅是药物依从性的预测因素，也是健康恢复的预测因素。老年 HF 患者如何理解和管理这种危及生命的事件是康复的核心。在康复过程中，调节持续的医疗和生活方式的改变需要通过使用适当的应对策略来有效地管理任何潜在的负面情绪。方法。采用探索性相关设计，要求 51 名老年 HF 患者完成贝克抑郁量表、药物和饮食信念问卷、日常事件反应问卷和自我调节量表。药物依从性的自我报告测量是半结构化访谈的一部分。该研究于 2003-2004 年进行。结果。使用描述性统计，给出了病理生理和心理社会特征。使用独立 t 检验评估性别效应。成对相关用于检查呈现情况、心理社会特征、药物依从性信念与自我报告的药物依从性行为之间的关系。所有积极的应对策略和自我调节都与药物依从性的积极意向有关。男性比女性更倾向于积极应对和自我调节策略。抑郁症状增加与依从性粗心有关。对药物依从性的信念与减少粗心的可能性有关。结论。康复中的能动性的三个条件，即自我效能和目标导向的意图，即使在计划的早期阶段似乎也很重要。积极的应对策略和自我调节为老年 HF 患者的药物依从性和更成功的持续康复提供了积极的基础。我们发现，在这种情况下，护士的教育作用显著增强。与临床实践的相关性。我们建议，处理老年患者依从性问题的护士需要通过解决患者对 HF 反应过程中的情感质量（自我概念、自尊和自我效能）以及健康相关元认知知识的质量来监测行为，这些知识是自我调节决策的基础（例如，患者对“健康”的概念及其实现和维持的战略知识）。
