McCann Terence V, Clark Eileen, Lu Sai
Professor of Nursing Research, School of Nursing, Midwifery, Institute of Health and Diversity, Victoria University, Melbourne, Vic., AustraliaSenior Lecturer in Sociology, Division of Nursing and Midwifery, La Trobe University, Wodonga, Vic., AustraliaResearch Officer, School of Nursing and Midwifery, Institute of Health and Diversity, Victoria University, Melbourne, Vic., Australia.
J Clin Nurs. 2008 Nov;17(11c):329-40. doi: 10.1111/j.1365-2702.2008.02354.x.
In this position paper, the self-efficacy model of medication adherence in chronic mental illness is presented, and its application to antipsychotic medication adherence is considered.
Poor adherence to antipsychotic medications is common in chronic mental illness. Major implications of this are relapse and re-hospitalisation. Several conceptual frameworks have been developed about adherence and, in some instances, have been incorporated in medication taking studies, but have resulted in inconsistent outcomes.
This paper draws on a review of literature from databases to inform the development of the self-efficacy model of medication adherence. Inclusion and exclusion criteria were developed from primary and secondary research questions.
The model places the person with chronic mental illness as an active participant central to the process of medication taking. It has three components: core factors, contextual influences and a continuum. The factors comprise a central factor, self-efficacy and four interrelated supporting influences: perceived medication efficacy; access to, and relationships with, health professionals; significant other support and supported living circumstances. The factors are affected by three broad contextual influences - personal issues, medication side-effects and complexity, and social stigma - which affect the way individuals take their medications. A continuum exists between adherence and non-adherence.
The model positions service users at the heart of adherence by giving prominence to self-efficacy, medication efficacy and to immediate social, psychological and environmental supports. Further work is needed to validate, refine and extend the model.
For practitioners involved in prescribing and medication management in people with chronic mental illness, the model provides a theoretical framework to strengthen adherence. It highlights the need to consider broader influences on medication taking. Moreover, it places the person with chronic mental illness as an active participant at the centre of strategies to enhance adherence.
在本立场文件中，提出了慢性精神疾病药物依从性的自我效能模型，并探讨了其在抗精神病药物依从性方面的应用。
慢性精神疾病患者对抗精神病药物的依从性较差是常见现象。这会导致复发和再次住院等严重后果。已经开发了几种关于依从性的概念框架，在某些情况下已被纳入药物服用研究，但结果并不一致。
本文通过对数据库文献的综述来为药物依从性自我效能模型的开发提供信息。纳入和排除标准是根据主要和次要研究问题制定的。
该模型将慢性精神疾病患者视为药物服用过程中的核心积极参与者。它有三个组成部分：核心因素、情境影响和一个连续体。这些因素包括一个核心因素——自我效能，以及四个相互关联的支持性影响因素：感知到的药物疗效；与医疗专业人员的接触及关系；重要他人的支持和支持性的生活环境。这些因素受到三种广泛的情境影响——个人问题、药物副作用和复杂性以及社会耻辱感——这些影响着个体服药的方式。依从性和非依从性之间存在一个连续体。
该模型通过突出自我效能、药物疗效以及直接的社会、心理和环境支持，将服务使用者置于依从性的核心位置。需要进一步开展工作来验证、完善和扩展该模型。
对于参与慢性精神疾病患者处方和药物管理的从业者而言，该模型提供了一个加强依从性的理论框架。它强调了考虑对药物服用的更广泛影响的必要性。此外，它将慢性精神疾病患者作为积极参与者置于增强依从性策略的中心位置。
