Wu Ping, Liu Naifeng
Department of Clinical Pharmacy, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University.
Institute of Cardiovascular Disease, Southeast University Medical School, Nanjing, People's Republic of China.
Patient Prefer Adherence. 2016 Jun 27;10:1161-7. doi: 10.2147/PPA.S105600. eCollection 2016.
The objective of this study was to identify, using the theory of planned behavior (TPB), patients' beliefs about taking oral antidiabetic drugs (OADs) as prescribed, and to measure the correlations between beliefs and medication adherence.
We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs) relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Spearman's rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05.
From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037) was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000), not accepting the disease (P=0.000), ignorance of life-long drug adherence (P=0.038), being busy (P=0.001), or poor memory (P=0.008) were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011).
The results indicate that the TPB model could be used to examine adherence to OADs. One facilitating control belief, and most of the barrier control beliefs of TPB were related to medication adherence among Chinese type 2 diabetes inpatients. It will be helpful to understand patients' self-medication and provide methods to develop instruments for identifying factors that influence OAD adherence.
本研究的目的是运用计划行为理论（TPB），确定患者对按医嘱服用口服抗糖尿病药物（OADs）的信念，并测量信念与药物依从性之间的相关性。
我们在中国一家三级医院对2型糖尿病患者进行了一项横断面研究，采用结构化问卷。共纳入130例患者，就与药物依从性相关的TPB变量（行为、规范和控制信念）进行访谈。使用八项Morisky药物依从性量表（MMAS-8）评估药物依从性。采用Spearman等级相关性分析评估TPB与MMAS-8之间的关联。进行逻辑回归分析以检验不同变量与MMAS-8之间的关系，以P<0.05确定统计学意义。
在130例符合条件的中国患者中，平均年龄60.6岁，男性比例为50.8%，我们的研究发现行为、规范和最具促进作用的控制信念与OAD依从性之间无显著关系。手头有OADs（P=0.037）是与依从行为相关的唯一促进性控制信念。离家或外出就餐（P=0.000）、不接受疾病（P=0.000）、对终身药物依从性的忽视（P=0.038）、忙碌（P=0.001）或记忆力差（P=0.008）是发现与依从性差相关的控制信念障碍。在所有因素中，TPB是影响OAD依从性的唯一重要决定因素（P=0.011）。
结果表明，TPB模型可用于检验OADs的依从性。在中国2型糖尿病住院患者中，TPB的一个促进性控制信念和大多数障碍性控制信念与药物依从性有关。这将有助于理解患者的自我用药情况，并为开发识别影响OAD依从性因素的工具提供方法。
