高血压患者有意和无意的用药不依从性：健康素养、自我效能感和用药信念的作用
Intentional and Unintentional Medication Non-Adherence in Hypertension: The Role of Health Literacy, Empowerment and Medication Beliefs.
作者信息
Náfrádi Lilla, Galimberti Elisa, Nakamoto Kent, Schulz Peter J
机构信息
Institute of Communication and Health, Università della Svizzera italiana , Lugano, Switzerland.
出版信息
J Public Health Res. 2016 Dec 21;5(3):762. doi: 10.4081/jphr.2016.762. eCollection 2016 Dec 9.
BACKGROUND
Medication non-adherence is a major public health issue, creating obstacles to effective treatment of hypertension. Examining the underlying factors of deliberate and non-deliberate non-adherence is crucial to address this problem. Thus, the goal of the present study is to assess the socio-demographic, clinical and psychological determinants of intentional and unintentional non-adherence.
DESIGN AND METHODS
A cross-sectional survey was conducted between March, 2015 and April, 2016. The sample consisted of hypertension patients holding at least one medical prescription (N=109). Measurements assessed patients' medication adherence, health literacy, empowerment, self-efficacy, medication beliefs, and patients' acceptance of their doctor's advice, socio-demographic and clinical characteristics.
RESULTS
Patients who occasionally engaged in either intentional or unintentional non-adherence reported to have lower adherence selfefficacy, higher medication concern beliefs, lower meaningfulness scores and were less likely to accept the doctor's treatment recommendations. Patients who occasionally engaged in unintentional nonadherence were younger and had experienced more side effects compared to completely adherent patients. Adherence self-efficacy was a mediator of the effect of health literacy on patients' medication adherence and acceptance of the doctor's advice was a covariate.
CONCLUSIONS
Regarding the research implications, health literacy and adherence self-efficacy should be assessed simultaneously when investigating the factors of non-adherence. Regarding the practical implications, adherence could be increased if physicians i) doublecheck whether their patients accept the treatment advice given and ii) if they address patients' concerns about medications. These steps could be especially important for patients characterized with lower self-efficacy, as they are more likely to engage in occasional nonadherence.
背景
药物治疗不依从是一个重大的公共卫生问题，为高血压的有效治疗带来了障碍。探究故意和非故意不依从的潜在因素对于解决这一问题至关重要。因此，本研究的目的是评估有意和无意不依从的社会人口学、临床和心理决定因素。
设计与方法
于2015年3月至2016年4月进行了一项横断面调查。样本包括至少持有一张医疗处方的高血压患者（N = 109）。测量评估了患者的药物依从性、健康素养、赋权、自我效能感、药物信念，以及患者对医生建议的接受程度、社会人口学和临床特征。
结果
偶尔出现有意或无意不依从的患者报告称，其依从自我效能感较低，药物担忧信念较高，意义得分较低，并且不太可能接受医生的治疗建议。与完全依从的患者相比，偶尔出现无意不依从的患者更年轻，且经历的副作用更多。依从自我效能感是健康素养对患者药物依从性影响的一个中介因素，而接受医生的建议是一个协变量。
结论
关于研究意义，在调查不依从因素时应同时评估健康素养和依从自我效能感。关于实际意义，如果医生做到以下两点，依从性可能会提高：一是再次确认患者是否接受所给予的治疗建议；二是解决患者对药物的担忧。对于自我效能感较低的患者而言，这些措施可能尤为重要，因为他们更有可能偶尔出现不依从情况。
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