Graffigna Guendalina, Barello Serena, Bonanomi Andrea
Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy.
PLoS One. 2017 Jun 27;12(6):e0179865. doi: 10.1371/journal.pone.0179865. eCollection 2017.
Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed.
To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway.
This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 -short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients' emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed.
According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis.
Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing the quality of care. The Patient Health Engagement Model might acts as a mechanism to increase patient activation and adherence.
如今，越来越多的科学研究探讨了影响患者自我管理和坚持治疗能力的因素及干预措施。患者激活被认为是患者自主管理健康能力的最可靠指标。仅有少数研究试图评估心理社会因素在促进患者激活方面的作用。需要对解释患者激活差异的心理社会因素进行更系统的建模。
检验患者激活对药物依从性的假设效应；检验积极情绪和患者/医生关系质量对患者激活的假设效应；检验患者健康参与（PHE模型）在该路径中的假设中介效应。
这项横断面研究纳入了352名讲意大利语的成年慢性病患者。该调查包括以下测量指标：i）患者激活（患者激活量表13 - 简表）；ii）患者健康参与模型（患者健康参与量表）；iii）患者依从性（4项 - 莫林斯基药物依从性量表）；iv）患者情绪感受质量（人体模型自我评估量表）；v）患者/医生关系质量（医疗保健氛围问卷）。采用结构方程模型来检验所提出的假设。
根据我们假设的理论模型，研究结果证实患者激活显著影响其报告的药物依从性。此外，心理社会因素，如患者的情绪感受质量和患者/医生关系质量被证明是影响患者激活水平的因素。最后，分析证实了患者健康参与模型的中介效应。
与先前研究结果一致，这些发现表明患者健康参与模型是提高护理质量的关键因素。患者健康参与模型可能作为一种机制来提高患者激活和依从性。
