Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, WI, USA.
Department of Pharmaceutical Sciences, College of Pharmacy, Roseman University of Health Sciences, Nevada, USA.
Res Social Adm Pharm. 2018 Sep;14(9):824-830. doi: 10.1016/j.sapharm.2017.12.005. Epub 2017 Dec 13.
Beliefs in medications and illness perceptions is associated with medication adherence among individuals with diabetes and several adherence interventions focus on patients' beliefs in medicines and illnesses. Though health literacy is important in medication adherence, the relationship between health literacy and medication adherence remains inconclusive; thus raising the question as to whether health literacy has an amplifying or reducing effect on the relationship between beliefs and adherence.
The study examined (1) the association between health literacy, beliefs in medicines, illness perceptions, and medication adherence in individuals with type 2 diabetes and (2) the moderating effects of health literacy (including numeracy and document literacy) on the relationship between illness perceptions, beliefs in medicines, and medication adherence.
Adults ≥20 years taking oral diabetes medicines at two family medicine clinics, completed a cross-sectional survey. Participants were assessed on beliefs in medicines, illness perceptions, health literacy, self-efficacy, and medication adherence. Multiple linear regressions examined the effect of health literacy, beliefs and self-efficacy, and the moderator effect of health literacy in the relationship between beliefs and adherence.
Of the 174 participants, more than half were women (57.5%) and white (67.8%). There was a significant positive association between self-efficacy and adherence (β = 0.486, p < .001), and a negative association between threatening illness perceptions and adherence (β = -0.292, p < .001). Health literacy had a significant moderator effect on the relationship between adherence and concerns beliefs (β = -0.156, p = .014) and threatening illness perceptions (β = 0.196, p = .002). The concern beliefs - adherence association was only significant at marginal and adequate literacy levels. When health literacy was separated into numeracy and document literacy, only numeracy moderated the illness perceptions - adherence relationship (β = 0.149, p = .038).
Health literacy, especially numeracy, needs to be initially addressed before diabetes adherence interventions that address individual concerns about medicines and threatening illness perceptions can work.
在患有糖尿病的个体中，对药物的信念和疾病认知与药物依从性相关，并且有几种药物依从性干预措施侧重于患者对药物和疾病的信念。尽管健康素养在药物依从性中很重要，但健康素养与药物依从性之间的关系仍不确定；因此，人们提出了一个问题，即健康素养是否对信念与依从性之间的关系具有增强或减弱的影响。
本研究旨在检验（1）2 型糖尿病患者的健康素养、对药物的信念、疾病认知与药物依从性之间的关系，以及（2）健康素养（包括计算能力和文献素养）对疾病认知、对药物的信念与药物依从性之间关系的调节作用。
在两家家庭医学诊所接受口服糖尿病药物治疗的年龄≥20 岁的成年人完成了一项横断面调查。参与者接受了对药物的信念、疾病认知、健康素养、自我效能感和药物依从性的评估。多元线性回归检验了健康素养、信念和自我效能感的作用，以及健康素养在信念与依从性关系中的调节作用。
在 174 名参与者中，超过一半为女性（57.5%），且为白人（67.8%）。自我效能感与依从性呈显著正相关（β=0.486，p<0.001），而威胁性疾病认知与依从性呈负相关（β=-0.292，p<0.001）。健康素养对依从性与担忧信念（β=-0.156，p=0.014）和威胁性疾病认知（β=0.196，p=0.002）之间的关系具有显著的调节作用。只有在基本和充分的读写能力水平下，担忧信念与依从性的关联才具有显著意义。当健康素养分为计算能力和文献素养时，只有计算能力调节了疾病认知与依从性之间的关系（β=0.149，p=0.038）。
在针对个体对药物和威胁性疾病认知的关注的糖尿病依从性干预措施生效之前，需要首先解决健康素养问题，尤其是计算能力。
