Division of Psychology, Nanyang Technological University, Singapore.
Department of Psychological and Brain Sciences, University of Delaware, Newark, DE.
Ann Behav Med. 2018 May 31;52(7):613-619. doi: 10.1093/abm/kay003.
Poor adherence to medical regimens is a serious problem that interferes with heart failure (HF) patients' disease management and contributes to poor clinical outcomes. Few prospective studies have examined the psychosocial predictors of adherence over time in HF patients.
This study examined the influences of depression, self-efficacy, social support, and their changes on self-reported medical adherence over 6 months in HF patients.
Participants were 252 HF outpatients, among whom 168 completed follow-up assessments. Hierarchical multiple regression analyses were conducted to examine whether psychosocial variables and their changes prospectively predicted adherence at 6 months, after adjusting for baseline adherence, age, gender, ethnicity, marital status, education, HF severity, medical comorbidity, and mental health treatment.
Baseline self-efficacy (β = .22, p < .05), increase in self-efficacy (β = .34, p < .001), and decrease in depression (β = -.15, p = .05) predicted improved adherence over 6 months, but social support did not. In the combined model that included all significant psychosocial predictors from previous analyses, baseline self-efficacy (β = .37, p = .001) and its increase (β = .35, p < .001) emerged as independent predictors of improved adherence at 6 months.
Promoting self-efficacy and reducing depressive symptoms may be promising targets of behavioral interventions to facilitate long-term disease management in HF patients.
药物治疗依从性差是一个严重的问题，会干扰心力衰竭（HF）患者的疾病管理，并导致临床结局不佳。很少有前瞻性研究在 HF 患者中随时间检查依从性的心理社会预测因子。
本研究考察了抑郁、自我效能、社会支持及其变化对 HF 患者 6 个月内自我报告的药物依从性的影响。
参与者为 252 名 HF 门诊患者，其中 168 名完成了随访评估。进行层次多重回归分析，以检验心理社会变量及其变化是否在调整基线依从性、年龄、性别、种族、婚姻状况、教育程度、HF 严重程度、合并症和精神卫生治疗后，能前瞻性预测 6 个月时的依从性。
基线自我效能（β=.22，p<.05）、自我效能增加（β=.34，p<.001）和抑郁减轻（β=-.15，p=.05）预测 6 个月时的依从性提高，但社会支持则不然。在包括之前分析中所有显著心理社会预测因子的综合模型中，基线自我效能（β=.37，p=.001）及其增加（β=.35，p<.001）是 6 个月时依从性提高的独立预测因子。
促进自我效能和减轻抑郁症状可能是针对 HF 患者进行行为干预以促进长期疾病管理的有前途的目标。
