De Las Cuevas Carlos, de Leon Jose
Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Canary Islands, Spain,
Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA.
Patient Prefer Adherence. 2019 Apr 10;13:527-536. doi: 10.2147/PPA.S201144. eCollection 2019.
Our previous studies with regard to adherence to psychiatric medications measured pharmacophobia, psychological reactance, and locus of control using a 42-item questionnaire requiring ~1.5 hours for completion. This study aims to develop the Patient's Health Belief Questionnaire on Psychiatric Treatment, a 17-item inventory which requires only 15 minutes to complete.
Our new questionnaire with five subscales was based on 17 items from three previously validated scales (on pharmacophobia, psychological reactance, and locus of control). In 588 consecutive Spanish psychiatric outpatients taking 1,114 psychiatric medications, we studied the responses to the questionnaire; to validate it, medication adherence was assessed by the Sidorkiewicz tool.
Validation of the construct was addressed by performing two exploratory factor analyses independent of each other (one for the eight-item section measuring the attitudes of patients toward psychotropic drugs and one for the nine-item section measuring perceived health locus of control [HLOC]), which led to five subscales that were called Positive and Negative Aspects of Medications, Doctor-HLOC, Internal-HLOC, and Psychological Reactance. The five subscales showed better internal consistency when corrected by number of items than the original 17-item scale. Logistic regression models of the continuous scores, dichotomized subscales, and Chi-squared Automatic Interaction Detector (CHAID) analysis indicated that all five subscales help in predicting adequate adherence, although the various subscales behave differently in different analyses.
Future studies need to verify and further extend the preliminary findings of this study that the questionnaire may have construct and predictive validity.
我们之前关于精神科药物依从性的研究使用一份42项的问卷来测量药物恐惧、心理抗拒和控制点，完成该问卷大约需要1.5小时。本研究旨在开发《患者精神科治疗健康信念问卷》，这是一份17项的量表，只需15分钟即可完成。
我们新的问卷有五个分量表，基于之前三个经过验证的量表（关于药物恐惧、心理抗拒和控制点）中的17个项目。在588名连续服用1114种精神科药物的西班牙精神科门诊患者中，我们研究了他们对问卷的回答；为了验证该问卷，通过西多凯维茨工具评估药物依从性。
通过进行两次相互独立的探索性因素分析来验证结构效度（一次针对测量患者对精神药物态度的八项部分，一次针对测量感知健康控制点[HLOC]的九项部分），这产生了五个分量表，分别称为药物的积极和消极方面、医生-HLOC、内部-HLOC和心理抗拒。与原始的17项量表相比，这五个分量表在按项目数量校正后显示出更好的内部一致性。连续得分、二分法分量表的逻辑回归模型以及卡方自动交互检测器（CHAID）分析表明，所有五个分量表都有助于预测足够的依从性，尽管各个分量表在不同分析中的表现有所不同。
未来的研究需要验证并进一步扩展本研究的初步发现，即该问卷可能具有结构效度和预测效度。
