Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.
PLoS One. 2019 Aug 30;14(8):e0221290. doi: 10.1371/journal.pone.0221290. eCollection 2019.
This study aims to explore the contribution of implicit attitudes and associations towards conventional disease-modifying antirheumatic drugs (cDMARDs), alongside explicit measures, on medication-taking behaviour and clinical outcomes in adult patients with rheumatoid arthritis (RA).
In this observational study, implicit attitudes (positive-negative) and health-related associations (health-sickness) were measured with Single Category Implicit Association Tests, whereas explicit outcomes were measured with a bipolar evaluative adjective scale and the Beliefs about Medicines Questionnaire Specific. The primary outcome of this study was medication-taking behaviour subjectively measured by self-report (i.e. validated Compliance Questionnaire on Rheumatology) and objectively measured with electronic drug monitors over a 3 month period. Spearman rank correlations were used to describe correlations between implicit and explicit outcomes. Nested linear regression models were used to assess the additional value of implicit measures over explicit measures and patient-, clinical-, and treatment-related characteristics.
Of the 1659 initially-invited patients, 254 patients with RA agreed to participate in this study. Implicit attitudes correlated significantly with necessity-concerns differential (NCD) scores (ρ = 0.13, P = 0.05) and disease activity scores (ρ = -0.17, P = 0.04), whereas implicit health-related associations correlated significantly with mean scores for explicitly reported health-related associations (ρ = 0.18, P = 0.004). Significant differences in age, number of DMARDs, biologic DMARD use, NCD-scores, and self-reported correct dosing were found between the four attitudinal profiles. Nested linear regression models revealed no additional value of implicit measures in explaining self-reported medication-taking behaviour and clinical outcomes, over and above all other variables.
Implicit attitudes and associations had no additional value in explaining medication-taking behaviour and clinical outcomes over and above often used explicitly measured characteristics, attitudes and outcomes in the studied population. Only age and NCD scores contributed significantly when the dependent variable was correct dosing measured with self-report.
本研究旨在探讨内隐态度和关联对接受传统疾病修正抗风湿药物（cDMARDs）的影响，以及对成年类风湿关节炎（RA）患者药物使用行为和临床结局的影响，这些影响是通过外显测量来评估的。
在这项观察性研究中，使用单类别内隐联想测验测量内隐态度（积极-消极）和与健康相关的关联（健康-疾病），而外显结果则使用双极评价形容词量表和专门的药物信念问卷进行测量。本研究的主要结果是通过自我报告（即经过验证的风湿病学用药依从性问卷）和电子药物监测器在 3 个月内进行客观测量来主观评估的药物使用行为。使用 Spearman 秩相关系数来描述内隐和外显结果之间的相关性。使用嵌套线性回归模型评估内隐测量相对于外显测量以及患者、临床和治疗相关特征的附加价值。
在最初邀请的 1659 名患者中，有 254 名 RA 患者同意参与本研究。内隐态度与必要性-关注差异（NCD）评分（ρ=0.13，P=0.05）和疾病活动评分（ρ=-0.17，P=0.04）显著相关，而内隐与健康相关的关联与明确报告的与健康相关的关联的平均得分显著相关（ρ=0.18，P=0.004）。在四个态度特征组之间，年龄、DMARD 数量、生物 DMARD 使用、NCD 评分和自我报告的正确剂量存在显著差异。嵌套线性回归模型表明，在内隐测量之外，没有其他变量能够对内隐测量在解释自我报告的药物使用行为和临床结局方面提供额外的价值。
在研究人群中，内隐态度和关联在外显测量的特征、态度和结果之外，对解释药物使用行为和临床结局没有额外的价值。只有年龄和 NCD 评分对自我报告的正确剂量这一因变量有显著贡献。
