B期心力衰竭患者感恩、自我效能感与药物依从性的结构方程模型
A Structural Equation Model of Gratitude, Self-efficacy, and Medication Adherence in Patients With Stage B Heart Failure.
作者信息
Cousin Lakeshia, Buck Harleah, Benitez Bryan, Mills Paul, Redwine Laura
机构信息
Lakeshia Cousin, PhD, APRN, AGPCNP-BC Postdoctoral Research Fellow, Moffitt Cancer Center, Tampa, Florida. Harleah Buck, PhD, RN, FPCN, FAAN Associate Professor, University of South Florida, College of Nursing, Tampa. Bryan Benitez, MS PhD Candidate, University of South Florida, Department of Psychology, Tampa. Paul Mills, PhD Professor, Family Medicine, and Public Health, University of California San Diego, School of Health Sciences, La Jolla. Laura Redwine, PhD Associate Professor, University of South Florida, College of Nursing, Tampa. The authors have no funding or conflicts of interest to disclose.
出版信息
J Cardiovasc Nurs. 2020 Nov/Dec;35(6):E18-E24. doi: 10.1097/JCN.0000000000000721.
BACKGROUND
Consistent self-care slows the progression of heart failure (HF). Gratitude, the practice of appreciating the positive aspects of life, may influence self-efficacy, which in turn is known to improve self-care. However, little is known about the relationships among gratitude, self-efficacy, and medication adherence in HF.
OBJECTIVE
The aim of this study was to test a model to determine if self-efficacy mediates the relationship between gratitude and medication adherence in asymptomatic patients with HF.
METHOD
This is a secondary analysis of data from a prospective observational study. Data were analyzed using a structural equation model to examine associations between gratitude, cardiac-specific self-efficacy, and medication adherence in 153 patients with HF. Gratitude, self-efficacy, and medication adherence were assessed using the Gratitude Questionnaire-6, Cardiac Self-efficacy Scale-Maintain Function Subscale, and the Morisky Medication Adherence Scale, respectively.
RESULTS
Patient mean (SD) age was 66 (11) years, and 95% of the participants were men. Patients were primarily white (79%), black (12%), or Asian (6%). Gratitude exerted an indirect effect on medication adherence through self-efficacy (b = 0.16; P < .05). Gratitude was positively related to self-efficacy (b = 0.50; P < .05), and self-efficacy was positively related to medication adherence (b = 0.31; P < .05). The model fit was acceptable (comparative fit index = 0.92, Tucker-Lewis index = 0.90, root-mean-square error of approximation = 0.08).
CONCLUSION
In this study, we found evidence that self-efficacy was a mechanism through which gratitude was associated with medication adherence in asymptomatic patients with HF, suggesting a way to improve self-care nonpharmacologically. Future work will examine whether gratitude intervention results in improved self-care.
背景
持续的自我护理可减缓心力衰竭（HF）的进展。感恩，即对生活中的积极方面心怀感激的行为，可能会影响自我效能感，而自我效能感又已知会改善自我护理。然而，关于感恩、自我效能感与心力衰竭患者药物依从性之间的关系，我们所知甚少。
目的
本研究旨在测试一个模型，以确定自我效能感是否在无症状心力衰竭患者中调节感恩与药物依从性之间的关系。
方法
这是一项对前瞻性观察性研究数据的二次分析。使用结构方程模型分析数据，以检验153例心力衰竭患者的感恩、心脏特异性自我效能感和药物依从性之间的关联。分别使用感恩问卷-6、心脏自我效能感量表-维持功能子量表和莫氏药物依从性量表评估感恩、自我效能感和药物依从性。
结果
患者的平均（标准差）年龄为66（11）岁，95%的参与者为男性。患者主要为白人（79%）、黑人（12%）或亚洲人（6%）。感恩通过自我效能感对药物依从性产生间接影响（b = 0.16；P < 0.05）。感恩与自我效能感呈正相关（b = 0.50；P < 0.05），自我效能感与药物依从性呈正相关（b = 0.31；P < 0.05）。模型拟合度可接受（比较拟合指数 = 0.92，塔克-刘易斯指数 = 0.90，近似均方根误差 = 0.08）。
结论
在本研究中，我们发现有证据表明自我效能感是无症状心力衰竭患者中感恩与药物依从性相关的一种机制，这提示了一种非药物改善自我护理的方法。未来的工作将研究感恩干预是否会改善自我护理。
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