Shen Bingjie, Guan Tianjia, Du Xinyu, Pei Chenyang, Zhao Jinhong, Liu Yuanli
School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
Patient Prefer Adherence. 2022 May 18;16:1257-1268. doi: 10.2147/PPA.S363148. eCollection 2022.
Previous studies suggested perceived social support has impact on medication adherence among hypertensive patients, but did not simultaneously elucidate the different contents or key providers of social support that patients perceived. This study was to identify the contents and providers of perceived social support beneficial for improving medication adherence among hypertensive patients in China, which could prove important for targeted interventions.
Following a multi-stage stratified sampling framework, a total of 903 hypertensive patients from 12 primary health institutions across a middle-income city were recruited from April to June 2021. Medication adherence was measured using the Chinese version of the Morisky, Green and Levine scale; perceived social support was determined using the name generator method. A binary logistic regression model was performed to identify the association between medication adherence and perceived social support. The contents of support included informational, emotional, and instrumental support (finances and caregiving). The support providers included spouse/partner, children, parents, siblings, other relatives, and friends.
A total of 506 (56.04%) patients optimally adhered to their antihypertensive medication. Female, older, urban patients, patients with shorter duration of hypertension and antihypertensive medications used showed better adherence (<0.05). Optimal medication adherence was positively associated with the overall score of caregiving support (adjusted odds ratio [] = 1.128; 95% confidence interval [] = [1.013-1.257]), informational support from the spouse/partner ( = 1.574; 95% = [1.112-2.227]), emotional support from the spouse/partner ( = 1.430; 95% = [1.032-1.981]), financial support from the spouse/partner ( = 1.439; 95% = [1.069-1.937]) and caregiving support from the spouse/partner ( = 1.652; 95% = [1.130-2.414]), whereas optimal medication adherence was negatively associated with caregiving support from friends ( = 0.499; 95% = [0.286-0.872]).
Informational, emotional, financial and caregiving support from spouses/partners have positive impacts on optimal medication adherence of hypertensive patients of community-level. Community-based interventions designed to improve medication adherence of hypertensive patients should target both patients and their spouses/partners; spouses/partners could be encouraged to provide various support to improve the medication adherence of hypertensive patients.
以往研究表明，感知到的社会支持对高血压患者的用药依从性有影响，但未同时阐明患者感知到的社会支持的不同内容或关键提供者。本研究旨在确定有利于提高中国高血压患者用药依从性的感知社会支持的内容和提供者，这可能对有针对性的干预措施具有重要意义。
按照多阶段分层抽样框架，于2021年4月至6月从一个中等收入城市的12家基层医疗卫生机构招募了903例高血压患者。使用中文版的Morisky、Green和Levine量表测量用药依从性；采用提名生成法确定感知到的社会支持。进行二元逻辑回归模型以确定用药依从性与感知到的社会支持之间的关联。支持内容包括信息支持、情感支持和工具性支持（经济和照料）。支持提供者包括配偶/伴侣、子女、父母、兄弟姐妹、其他亲属和朋友。
共有506例（56.04%）患者最佳地坚持服用降压药物。女性、年龄较大、城市患者、高血压病程较短且使用降压药物的患者依从性较好（<0.05）。最佳用药依从性与照料支持总分呈正相关（调整优势比[]=1.128；95%置信区间[]=[1.013 - 1.257]），与配偶/伴侣提供的信息支持（=1.574；95% =[1.112 - 2.227]）、配偶/伴侣提供的情感支持（=1.430；95% =[1.032 - 1.981]）、配偶/伴侣提供的经济支持（=1.439；95% =[1.069 - 1.937]）以及配偶/伴侣提供的照料支持（=1.652；95% =[1.130 - 2.414]）呈正相关，而最佳用药依从性与朋友提供的照料支持呈负相关（=0.499；95% =[0.286 - 0.872]）。
配偶/伴侣提供的信息、情感、经济和照料支持对社区层面高血压患者的最佳用药依从性有积极影响。旨在提高高血压患者用药依从性的社区干预措施应针对患者及其配偶/伴侣；可鼓励配偶/伴侣提供各种支持以提高高血压患者的用药依从性。
