Wu Jianbo, Shen Jie, Tao Zhujun, Song Zhongjuan, Chen Zhi-Long
Department of Pharmacy, Huadong Hospital, Fudan University, Shanghai, People's Republic of China.
Patient Prefer Adherence. 2023 Jan 21;17:217-226. doi: 10.2147/PPA.S382362. eCollection 2023.
Poor antidiabetic medication adherence remains a great barrier to effective diabetes self-management among aging adults. This study investigates the mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence in elderly patients with type 2 diabetes.
This cross-sectional study evaluated a sample of 309 hospitalized elderly patients who completed the assessment of medication beliefs, self-efficacy for medication uses and medication adherence in a tertiary hospital in Shanghai, China. A bootstrapping sampling method and hierarchical moderator regression analysis were used to verify the hypothesis of mediation and moderation effects of self-efficacy on the relationship between medication beliefs and adherence.
Self-efficacy for medication use acted as a moderator (=-0.063, =-2.215, =0.028) and partial mediator (CI=4.5-16.63, =0.001; CI=1.524-5.323, =0.014; CI=2.151-11.817, =0.001) on the relationship between general harm medication beliefs and medication adherence. Participants with lower general harm medication beliefs may develop higher self-efficacy, which, in turn, results in a higher level of medication adherence, and higher self-efficacy may attenuate the negative effect of high general harm medication beliefs on medication adherence.
Self-efficacy for medication use not only mediated the relationship between general harm beliefs about medication and medication adherence, but moderated it negatively. The findings of this study indicate an opportunity to improve the prognosis of elderly Chinese patients with type 2 diabetes through improved medication adherence by strengthening factors such as self-efficacy for appropriate medication use and general harm beliefs about medication.
抗糖尿病药物依从性差仍然是老年人有效进行糖尿病自我管理的一大障碍。本研究调查自我效能感在老年2型糖尿病患者药物信念与依从性之间关系中的中介作用和调节作用。
这项横断面研究评估了309名住院老年患者的样本，这些患者在中国上海的一家三级医院完成了药物信念、药物使用自我效能感和药物依从性的评估。采用自抽样法和分层调节回归分析来验证自我效能感在药物信念与依从性之间关系中的中介作用和调节作用的假设。
药物使用自我效能感在一般有害药物信念与药物依从性之间的关系中起到调节作用（β=-0.063，t=-2.215，p=0.028）和部分中介作用（95%CI=4.5-16.63，p= =0.001；95%CI=1.524-5.323，p=0.014；95%CI=2.151-11.817，p=0.001）。一般有害药物信念较低的参与者可能会产生较高的自我效能感，进而导致更高的药物依从性，而较高的自我效能感可能会减弱高一般有害药物信念对药物依从性的负面影响。
药物使用自我效能感不仅介导了关于药物的一般有害信念与药物依从性之间的关系，而且对其起到负向调节作用。本研究结果表明，通过加强适当药物使用的自我效能感和关于药物的一般有害信念等因素来提高药物依从性，从而改善中国老年2型糖尿病患者的预后。
