School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
Center for Technology and Behavioral Health, Dartmouth College, Hanover, USA.
Ethn Health. 2023 Oct;28(7):983-1005. doi: 10.1080/13557858.2023.2198683. Epub 2023 Apr 8.
(1) Evaluate changes in medication adherence and the role of psychosocial and interpersonal factors on adherence. (2) Explain the changes in medication adherence based on patient perceptions of adherence behaviors.
We used an explanatory sequential mixed methods design for surveys at baseline and 1-year follow-up, followed by interviews. The Integrated Theory of Health Behavior Change guided the design of a questionnaire including self-reported measures of medication adherence, psychosocial factors such as illness and medication beliefs, self-efficacy, and depressive symptoms, interpersonal factors including social support and patient-provider communication, and socio-demographic and clinical factors. A convenience sample ( = 228) of adult patients with type 2 diabetes who self-identified as Black/African American completed the mail/telephone surveys. Nine semi-structured interviews were conducted with respondents of both surveys who had changes in medication adherence. Descriptive, mean differential, bivariate correlational analyses, and content analysis was conducted. Data integration merged quantitative and qualitative results as a joint display.
Response rates for the baseline and follow-up survey were 28% and 47% respectively. Medication adherence scores were significantly correlated with illness perceptions ( = .30) and depression ( = .25) at baseline, and self-efficacy ( = -.51) and depression ( = .37) at follow-up. Qualitative themes included patient perceptions of adherence behaviors, impact of the COVID-19 pandemic, health literacy and self-efficacy. Mixed methods integration showed contrasting perceptions of the same themes including adherence behaviors, medication beliefs, social support, and patient-provider communication among participants whose medication adherence increased and decreased overtime.
Self-efficacy, diabetes beliefs, and depressive symptoms were key psychosocial factors that affected medication adherence among Blacks/African Americans. Contrasting perceptions of beliefs in medicines, social support, provider relationships and communication among increased and decreased adherence participant groups explained the changes in adherence, which can be used to adapt existing interventions.
（1）评估药物依从性的变化以及心理社会和人际因素对依从性的影响。（2）根据患者对药物依从行为的认知来解释药物依从性的变化。
我们采用了一个解释性的序贯混合方法设计，对基线和 1 年随访时的调查进行了调查，然后进行了访谈。健康行为改变综合理论指导了问卷的设计，包括自我报告的药物依从性测量、疾病和药物信念等心理社会因素、自我效能感和抑郁症状、包括社会支持和医患沟通在内的人际因素以及社会人口统计学和临床因素。一个便利样本（ = 228）的自我认定为黑人/非裔美国人的 2 型糖尿病成年患者完成了邮件/电话调查。对调查中药物依从性发生变化的受访者进行了 9 次半结构化访谈。进行了描述性、平均差异、双变量相关分析和内容分析。数据整合将定量和定性结果合并为联合展示。
基线和随访调查的回复率分别为 28%和 47%。药物依从性评分与疾病认知（ = .30）和抑郁（ = .25）在基线时显著相关，与自我效能（ = -.51）和抑郁（ = .37）在随访时显著相关。定性主题包括患者对药物依从行为的认知、COVID-19 大流行的影响、健康素养和自我效能。混合方法整合显示，在药物依从性增加和减少的参与者群体中，对相同主题的看法存在对比，包括药物依从行为、药物信念、社会支持和医患沟通。
自我效能感、糖尿病信念和抑郁症状是影响黑人/非裔美国人药物依从性的关键心理社会因素。在药物依从性增加和减少的参与者群体中，对药物信念、社会支持、提供者关系和沟通的看法存在对比，这解释了依从性的变化，可用于改进现有的干预措施。
