经皮冠状动脉介入治疗后冠心病患者药物依从性的预测因素：基于计划行为扩展理论的结构方程模型
Predictors of Medication Adherence of Patients With Coronary Heart Disease After Percutaneous Coronary Intervention: A Structural Equation Modeling Based on the Extended Theory of Planned Behavior.
作者信息
He Qing-Hua, Zheng Jing, Liu Jia-Li, Wang Jun, You Li-Ming
出版信息
J Cardiovasc Nurs. 2022;37(4):350-358. doi: 10.1097/JCN.0000000000000755. Epub 2020 Oct 5.
BACKGROUND
The theory of planned behavior (TPB), combined with social support, forms the extended TPB, which has shown to predict adherence to health-related behavior effectively, but few studies have applied it to explain medication adherence in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).
OBJECTIVES
The aim of this study was to explore the factors associated with medication adherence and the underlying mechanisms based on the extended TPB among patients with CHD after PCI.
METHODS
A cross-sectional descriptive study was conducted among patients with CHD after PCI in 2 major hospitals in Guangzhou, China. Medication adherence was measured with the Medication Adherence Report Scale. Constructs of the TPB contributing to medication adherence were assessed by the Theory of Planned Behavior Questionnaire for Medication Adherence. Social support was measured by the Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to examine the hypotheses based on the extended TPB.
RESULTS
A total of 300 patients were surveyed and 26.0% of them were nonadherent. The structural equation modeling had good fit indices and estimated 62.6% of the variance in medication adherence. Regarding the relationships between the extended TPB constructs and medication adherence, "intention" was directly associated with medication adherence, and "perceived behavioral control" positively predicted medication adherence directly and indirectly. "Affective attitude" and "subjective norm" were indirectly associated with medication adherence through "intention." Social support exerted an indirect effect on medication adherence through "subjective norm."
CONCLUSIONS
The extended TPB is an appropriate model to predict medication adherence and provides an effective framework for adherence-enhancing interventions.
背景
计划行为理论（TPB）与社会支持相结合形成了扩展的TPB，已证明其能有效预测与健康相关行为的依从性，但很少有研究将其用于解释经皮冠状动脉介入治疗（PCI）后冠心病（CHD）患者的药物依从性。
目的
本研究旨在探讨PCI术后CHD患者中与药物依从性相关的因素及基于扩展TPB的潜在机制。
方法
在中国广州的2家大型医院对PCI术后的CHD患者进行了一项横断面描述性研究。采用药物依从性报告量表测量药物依从性。通过药物依从性计划行为问卷评估TPB中有助于药物依从性的结构。采用多维感知社会支持量表测量社会支持。使用结构方程模型检验基于扩展TPB的假设。
结果
共调查了300例患者，其中26.0%为非依从性患者。结构方程模型具有良好的拟合指数，估计了药物依从性方差的62.6%。关于扩展TPB结构与药物依从性之间的关系，“意图”与药物依从性直接相关，“感知行为控制”直接和间接正向预测药物依从性。“情感态度”和“主观规范”通过“意图”与药物依从性间接相关。社会支持通过“主观规范”对药物依从性产生间接影响。
结论
扩展的TPB是预测药物依从性的合适模型，并为增强依从性的干预措施提供了有效的框架。
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