Yang Chunsong, Deng Weiqi, Zeng Linan, Tao Qiuji, Zhang Lingli
Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
West China School of Pharmacy, Sichuan University, China.
Epilepsy Behav. 2025 Jan;162:110153. doi: 10.1016/j.yebeh.2024.110153. Epub 2024 Nov 29.
Based on the protection motivation theory (PMT), which is an extension of the health belief model that takes the "reward" brought by behavior in the long-term process as a consideration factor and considering the influence of environmental and social factors on behavior patterns, this cross-sectional study evaluated medication adherence among children with epilepsy using structural equation modeling.
Children with epilepsy from pediatric neurology clinics were consecutively sampled at West China Second Hospital of Sichuan University from July 2021 to January 2024. According to PMT, we designed the 23-item questionnaire, which included seven factors, namely severity, susceptibility, external return, internal returns, self-efficacy, reaction efficiency, and reaction cost. Medication adherence was assessed using the Morisky Medication Adherence Scale. The reliability and validity of the scale were tested by confirmatory factor analysis, and path analysis was used to conduct hypothesis testing and calculate standardized path coefficients.
We enrolled 1357 children with epilepsy (mean age, 8.36 ± 4.04 years). Younger age, being an only child, caregivers' unemployment, and comorbidities were associated with high medication adherence scores. The designed scale of PMT displayed good reliability and validity. Through path analysis of the structural equation model, self-efficacy, susceptibility, and severity exerted significant positive effects on adherence, and external return, internal returns, and reaction cost had significant negative effects on adherence.
Medication adherence in children with epilepsy is relatively poor. PMT can explain and predict the medication adherence behavior and behavior intention of patients with epilepsy. It is recommended to increase the health education, personalize medication guidance, and provide telephone interventions to caregivers of children with epilepsy to enhance medication adherence and further improve therapeutic efficacy.
基于保护动机理论（PMT），该理论是健康信念模型的延伸，将行为在长期过程中带来的“回报”作为考虑因素，并考虑环境和社会因素对行为模式的影响，本横断面研究采用结构方程模型评估癫痫患儿的药物依从性。
2021年7月至2024年1月期间，在四川大学华西第二医院儿科神经科门诊对癫痫患儿进行连续抽样。根据保护动机理论，我们设计了包含23个条目的问卷，其中包括七个因素，即严重性、易感性、外部回报、内部回报、自我效能感、反应效能和反应成本。使用Morisky药物依从性量表评估药物依从性。通过验证性因素分析检验量表的信效度，并采用路径分析进行假设检验和计算标准化路径系数。
我们纳入了1357例癫痫患儿（平均年龄8.36±4.04岁）。年龄较小、独生子女、照顾者失业和合并症与较高的药物依从性得分相关。所设计的保护动机理论量表显示出良好的信效度。通过结构方程模型的路径分析，自我效能感、易感性和严重性对依从性产生显著正向影响，而外部回报、内部回报和反应成本对依从性产生显著负向影响。
癫痫患儿的药物依从性相对较差。保护动机理论能够解释和预测癫痫患者的药物依从性行为及行为意图。建议加强健康教育、提供个性化用药指导，并对癫痫患儿的照顾者进行电话干预，以提高药物依从性并进一步改善治疗效果。
