Fu Feng, Jiang Jing, Gu Wenchao, Li Leijiang, Zhang Jing, Deng Xiurui, Liu Chao, Tian Lingyun, Li Yinglan
Nursing Department of Xinjiang Medical University, 567 Shangde North Road, Urumgi, Xinjiang Uygur Autonomous Region, 830000, China.
Health Care Research Center for Xinjiang Regional population, 567 Shangde North Road, Urumgi, Xinjiang UygurAutonomous Region, 830000, China.
BMJ Open. 2025 May 6;15(5):e090983. doi: 10.1136/bmjopen-2024-090983.
This study aims to identify factors influencing medication adherence for deep vein thrombosis (DVT) prophylaxis in post-discharge patients after joint replacement surgery using Protection Motivation Theory (PMT).
This study employed qualitative semi-structured interviews with patients discharged after hip or knee replacement surgery.
Using purposive sampling to ensure a diverse representation of patient profiles, participants were recruited from patients who underwent total knee replacement surgery from April 2024 to May 2024 and were discharged 1-month prior.
12 patients who had undergone total knee replacement surgery participated in the study. The median (IQR) age of participants was 57.5 (55-67.25) years.
Semi-structured interviews were conducted via online video calls. These interviews were audio recorded and transcribed verbatim. Data were analysed using Colaizzi's seven-step method. Themes were identified based on the dimensions of the PMT: susceptibility, severity, internal rewards, external rewards, response efficacy, self-efficacy and response costs. Two researchers independently coded and extracted themes, with discrepancies resolved through team discussions and verification with respondents.
Participants acknowledged the importance of adhering to anticoagulant medication to prevent DVT and its complications, understanding the severe consequences, such as the life-threatening nature of pulmonary embolism and the impact on daily activities. Perceived health status influenced adherence, with some participants feeling their good health negated the need for anticoagulants. External factors, including the desire to avoid side effects and financial constraints, also played significant roles in adherence decisions. Belief in the effectiveness of anticoagulants motivated adherence, but confidence in managing medication varied among participants. Practical barriers such as physical limitations and psychological burdens significantly impacted adherence.
Improving medication adherence requires a multifaceted approach addressing cognitive, motivational and practical barriers. Continuous education, financial assistance, support systems and tailored interventions are crucial. PMT provides a robust framework for understanding and enhancing adherence behaviours, ultimately improving health outcomes in post-discharge joint replacement patients.
本研究旨在运用保护动机理论（PMT）确定影响关节置换术后出院患者预防深静脉血栓形成（DVT）药物依从性的因素。
本研究采用质性半结构式访谈法，对髋关节或膝关节置换术后出院的患者进行访谈。
采用目的抽样法以确保患者特征的多样化代表性，研究对象从2024年4月至2024年5月接受全膝关节置换手术且提前1个月出院的患者中招募。
12例接受全膝关节置换手术的患者参与了本研究。参与者的年龄中位数（四分位间距）为57.5（55 - 67.25）岁。
通过在线视频通话进行半结构式访谈。访谈进行了录音并逐字转录。数据采用Colaizzi七步法进行分析。根据保护动机理论的维度确定主题：易感性、严重性、内部奖励、外部奖励、反应效能、自我效能和反应成本。两名研究人员独立编码并提取主题，通过团队讨论和与受访者核实解决分歧。
参与者认识到坚持服用抗凝药物以预防深静脉血栓形成及其并发症的重要性，了解到严重后果，如肺栓塞危及生命的性质以及对日常活动的影响。感知到的健康状况影响依从性，一些参与者认为自己身体健康便无需服用抗凝剂。外部因素，包括避免副作用的愿望和经济限制，在依从性决策中也发挥了重要作用。对抗凝剂有效性的信念促使患者坚持服药，但参与者在管理药物方面的信心各不相同。身体限制和心理负担等实际障碍对依从性有显著影响。
提高药物依从性需要采取多方面措施，解决认知、动机和实际障碍。持续教育、经济援助、支持系统和量身定制的干预措施至关重要。保护动机理论为理解和增强依从行为提供了一个有力的框架，最终改善出院后关节置换患者的健康结局。
