基于COM⁃B模型的老年慢性心力衰竭病人服药依从性影响因素  

Influencing factors of medication adherence among older patients with chronic heart failure:an analysis based on COM⁃B model

作　　者：谢传桃 顾艳荭 李玉梅 孙娜 蒋锐杰 XIE Chuantao;GU Yanhong;LI Yumei;SUN Na;JIANG Ruijie(Shanghai Fifth People's Hospital,Fudan University/Center of Community-Based Health Research,Fudan University,Shanghai 200240 China)

机构地区：[1]复旦大学附属上海市第五人民医院、复旦大学社区健康研究中心,上海200240

出　　处：《护理研究》2024年第2期246-251,共6页Chinese Nursing Research

基　　金：复旦大学附属上海市第五人民医院院级医学重点专科建设计划项目,编号:2020WYZDZK10;复旦大学附属上海市第五人民医院院内护理科研课题,编号:2022WYHLZT01。

摘　　要：目的:了解老年慢性心力衰竭病人服药依从性现状,基于能力、机会、动机⁃行为(COM⁃B)模型分析药物素养、认知功能、社会支持及服药信念对服药依从性的作用路径。方法:便利抽取2022年1月—9月复旦大学附属上海市第五人民医院心内科收治的412例老年慢性心力衰竭病人为研究对象,采用一般资料调查表、Morisky服药依从性量表(MMAS)、简易智能状态检查量表(MMSE)、社会支持量表(SSRS)、药物素养评估量表(MedLitRxSE)、服药信念特异性量表(BMQ⁃specific)进行调查,采用结构方程模型进行路径分析。结果:老年慢性心力衰竭病人MMAS得分为(5.75±1.75)分,服药依从性差189例(45.9%)。药物素养、认知功能、社会支持和服药信念对服药依从性均有直接影响,效应值分别为0.278,0.099,0.127和0.531。药物素养还可通过服药信念间接影响服药依从性,效应值为0.146;认知功能还可通过药物素养、服药信念间接影响服药依从性,效应值为0.167;社会支持还可通过药物素养间接影响服药依从性,效应值为0.151。结论:老年慢性心力衰竭病人服药依从性水平较低,药物素养、认知功能、社会支持均可通过直接或间接效应对服药依从性产生影响,服药信念直接影响病人服药依从性。Objective:To investigate the status quo of medication adherence among older patients with chronic heart failure,and to analyze pathways of medication literacy,cognitive function,social support,and medication beliefs on medication adherence based on capacity,opportunity,motivation⁃behavior(COM⁃B)model.Methods:A total of 412 older patients with chronic heart failure admitted to the Department of Cardiology,Shanghai Fifth People's Hospital,Fudan University were conveniently selected as subjects from January to September 2022.General information questionnaire,Morisky Medication Adherence Scale(MMAS),Mini⁃Mental State Examination(MMSE),Social Support Rated Scale(SSRS),Medication Literacy Assessment in Spanish and English(MedLitRxSE)and The Beliefs about Medicines Questionnaire⁃Specific(BMQ⁃specific)were used for investigation.A structural equation modeling was adopted for path analysis.Results:The MMAS score of older patients with chronic heart failure was 5.75±1.75,189 patients(45.9%)had poor medication adherence.Medication literacy,cognitive function,social support,and medication beliefs had direct impact on medication adherence,and the effect were 0.278,0.099,0.127 and 0.531,respectively.Medication literacy also indirectly affected medication adherence through medication belief,with effect of 0.146.Cognitive function also indirectly affected medication adherence through medication literacy and medication beliefs,with effect of 0.167.Social support also indirectly affected medication adherence through medication literacy,with effect of 0.151.Conclusions:Older patients with chronic heart failure have low medication adherence level.Medication literacy,cognitive function,and social support all affect medication adherence through direct or indirect effects,and medication beliefs directly affect medication adherence.

关 键 词：老年人 心力衰竭 服药依从性 药物素养 认知功能 社会支持 服药信念 路径分析 

分 类 号：R473.5[医药卫生—护理学]