频繁急性加重COPD患者吸入药物依从性影响因素的质性研究  

Factors influencing inhaled medication adherence in patients with frequent acute exacerbations of chronic obstructive pulmonary disease:a qualitative study

作　　者：陈美佳 胡玉玲 王为杰 龚钊乾 刘兵[1,2] 蔡绍曦 Chen Meijia;Hu Yuling;Wang Weijie;Gong Zhaoqian;Liu Bing;Cai Shaoxi(Department of Respiratory and Critical Care Medicine,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院呼吸与危重症医学科,广东广州510515 [2]南方医科大学护理学院

出　　处：《护理学杂志》2025年第5期37-41,47,共6页Journal of Nursing Science

基　　金：国家自然科学基金项目(82270024)。

摘　　要：目的了解频繁急性加重的慢性阻塞性肺疾病(COPD)患者使用吸入药物的影响因素,为制订相应的吸入药物依从性管理方案提供依据。方法基于能力、机会、动机-行为(COM-B)模型,通过目的抽样,采用描述性质性研究,对2023年11月至2024年1月就诊于南方医科大学南方医院的17例频繁急性加重的COPD患者进行半结构式访谈,运用定向内容分析法对资料进行分析。结果共提炼出3个主题及10个子主题,分别是能力因素(吸入药物使用技能、疾病和药物相关认知、药物自我管理);机会因素(家庭支持、医疗护理可及性不够、经济负担);动机因素(治疗自我效能、急性加重体验、感知治疗益处、疾病污名化)。结论频繁急性加重的COPD患者在使用吸入药物过程中面临多重挑战,应综合评估影响患者吸入药物依从性的能力、机会和动机因素,注重对其提供教育和培训以提升患者的技能和素养,同时创造良好的外部资源环境,以提升其吸入药物依从性。Objective To understand the factors influencing the inhaled medications in patients with frequent acute exacerbations of chronic obstructive pulmonary disease(COPD),and to provide a basis for the development of appropriate inhaled medication adherence management programs.Methods Based on the Capability,Opportunity,Motivation-Behavior(COM-B)model,a descriptive qualitative study was conducted.Using purposive sampling method,17 patients with frequent acute exacerbations of COPD who were admitted to Nanfang Hospital of Southern Medical University between November 2023 and January 2024 were selected for semi-structured interviews.Directed content analysis was employed to analyze the data.Results A total of 3 themes and 10 sub-themes were extracted,which were competency factors(inhaled medication use skills,disease and medication-related perceptions,and medication self-management),opportunity factors(family support,insufficient accessibility to medical care,and financial burden),and motivational factors(treatment self-efficacy,acute exacerbation experience,perceived treatment benefits,and disease stigmatization).Conclusion COPD patients with frequent acute exacerbations face multiple challenges in the use of inhaled medications,and should be comprehensively assessed for the capability,opportunity,and motivational factors affecting patient adherence to inhaled medications,with an emphasis on providing education and training to enhance patients′skills and literacy,as well as creating a favorable environment of external resources to enhance their adherence to inhaled medication adherence.

关 键 词：慢性阻塞性肺疾病 频繁急性加重 吸入药物 依从性 能力、机会、动机-行为模型 影响因素 质性研究 

分 类 号：R473.5[医药卫生—护理学]