注意缺陷多动障碍儿童服药依从性的定性研究

A thematic framework analysis of medication adherence for children with attention-deficit/hyperactivity disorder:What do parent say?

目的:探索注意缺陷多动障碍(ADHD)儿童服药依从性的相关因素,为制定提高服药依从性的策略提供依据。方法:选取17名7～13岁符合美国精神障碍诊断与统计手册第4版(DSM-IV)ADHD诊断标准的儿童的家长20名进行半结构式访谈,利用主题框架法并借助定性分析软件对资料进行分析。结果:副作用是ADHD儿童家长做出开始服药决定最主要的阻碍因素,对症状严重性的感知是家长做出开始服药决定最主要的促成因素。服药过程中,药物副作用是家长最大的顾虑。服药前后,改善最大的方面是注意力、多动、冲动等核心症状和日常学习生活能力,而同伴交往技能、家长互动能力和自尊心短期内改善不显著。病情的改善会激励家长依从药物治疗,反之则会动摇坚持服药。结论:提高ADHD儿童服药依从性的健康传播策略开发可以着眼于药物副作用、疾病危害等核心信息,并不断促使家长对患儿症状点滴改善的感受和知觉。

Objective： To explore factors related to the medication adherence of attention-deficit/hyperactivity disorder （ADHD） then further develop specific health interventions to improve adherence. Methods： Twenty parents of 17 children with ADHD meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV） were selected. A semi-structure interview was conducted, audio-taped, noted, and transcribed verbatim. Thematic framework analysis was conducted with the help of MAXQDA software. Results： Adverse effect of medication for children of ADHD was the gravest barrier regarding parents＇ decision of medication initiation, while the perceived seriousness of ADHD, especially about the impaired learning ability in school, was the most important factor that would influence parent＇s initiation decision. During treatment, the adverse effect of drugs was the gravest concerns of parents, even resulting in discontinuation of drugs. Medication brought apparent im- provement in the ADHD core symptoms （inattention, hyperactivity and impulsiveness） and in the ability to do school work, while improvement in peer relationship and parent-child interaction was not apparent. Some improvement of the ADHD symptoms would promote medication adherence and vice versa. Conclusion： It suggests that the health intervention focusing on adverse effect of medication may promote parent＇ s decision of medication initiation and maintenance, the perceived improvement of symptoms could contribute to adherence as well.