基于知信行模型肺结核患者治疗依从行为影响因素及应对方式的中介调节作用研究

Moderated-mediating effect of influencing factors and coping styles of treatment adherence in pulmonary tuberculosis patients based on knowledge-attitude-practice model

目的 基于知信行模型探讨肺结核患者治疗依从行为的影响因素以及应对方式对治疗依从行为的调节作用。方法 于2021年4月8日至6月9日,从重庆市公共卫生医疗救治中心结核病门诊招募231名肺结核患者,男性133名,女性98名,年龄(26.97±8.57)岁。通过线上问卷调查,收集患者的一般人口学资料,治疗依从认知、信念以及行为水平,应对方式类型(面对、逃避、屈服)及水平。结果 (1)依从认知(β=3.014)、依从信念(β=0.505)对依从行为均有正向预测作用(P<0.01)。(2)依从认知对依从信念有正向预测作用(β=2.587,P<0.01)。(3)屈服在较低水平(■-1s)和平均水平(■)时,依从信念对依从行为的预测作用均有意义(ρ=0.483,95%CI:0.293~0.674,P<0.01;ρ=0.271,95%CI:0.170~0.373,P<0.01),而屈服达到较高水平(■+1s)时,依从信念对依从行为的预测作用无意义(ρ=0.059,95%CI:-0.071~0.189)。(4)回避与依从认知的交互作用对依从信念有负向预测作用(β=-0.144,P<0.05),面对与依从认知的交互作用对依从信念有正向预测作用(β=0.066,P<0.05)。结论 依从认知和信念的提升均可促进结核患者依从行为的发生;屈服应对程度的降低,有利于肺结核患者增强依从信念,建立依从行为。

Objective To explore the influencing factors of patient adherence behavior to tuberculosis treatment based on knowledge-attitude-practice(KAP) model and investigate the moderating effect of coping styles on the behaviors. Methods A total of 231 pulmonary tuberculosis patients were recruited from the Tuberculosis Clinic of Chongqing Public Health Medical Center from April 8 to June 9, 2021. There were 133 males and 98 females, with an average age of 26.97±8.57 years. A cross-sectional survey was conducted using a Web-based questionnaire to collect their demographic data, knowledge, attitudes and self-reported practice behaviors related to treatment compliance, and coping styles(confrontation, avoidance and acceptance-resignation). Results(1)Adherence knowledge and attitudes showed positive predictive effect on adherence behavior(β=3.014, β=0.505, P<0.01);(2) Adherence knowledge had positive predictive effect on adherence attitudes(β=2.587, P<0.01);(3) Adherence attitudes still showed significant predictive effect on adherence behavior even when acceptance-resignation at lower level(■-1s)and average level■: 0.293~0.674, P<0.01;ρ=0.271, 95%CI: 0.170~0.373, P<0.01), but the effect was not significant when acceptance-resignation at high level(■■+1s);(4) The interaction between avoidance and adherence knowledge showed negative predictive effect on adherence attitudes(β=-0.144, P<0.05), while the interaction between confrontation and adherence knowledge was positive predictor for adherence attitudes(β=0.066, P<0.05). Conclusion Improvement of adherence knowledge and attitudes contribute to adherence behavior. A decreased acceptance-resignation level can help the pulmonary tuberculosis patients enhance adherence attitude and promote their adherence behavior.