健康信念在非瓣膜性心房颤动患者疾病感知与服药依从性之间的中介效应研究

Mediating Effect of Health Beliefs on Disease Perception and Medication Adherence in Patients with Non-Valvular Atrial Fibrillation

目的探讨健康信念在非瓣膜性心房颤动(NVAF)患者疾病感知与服药依从性之间的中介效应。方法采用便利抽样法选取2019年1月至2022年8月于皖南医学院第二附属医院收治的NVAF患者为调查对象。采用一般资料调查表、Champion健康信念模型量表(CHBMS)、简易疾病感知问卷(BIPQ)和Morisky服药依从性量表(MMAS)对其进行问卷调查,采用Pearson相关分析探讨NVAF患者CHBMS总分、BIPQ总分、MMAS总分及各维度得分的相关性,构建结构方程模型并采用偏差校正Bootstrap法进行检验。结果共发放问卷340份,回收有效问卷327份,有效回收率为96.18%。327例NVAF患者CHBMS总分为(104.7±12.3)分,BIPQ总分为(58.3±7.4)分,MMAS总分为(5.7±0.6)分。不同年龄、居住情况、医疗负担及是否发生药物不良反应NVAF患者MMAS总分比较,差异有统计学意义(P<0.05)。Pearson相关分析结果显示,NVAF患者CHBMS总分及其各维度得分与BIPQ总分及其各维度得分均呈负相关,与MMAS总分均呈正相关(P<0.05);MMAS总分与BIPQ总分及其各维度得分均呈负相关(P<0.05)。疾病感知可以负向影响服药依从性(β=-0.49,P<0.05)和健康信念(β=-0.45,P<0.05),健康信念可以正向影响服药依从性(β=0.37,P<0.05)。健康信念的间接效应值为0.17,中介效应值占总效应的25.42%。结论NVAF患者健康信念、疾病感知及服药依从性均处于中等水平。疾病感知可以负向影响服药依从性和健康信念,健康信念可以正向影响服药依从性,且健康信念在NVAF患者疾病感知与服药依从性间具有部分中介效应。

Objective To investigate the mediating effect of health beliefs on disease perception and medication adherence in patients with non-valvular atrial fibrillation(NVAF).Methods A convenient sampling method was used to select patients with NVAF admitted to the Second Affiliated Hospital of Wannan Medical College from January 2019 to August 2022.A questionnaire survey was conducted using general information questionnaire,Champion Health Belief Model Scale(CHBMS),Brief Illness Perception Questionnaire(BIPQ)and Morisky Medication Adherence Scale(MMAS).Pearson correlation analysis was used to explore the correlation between the total scores of CHBMS,BIPQ,MMAS and various dimension score in patients with NVAF.A structural equation model was established and tested using the deviation corrected Bootstrap method.Results A total of 340 questionnaires were distributed and 327 valid questionnaires were returned,with a valid return rate of 96.18%.In patients with NVAF,the total score of CHBMS was(104.7±12.3),the total score of BIPQ was(58.3±7.4),the total score of MMAS was(5.7±0.6).There was significant difference in the total score of MMAS among NVAF patients with different age,living conditions,medical burden and with or without adverse drug reactions(P<0.05).Pearson correlation analysis showed that the total score of CHBMS and each dimension score in NVAF patients were negatively correlated with the total score of BIPQ and each dimension score,and positively correlated with the total score of MMAS(P<0.05);the total score of MMAS was negatively correlated with the total score of BIPQ and each dimension score(P<0.05).Disease perception can negatively affect medication adherence(β=-0.49,P<0.05)and health beliefs(β=-0.45,P<0.05),health beliefs can positively affect medication adherence(β=0.37,P<0.05).The indirect effect value of health beliefs was 0.17,and the intermediary effect value accounts for 25.42%of the total effect.Conclusion The health beliefs,disease perception,and medication adherence in patients with NVAF are all at a moderate level.Disease perception can negatively affect medication adherence as well as health beliefs,while health beliefs can positively affect medication adherence,and health beliefs have a partial mediating effect between disease perception and medication adherence in patients with NVAF.