基于健康信念模型(HBM)的社区冠心病患者遵医行为影响因素的横断面研究

目的 以健康信念模型（health belief model，HBM）为理论基础，探索影响冠心病患者遵医行为的影响因素。方法 采用横断面调查研究，对上海市静安区189例社区冠心病患者进行问卷调查。调查内容包括人口社会学特征、冠心病患病情况、健康信念模型维度（疾病易感性、疾病严重性、行为益处、行为障碍和自我效能）；通过Morisky量表评价服药依从性和健康促进生活方式量表Ⅱ（health promoting lifestyle profile Ⅱ，HPLP-Ⅱ）评价健康生活方式的依从性。采用t检验和F检验分析人口学特征对健康促进生活方式和遵医服药行为的影响。采用Pearson相关分析和多元线性回归分析健康信念模型各维度与健康促进生活方式和遵医服药行为之间的关系。结果 189例患者中，男性占38.6%，女性占61.4%，137例大于60岁。健康信念模型各维度与健康促进生活方式各维度及遵医服药行为均成显著正相关，r值为0.173~0.734。多元线性回归分析结果显示：感知障碍（β=0.190，P=0.021）对健康责任的影响有统计学意义（R²=0.073，P=0.016），感知易感性（β=0.134，P=0.008）对身体活动的影响有统计学意义（R²=0.274，P<0.001），感知严重性（β=0.221，P=0.005）和感知益处（β=0.100，P=0.008）对精神成长的影响有统计学意义（R²=0.423，P<0.001），感知益处（β=0.181，P=0.026）对压力管理的影响有统计学意义（R²=0.302，P<0.001）；感知易感性（β=0.689，P=0.027）、感知严重性（β=0.580，P=0.003）、感知障碍（β=0.689，P=0.002）和自我效能（β=0.417，P=0.023）对遵医服药行为的影响有统计学意义（R²=0.645，P<0.001）。结论 健康信念模型中各维度对冠心病患者的遵医服药行为和健康促进生活方式有影响，可以通过提升患者的健康信念，增强冠心病患者遵医服药行为和健康生活方式的依从性。

Factors associated with medication adherence in community patients with coronary artery disease based on health belief model(HBM): a cross-sectional study

Objective To explore factors affecting medication adherence in patients with coronary artery disease (CAD) based on Health Belief Model (HBM). Methods This community register-based,cross-sectional study consisted of individuals diagnosed with CAD in Jing'an District of Shanghai (n=189).The data were obtained through face-to-face interviews using a questionnaire covering sociodemographic characteristics,CAD status,HBM variables,Health-Promoting Lifestyle Profile Ⅱ (HPLP-Ⅱ),and the 8-item Morisky Medication Adherence Scales (MMAS-8).The independent two-sample t-test and F-test were used to analyze the influence of demographic characteristics on health-promoting lifestyle and medication adherence.Pearson's correlations were used to analyze associations among variables.Multiple linear regression models were used to evaluate effects of HBM variables on adherence to medication behavior,and health-promoting lifestyles. Results Among the 189 patients,38.6% were males and 61.4% were females, 137 cases were over 60 years old. There were significant positive correlations between the HBM variables, adherence to health promoting lifestyles and medication behavior. The value of the correlation coefficient varies from 0.173 to 0.734. Multiple linear regression analysis suggested that the perceived barriers (β=0.190,P=0.021) on health responsibility (R²=0.073,P=0.016),the perceived susceptibility (β=0.134,P=0.008) on physical activity (R²=0.274,P<0.001),the perceived severity (β=0.221,P=0.005) and the perceived benefits (β=0.100,P=0.008) on mental growth (R²=0.423,P<0.001),the perceived benefit (β=0.181,P=0.026) on stress management (R²=0.302,P<0.001),were significant impact factors,respectively.Additionally,the perceived susceptibility (β=0.689,P=0.027),perceived severity (β=0.580,P=0.003),perceived impairment (β=0.689,P=0.002),and self-efficacy (β=0.417,P=0.023) had a statistically significant effects on medication behavior (R²=0.645,P<0.001). Conclusion The HBM provides a useful framework for investigating predictors of medication adherence in patients with CAD.Future intervention to improve medication adherence should focus on changing the health beliefs among patients with CAD.