| Objectives:The purpose of this study was to(i)investigate the current status of medication adherence of persons with rheumatoid arthritis(RA);(ii)provide a theoretical basis for nursing intervention on persons with RA by exploring the influence of demographic and disease characteristics,physiological characteristics(functional disability)and social psychological characteristics(illness perception,social support,medication belief,self-efficacy and depression)on medication adherence of RA patients,utilizing the Capability,Opportunity,and Motivation Behaviour(COM-B)model.Methods:The quantitative research was designed as a cross-sectional and descriptive survey.A convenience sample of 225 patients with RA was recruited from one three level of first-class hospital in Wuhan from September to December 2020.Eight self-report questionnaires were administered to collect data,measuring sample characteristics,medication adherence(CQR),illness perception(BIPQ),functional disability(HAQ),social support(MSPSS),self-efficacy(ASES-8),belief about medicines(BMQ),and depression(PHQ-9).Descriptive statistics,the univariate analysis(independent t-test for two groups;one-way analysis of variance for three or more groups),the correlation analysis(Pearson’s correlation),and the multiple linear regression were carried out to analyze the data using IBM SPSS Statistics Version 20.0.Finally,based on the COM-B conceptual model and the above analysis results,a structured equation model of the relationship between each influencing factor and the adherence of RA patients was constructed.The parameters of the model were estimated using the AMOS24.0 statistical software maximum likelihood method.Results:1.The mean score of CQR was(68.18 ± 10.20).75.6% of the patients had a score lower than 80.2.The results showed that age was positively correlated with the medication adherence score of RA patients,and disease duration was negatively correlated with the medication adherence score of RA patients;the medication adherence score of patients with low education level,low income level,being unemployed,at their own expense and more than two types of medication was lower(p < 0.01 or p < 0.05).3.The average score of illness perception was(51.48±4.93),which was negatively correlated with the score of medication adherence(r=-0.690,p<0.01).The average score of functional disability was(0.85±0.29),which was negatively correlated with the score of medication adherence(r=-0.279,p<0.01).The average score of social support was(52.74±6.31),which was positively correlated with the score of medication adherence(r=0.579,p<0.01).The average score of self-efficacy was(4.81 ± 0.99),which was positively correlated with the score of medication adherence(r= 0.638,p<0.01).The average score of depression was(6.81±0.99),which was negatively correlated with the score of medication adherence(r=-0.667,p<0.01).4.The results of multiple linear regression analysis showed that medication belief(β=0.336,p<0.001),illness perception(β=-0.234,p<0.001),disease duration(β=-0.230,p<0.001),social support(β=0.199,p=0.009),functional disability(β=-0.198,p< 0.001),self-efficacy(β= 0.130,p= 0.011),depression(β=-0.123,p<0.002)and age(β=0.121,p= 0.04)were significantly associated with the score of medication adherence,which explained 71.7% of the total variation of medication adherence.5.The results of structural equation model analysis showed that negative illness perception(-0.404),positive medication belief(0.306),social support(0.275),functional disability(-0.272),depression(-0.212),disease duration(-0.211),age(0.168)and self-efficacy(0.156),which explained 65.7% of the total variance.Social support,disease cognition and functional disability have both direct and indirect effects on medication adherence,while medication belief,self-efficacy and depression have direct effects on medication adherence.Conclusion:1.The overall level of medication adherence of RA patients in China is lower.RA patients’ illness perception is negative and and their disability is mild.Persons with RA report negative medication belief,moderate social support and self-sfficacy,and the majority of patients are depressed.2.Illness perception,functional disability,social support,medication belief,self-efficacy,depression,disease duration and age are the factors that directly or indirectly affect the medication adherence of RA patients.In clinical practice,we should pay attention to the medication adherence of young patients.Utilizing COM-B model on behavioral intervention,we can formulate relevant measures to promote RA patients to establish positive Illness perception and medication belief,enhance self-efficacy,increase social support,prevent or alleviate functional disability,and improve depression psychological status.It is suggested that future studies can test the effect of the above intervention measures on medication adherence. |
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