| Objective:1.To understand the current situation of inhaled drug compliance in COPD patients,analyze the correlation among compliance,social support and medication belief,and explore the influencing factors of inhaled drug compliance in COPD patients.2.To develop a health education curriculum on inhaled drugs for patients with chronic obstructive pulmonary disease,and to develop an intervention program on inhaled drugs.3.To investigate the effect of health education based on the Greene model on the application of patients’ medication compliance,inhalation operation level,medication belief,quality of life,oxygen saturation and lung function,and to provide reference for improving the compliance of inhaled medication in patients with chronic obstructive pulmonary disease.Methods:1.Patients with COPD meeting the criteria were selected from the respiratory department of a Grade-A hospital in Yangzhou City from November 2021 to January 2022 by convenient sampling method,and the status of the patients was investigated by general data questionnaire,inhaled medication compliance scale,medication belief scale,and social support scale.To understand the level of inhaled medication compliance,influencing factors and the relationship between variables in patients with COPD.2.Literature review of intervention methods and contents of inhaled medication for COPD patients;collect ideas and suggestions of inhaled medication health education courses from COPD patients through qualitative interviews;construct the draft of inhaled medication health education program for COPD patients based on Green’s theory;revise the intervention program through expert consultation and preliminary tests;finally determine the implementation plan of health education.3.From June to December 2022,patients with COPD who were admitted to the respiratory Department of the Affiliated Hospital of Yangzhou University and met the criteria were selected by convenience sampling method.36 patients were included in the intervention group and control group,and 3 patients were withdrawn midway(2 in the control group and 1 in the observation group).A total of 69 patients,35 in the observation group and 34 in the control group,completed the complete intervention process.The control group received routine health education;The observation group received inhaled drug health education program based on Green model on the basis of routine health education.The total intervention time was 3 months,drug compliance,inhalation operation level,medication belief,quality of life and blood oxygen saturation of patients were evaluated before intervention,1 month,2 months and 3 months,and lung function of patients was evaluated at 3 months.Results:1.Cross-sectional survey results show that 207 patients had an adherence score of 35.81±9.03,of which 1.3%were at high level,62.2%were at low level,and 28.4%were at medium level.There were statistical differences in the adherence scores by age,education level,monthly income,residence status,duration of disease,frequency of use,knowledge of disease,and type of medication used daily(P<0.05),with a total score of 36.82 ±7.99 for social support and 1.01±4.55 for medication beliefs in patients with chronic obstructive pulmonary disease.There was a significant positive correlation between medication beliefs,social support and medication adherence(r=0.362,0.721,0.485,P<0.01).Age,monthly income level,disease knowledge,social support score,and medication adherence belief score explained 62.1%of the variance in medication adherence(r2=0.639).2.The inhaled drug health education program for COPD patients consists of five modules,which are disease knowledge teaching,skill guidance,self-efficacy improvement,behavior change and behavior change strengthening.Individual instruction,case sharing,telephone follow-up and WeChat platform were used to carry out the intervention twice during hospitalization,1 month,2 months and 3 months after discharge,with each intervention lasting about 45 minutes.3.A total of 69 subjects were included in the experimental study,including 35 in the observation group and 34 in the control group.(1)After intervention,there was a statistically significant difference in the intergroup effect of compliance between the two groups(P<0.05),and a statistically significant difference in the time effect(P<0.001),which showed an increasing trend over time.There was interaction effect between intervention mode and time(P<0.05).T-test showed that the scores of the observation group were higher than those of the control group at 1 month,2 months and 3 months of intervention,and the difference was statistically significant(P<0.05).The change of compliance score of the two groups was different,and the overall trend was increasing.(2)There was a statistically significant difference in the intergroup effect between the two groups of inhalation operation scores(P<0.001),and the time effect indicated that the inhalation operation scores of the two groups were affected by different time points(P<0.001)and showed an increasing trend over time.There was an interaction effect of intervention mode and time factor(P=0.001).T-test revealed that the score of the intervention group was higher than that of the control group,and the difference was statistically significant(P<0.05).The change of inhalation operation scores was different between the two groups,with an overall trend of increase,and the increase was higher in both intervention groups than in the control group.(3)The differences between the intergroup effects and time effects of medication belief scores in the two groups were statistically significant(P<0.001)and showed an increasing trend over time.There was an interaction effect of intervention mode and time factor(P<0.001).T-test found that the scores in the intervention group were higher than those in the control group,and the difference was statistically significant(P<0.05).The change in medication belief scores was different between the two groups,with an overall increasing trend,and the increase in the intervention group was higher than that in the control group,and the control group showed a slow increase after a small decrease after 2 months of intervention.(4)The between-group effects showed statistically significant differences in quality of life scores between the two groups by intervention modality(P<0.05)and statistically significant differences in time effects(P<0.001),with a decreasing trend over time.There was an interaction effect of intervention mode and time factor(P<0.05).Applying the two independent samples t-test revealed that the intervention group scored lower than the control group,with a statistically significant difference(P<0.05).The quality of life scores of patients in the two groups changed differently,with an overall decreasing trend,and the decrease in the intervention group was greater than that in the control group,while the decrease in the control group was more moderate.(5)The intergroup effect difference of oxygen saturation between the two groups was statistically significant(P=0.009),and the time effect difference was statistically significant(P<0.001),which showed an increasing trend over time.There was interaction effect between intervention mode and time(P<0.05).The t test of two independent samples showed that after 3 months of intervention,the oxygen saturation of the observation group was still higher than that of the control group,and the difference was statistically significant(P<0.05).The changes of oxygen saturation of the two groups were different,showing an overall increasing trend.The increase range of the intervention group was greater than that of the control group,and the increase range of the control group was stable.(6)The paired sample t test was used to compare the values of FEV1,FVC and FEV1/FVC before and after intervention in the two groups,which showed that the values after 3 months were significantly higher than those before intervention,with statistical significance(P<0.05).Independent sample t test was used for comparison between groups,and the FVC and FEV1/FVC values in the intervention group were significantly higher than those in the control group,with statistical significance(P<0.05),while the FEV1 value in the intervention group was higher than that in the control group,with no statistical significance(P>0.05).Conclusions:1.The overall medication adherence of COPD patients was low,and the level of medication beliefs and social support was moderate.2.Age,education level,monthly income,duration of disease,type and frequency of daily medication use,knowledge of disease,and housing status were the influencing factors of medication adherence.3.Health education of the Greene model is effective in improving medication adherence,reducing inhalation errors,forming positive medication beliefs,improving quality of life,and stabilizing oxygen saturation and lung function in patients with chronic obstructive pulmonary disease. |
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