| ObjectiveThe objective of this study was to understand the status quo of medication adherence in Primary Nephrotic Syndrome(PNS)patients,and to analyze the influencing factors.Next,the relationship between health literacy,social support,medication belief and medication adherence in PNS patients was discussed.Finally,the semi-structured interview was used to understand the real experience of PNS patients in the treatment process,and the problems existing in the treatment process of patients were further discussed and corresponding countermeasures were proposed.It is hoped to provide reference for the formulation of corresponding nursing measures for PNS patients in clinic,so as to improve patients’ medication adherence,delay disease progression and reduce the occurrence of complications.MethodThe method of quantitative and qualitative research is used in this study.1.Quantitative researchFrom October 2021 to August 2022,229 patients with PNS who were not hospitalized for the first time or were revisited in the outpatient department of nephrology in a Grade-III Class A general hospital in Henan Province were selected as the investigation objects by convenience sampling method.The survey tools included: General Data Questionnaire,Morisky Medication Adherence Scale,Health Literacy Management Scale,Social Support Rating Scale,Beliefs about Medicines Questionnaire-Specific.SPSS 23.0 statistical software was used for data statistics and analysis.Frequency,component ratio,mean ±standard deviation were used for statistical description.Independent sample test or one-way analysis of variance were used to analyze the differences.Pearson correlation analysis was used to analyze the correlation between health literacy,social support,medication belief and medication adherence in patients with PNS.Multiple linear regression analysis was conducted to identify the influencing factors of medication adherence in patients with PNS.2.Qualitative researchA semi-structured interview was conducted for PNS patients whose medication adherence score was at a low level in the quantitative study.The sample size was saturated with data and no new topics appeared in the interview content.The interview data was imported into NVivo 12.0 software for management analysis,and the analysis method was Colaizzi 7-step analysis method.Result1.Quantitative research(1)The total score of 229 PNS patients’ medication adherence scale was(6.28±1.69)points,which was at the medium level,and 89 patients’ medication adherence was at the low level(that is,medication adherence score<6 points),accounting for 38.86% of the total number.The score of health literacy was(94.22±11.94),indicating a low level of health literacy.The score of social support was(35.50±5.21)points,which was in the middle level of social support,and the score of medication belief was(6.39±5.26)points.(2)Pearson correlation analysis showed that medication adherence in patients with PNS was positively correlated with health literacy(r=0.742,< 0.01),medication adherence was positively correlated with social support(r=0.688,< 0.01),and medication adherence was positively correlated with medication belief(r=0.724,< 0.01).(3)The results of multiple linear regression analysis showed that the course of disease,adverse drug reactions,taking medicine,health literacy,social support and medication belief were main factors influencing the medication adherence of PNS patients.2.Qualitative researchInterviews were conducted on the influencing factors of medication adherence of PNS patients and their real feelings during the treatment process.A total of 15 patients were interviewed,and 5 themes and 15 sub-themes were extracted.They were insufficient health behavior ability(insufficient attention to disease and medication,lack of health literacy,weak awareness of drug safety management,lack of role,lack of disease-related knowledge),adverse mental state(negative emotional influence,unfirm belief in medication,low level of self-efficacy,stigma),drug treatment factors(adverse drug reactions,poor treatment effect),obstacles in the medical treatment process(inconvenient access to medicine,poor medical experience),weak support system(family economic difficulties,inadequate family and social support).Conclusion(1)The medication adherence of PNS patients was at a medium and low level.(2)Medication adherence of PNS patients was significantly positively correlated with health literacy,social support and medication belief.Patients with higher health literacy,better social support and stronger medication belief had better medication adherence.(3)The main influencing factors of medication adherence in PNS patients were: medication belief,health literacy,social support,medical treatment,adverse drug reactions,and course of disease.(4)PNS patients have problems such as insufficient health behavior ability,bad mental state,drug treatment factors,obstacles in the medical treatment process and weak support system,which affect patients’ medication adherence. |
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