| Objective: Develop the disease knowledge questionnaire and health behavior questionnaire with good reliability and validity for breast cancer patients who receiving endocrine therapy.A cross-sectional survey was conducted to understand the change trend of adherence to adjuvant endocrine therapy,find the tripping point of adherence change,and to identify the intervention time and intervention object accurately.Basis on the Trans-theoretical Model(TTM)and combined with KABP,intervention plan to improve the disease knowledge and health behavior to breast cancer women with endocrine therapy is made and implemented.Help Br Ca women maintain a stable period of healthy behavior,and to evaluate the effects of intervention on patient compliance,disease knowledge,health beliefs,health behavior,health index and medication behavior.Methods: mixed methods.Part 1: Development and application of disease knowledge questionnaire and health behavior questionnaire for Br Ca women who receiving AET.Follow the guidelines for psychological measurement tools strictly,base on the literature review,define the knowledge and healthy behavior of endocrine therapy for breast cancer.According to the existing guidelines,expert consensus and psychological characteristics of breast cancer patients,the dimensions and initial entries of the questionnaire on disease knowledge and health behavior were constructed.Five experts were invited to evaluate and revise the first draft of the questionnaires twice,and the content validity index was applied to determine the content validity of the questionnaires.Ten patients were selected to measure the surface validity of the questionnaires.Based on the evaluation results of experts and patients,the initial questionnaires were formed.The initial questionnaires were used to investigate 286 Br Ca women with AET.Exploratory factor analysis(EFA)and confirmatory factor analysis(CFA)were used to evaluate the structural validity of the two questionnaires after the project analysis.Cronbach's ? coefficient is calculated to determine the internal consistency reliability of the questionnaire.The disease knowledge questionnaire also measures the half-fold reliability,the health behavior questionnaire measures the re-measure reliability and half-fold reliability.Finally forms the formal questionnaires.The disease knowledge questionnaire and health behavior questionnaire are used to analyze the survey data,evaluate the status of disease knowledge and health behavior of patients receiving endocrine therapy for breast cancer,and analyze the influencing factors.Part 2: Construction and evaluation of intervention programs to improve disease knowledge and health behavior of breast cancer women.1.Factors influencing medication-taking behavior in BrCa women with adjuvant endocrine therapy according qualitative systematic review: Qualitative studies were extracted from Pub Med,EMBASE,CINAHL,Psyc INFO,CBM,CNKI,wanfang and vipu from inception of each database until February 2019.The systematic search method SPIDER(sample,phenomenon of interest,design,evaluation,research type)was used.Thematic synthesis of the qualitative data was used.We appraised the papers prior to synthesis using JBI-QARI Critical Appraisal Checklist to assess individual study quality.Two reviewers independently assess the studies,analyze the selected studies and abstract of the following data: author,year,country,et al.Included studies were imported into NVivo 11 computer data analysis software.Following the method of thematic synthesis described by Thomas and Harden,the research information is subject integrated.2.Adherence status of AET in Br Ca women and its influencing factors: Compliance to medications is assessed using Morisky Medication Adherence Scale.Status of endocrine therapy are assessed at ten additional questions.888 patients met the inclusion and exclusion criteria.Binomial regression was used when assessing the factors associated with persistence,multinomial regression models was used to assess factors associated with compliance.Check level ?=0.05.3.Construction and evaluation of intervention programs to improve disease knowledge and health behavior of breast cancer women: Set up a research team to write a breast cancer health awareness brochure,according to the contents of the first-stage disease knowledge and health behavior questionnaire.A phased intervention program is developed based on the cross-theoretical model and the results of diastolic integration of the influence of medication behavior.Establish a follow up procedure for patients undergoing endocrine therapy for breast cancer.Based on the results of the first cross-sectional survey of drug compliance,107 patients with breast cancer who met the inclusion criteria were randomly divided into the intervention group and the control group.The patients who received endocrine drugs for 18 to 30 months after treatment in two grade-a hospitals in Liaoning province.The control group received routine health education and followed the standard follow-up procedure by telephone or We Chat at the first and third months.On the basis of the control group,the intervention group evaluated the stages of patients' healthy behaviors and the types of medication behaviors before the intervention,established the We Chat group,summarized the characteristics of patients' behavior stages according to the definition of each stage of the cross-theoretical model,and implemented the intervention according to the intervention plan developed by the research team.Once a week,twice a day and give timely answers to patients' questions.The effect of the intervention was compared after 3 months of randomized control intervention.Results:Part 1: Research on current situation and influencing factors of disease knowledge,health behavior and factors of Br Ca women who receiving endocrine therapy1.The disease knowledge questionnaire finally included 5 dimensions and 21 items:The content validity of the questionnaire is 0.92,and the range of content validity is 0.867-1.0.All initial entries are retained after project analysis.Exploratory factor analysis form 21 items of five factor questionnaire,the cumulative contribution rate of the questionnaire was63.985%.Confirmatory factor analysis found that the fitting indexes met the requirements.The overall Cronbach's ? of the questionnaire was 0.919,the half-reliability was 0.882(p<0.01),and the Cronbach's ?t of each dimension ranged from 0.604 to 0.853.The average score of disease knowledge of patients receiving endocrine therapy for breast cancer was79.79±14.49 points.Disease knowledge was mainly affected by patients' education level and medical expense burden(p<0.05).2.The health behavior questionnaire eventually included 5 dimensions and 25 entries: The total content validity index of the questionnaire was 0.93,and the content validity index ranged from 0.8 to 1.0.After project analysis,10 items were deleted and 27 items were reserved.Exploratory factor analysis resulted in a questionnaire with 25 items and 5 factors,the cumulative contribution rate of the questionnaire was 59.425%.Confirmatory factor analysis found that the fitting indexes met the requirements.The overall Cronbach's ? of the questionnaire was 0.899,Cronbach's ? of each dimension was 0.616?0.896,and the fractional half-reliability of the questionnaire was 0.859 and the retest reliability was0.704,(p < 0.05).The average score of healthy behavior of patients receiving endocrine therapy for breast cancer was 97.38±13.Duration of medication,alcohol consumption,and work status were the main factors affecting healthy behavior.Part 2: Construction and evaluation of intervention programs to improve disease knowledge and health behavior of breast cancer women.1.Factors influencing medication-taking behavior in BrCa women with adjuvant endocrine therapy according qualitative systematic review: A total of 486 were identified in the initial search.Only 17 articles met inclusion criteria and were included in this review.Sample sizes ranged from 12 to 43.Five analytical themes and 17 descriptive subthemes were identified.The five analytical themes were knowledge,decision balance,self-efficacy,support,and medication behavior.The medication taking behavior of breast cancer women can be classified into four types: acceptance/persistence,bearing/suffering,hesitation/adjustment,refusing/abandoning.The four types can switch from one to another.2.Adherence status of AET in BrCa women and its influencing factors: 888 BrCa women who started adjuvant endocrine therapy finally completed follow-up,769(86.6 %)persisted,119(13.4 %)discontinued.Patients with TAM for 2 to 3 years had a significant interruption rate,while those in the AIs group had a significantly increased interruption rate at 1 to 2 and 3 years.Of the 769 patients who were still taking the medicine,422 patients reported adherence to the medicine and almost no drug leakage,accounting for54.88% of the patients taking the medicine.Among 754 patients who completed the MMAS questionnaire,63.9% had good compliance and 36.1% had poor compliance.The results of multi-factor analysis showed that the duration of medication was mainly affected by age(?39 or above 60),duration of medication,type of medication and side effects.Compliance was mainly affected by duration of medication,number of associated diseases and side effects.3.Construction and evaluation of intervention programs to improve disease knowledge and health behavior of breast cancer women: After the intervention with the phased intervention program developed by the cross-theoretical model,the difference in medication compliance scores between the intervention group and the control group and at different measured times was statistically significant(p < 0.05),and there was an interaction between the groups and the time factors.There were significant statistical differences in the scores of patients' health knowledge,belief and behavior before and after the intervention(p<0.05).There was a statistically significant difference in the stage of health behavior between the intervention group and the control group(p<0.05),and there was an interaction between the groups and time(p < 0.05).There were significant differences in health index and self-assessment scores of health status at different measurement points(p<0.05).Further comparison of EQ-5D health five dimensions and three levels showed that the difference of self-care dimension between the intervention group and the control group and at different measurement time points was statistically significant(p<0.01).There was an interaction between groups and time factors,and there was a significant difference in daily life dimension at different measurement time points(p<0.05).According to the corresponding compliance score,the scores of each medication type were calculated,the differences were found before and after treatment with acceptance/persistence type and refusing/abandoning type(p<0.05).Conclusion:1.The disease knowledge questionnaire and health behavior questionnaire developed in this study have good reliability and validity,and can effectively and objectively evaluate the awareness of disease knowledge and the implementation of health behavior of patients receiving endocrine therapy for breast cancer.2.The medication behavior of patients undergoing endocrine therapy for breast cancer is influenced by knowledge,decision balance,self-efficacy and support.The balance of knowledge and decision making determines whether a patient will receive endocrine therapy,while support and self-efficacy determine the type of medication behavior.The bearing/suffering-type and hesitation/adjustment-type women should be noticed and identified.3.The medication adherence of breast cancer patients with endocrine therapy decreased significantly in the 2nd ~ 3rd year.Medication adherence is affected by various factors such as medication type,duration and side effects.It is suggested that special attention should be paid to the patients in the 2nd ~ 3rd year of taking the medicine,and effective measures should be taken to ensure that the side effects of the medicine can be targeted intervention and the knowledge of endocrine drugs can be acquired in time.4.The intervention program based on the cross-theoretical model can improve the medication adherence,health knowledge,belief and behavior of patients receiving endocrine therapy for breast cancer,and improve the patient's health index and self-assessment score.The measurement of medication adherence can be evaluated in combination with medication behavior type and MMAS scale. |
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