| Objective: The thesis describes the health belief connotation of endocrine therapy premenopausal breast cancer survivors in Chinese mainland,discovers the factors of endocrine therapy adherence and develops Endocrine Therapy Related Health Beliefs Questionnaire which is appropriate for endocrine therapy breast cancer survivors in the background of Chinese culture.The researcher also studies the current status of health belief and endocrine therapy adherence of the breast cancer survivors and then discusses the relationship between health belief and adherence.Through evidence-based nursing,develop intervention protocol of improving the adherence of endocrine therapy in breast cancer survivors combining qualitative and quantitative research results,implement the intervention protocol and evaluate effect of it.Method: mixed-methods Part one : A qualitative research on the connotation of health belief for the breast cancer endocrine therapy survivorsWith the research method of quality description,the research selects 30 premenopausal breast cancer survivors who are carried out breast surgery operation and endocrine therapy for more than half a year from June 2014 to June 2016 in the First Hospital of China Medical University to conduct semi-structured interviews.The researcher collects the documents and data by recording and taking notes during the interviews,research on the text data transcribed by Nvivo11.0 software using content analysis method and extracts the theme and constructs the theoretical framework.Part two: Development and application on health belief questionnaire of endocrine therapy breast cancer survivors.1.Health belief questionnaire development: in the first stage,the researcher constructs questionnaire item pool and dimension relying on the literature reviews and the research results of the first part based on health belief model as the theoretical foundation.The researcher invites the mammatologist,psychologists and nursing experts and assess items and dimensions for two rounds and then the items and dimensions are carried out among 10 survivors as pre-surveys so as to be modified and form the health belief initialized questionnaire.In the second stage,cross-sectional survey is conducted on 289 breast cancer endocrine therapy survivors by means of health belief questionnaire to analyze the data by using face validity,content validity index,Cronbach’s α coefficient,factor analysis,criterion-related validity and so on.In the third stage,the researcher carries out the reliability and validity testing of the questionnaire structure from the second stage so as to revise and improve the questionnaire further and then concludes the formal health belief questionnaire.2.A research on the health belief and the current status of endocrine therapy adherence of the breast cancer survivors.Selecting 329 premenopausal breast cancer survivors who are treated endocrine therapy for more than half a year in the follow-up database randomly as the research objects,the researcher uses the health belief questionnaire,the Morisky Medication Adherence Scale(MMAS-8)and the survivors’ general information questionnaire as a tool to collect data and then applies the SPSS18.0 software to conduct descriptive statistical analysis,independent-samples T test,Pearson correlation analysis and multivariate regression analysis to analyze the data.Part three: Construction and application on intervention protocol of hormonal therapy compliance for breast cancer survivors.Using evidence-based nursing method,the researcher finds out the best the evidence for intervention by searching the original research and the secondary research literature on influencing factors of treatment adherence and intervention effect analysis of endocrine therapy adherence of breast cancer survivors,combing the research results of the first and the second parts to construct the intervention protocol of endocrine therapy for breast cancer survivors.In the control group,using the normal education material of hospital when survivors leave hospital and inform them to attend every week education meeting and the big education meeting held twice every year.In the intervention group,using not only the method of control group but also the health belief model intervention protocol including the mobile client application program(APP)and twittering through the digital education content once a week,medicine remind twice a day,a doctor and a nurse from the follow-up group answer the questions of the survivors from the intervention group everyday.The researcher has a telephone follow-up study on the members of the follow-up group and had training for APP follow-up work.Compare the breast cancer endocrine therapy health belief and the adherence evaluation score of two groups of subjects who are randomly chosen to conclude the data during the periods of before intervention,1 month after intervention and 3 months after intervention by the Mann-Whitney U test.Results: Part one: Health belief connotation of breast cancer endocrine therapy survivorsConceptual framework and themes of health belief connotation of premenopausal breast cancer endocrine therapy survivors includes the cognition of the risk of recurrence or metastasis of breast cancer,the cognition of the effect of recurrence or metastasis of breast cancer,the cognition of the content,importance,benefits and barriers of endocrine therapy,behavioral clues to endocrine therapy.Demographic and socio-cultural factors are also crucial to health belief.Part Two: Health belief questionnaire includes 32 items,6 dimensions1.Questionnaire validity: ? content validity: content validity index CVI value is between 0.8~1;? structure validity: evaluate by exploratory factor analysis method,KMO = 0.753,Bartlett spherical test p < 0.01,which is suitable for factor analysis.Principal component analysis using the maximum variance orthogonal rotation method,extract six common factors and the cumulative contribution rate is 50.748%.We verify further in the way of confirmatory factor analysis and apply the structural equation model method.Most of entry path coefficients is above 0.5 which shows a highly correlation among the various dimensions.Maximum likelihood model is applied to estimate the coefficient: vast majority load coefficient is above 0.5 which illustrates the topic can effectively reflect the characteristics of corresponding factors.? criterion-related validity: the correlation coefficient of “the new version of Health Belief Scale Criterion ”questionnaire is 0.446(P<0.01).2.Questionnaire reliability: ? internal consistency reliability: the total questionnaire Cronbach’s α coefficient is 0.8,which is well-consistent,and the Cronbach’s α coefficient of each dimension is between 0.765 and 0.890.? retest reliability: the retest correlative coefficient of the total questionnaire is 0.963,and the retest correlative coefficient of six dimensions is between 0.874~0.997(P<0.01).3.Cross-sectional study indicates that the overall healthy belief level of 329 premenopausal breast cancer survivors is low,and the average value of health belief questionnaire is 119.33±17.63.The adherence was moderate,and the average score of MMAS-8 is 6.34±1.53.Layered data analysis shows that: the average score of the health belief questionnaire of the survivors who take medicine for the first year is 121.34±16.84,and health belief level which is high(questionnaire score≥120)of the survivors take up 53.3%.MMAS-8 average score is 6.59±1.32 and the endocrine therapy adherence rate is 59.3%;the average score of the health belief questionnaire survivors who take medicine for the second year is 117.64±18.15,and the survivors who have high level of health beliefs occupy 42.5%.The average score of MMAS-8 is 6.12±1.65 and endocrine therapy adherence rate is 53.6%.The correlation coefficient between health belief scores and adherence scores is 0.6(P < 0.01),which suggests that health belief and adherence are positively correlated and each dimension of health beliefs is positively correlated with adherence.Part 3: Construction and application on intervention protocol of endocrine therapy adherence for breast cancer survivors.The baseline data between intervention group and control group which is of no statistical difference is comparable.The researcher carries out the Mann-Whitney U inspection on the score of the health belief and treatment adherence after intervention for one month and three months,which is of statistical difference(P<0.001).Score of health beliefs and treatment adherence has increased which indicates that intervention protocol can significantly improve survivors’ health belief level and endocrine therapy adherence after intervention in 1 month and 3 months of endocrine therapy.Conclusion: 1.The adherence of premenopausal breast cancer survivors endocrine therapy in China mainland is poor with low adherence rate and the rate goes down as the treatment time.2.The factors affecting the adherence of premenopausal breast cancer endocrine therapy survivors include age,education level,merger disease,obvious drug side-effects and health belief and so on.The level of healthy belief was positively correlated with adherence which is an effective intervention factor of social psychology and nursing and appropriate intervention and follow-up program can improve the survivors’ health belief and thus improve the treatment compliance.The high-quality research on effective intervention protocol of the improvement adherence rarely exists both home and abroad.3.Health belief questionnaire of breast cancer endocrine therapy survivors with Chinese culture characteristic has high reliability and validity,and can be used as an assessment tool in studying the level of the health belief of breast cancer endocrine therapy survivors.Evaluation results of the questionnaire can provide reference for the contents of the intervention and follow-up plan.4.Mobile client application program(APP)as an implement tool intervention and follow-up scheme can effectively improve the adherence of short-term endocrine therapy.In the future,we can increase the intervention period to verify the effectiveness of the intervention plans further. |
