作者：肖华玲，徐静，雷兰，刘雪芹，舒艾娅，李紫微，覃于洪

单位：

408099重庆市，重庆大学附属涪陵医院肝病与转化医学科

Units：

Department of Liver Disease and Translational Medicine, Chongqing University Fuling Hospital, Chongqing 408099, China

关键词：

高血压；老年人；服药依从性；格林模式；路径分析

Keywords：

Hypertension; Aged; Medication adherence; Green model; Path analysis

CLC：

R 544.1

DOI：

10.12114/j.issn.1008-5971.2024.00.013

Funds：

重庆市自然科学基金面上项目（cstc2021jcyj-msxmX0682）

摘要：

　目的　采用格林模式分析老年高血压患者服药依从性的影响因素，然后将其分为倾向因素、促成因素 和强化因素，并分析这些因素对老年高血压患者服药依从性的作用路径。方法　基于格林模式，将高血压知识、自我 效能作为老年高血压患者服药依从性的倾向因素，健康教育作为老年高血压患者服药依从性的促成因素，社会支持作 为老年高血压患者服药依从性的强化因素，并做出如下假设：（1）倾向因素、促成因素、强化因素对服药依从性有 直接作用；（2）促成因素通过倾向因素间接作用于服药依从性；（3）强化因素分别通过倾向因素和促成因素间接作 用于服药依从性。选取2020年9—12月在重庆大学附属涪陵医院老年科就诊的老年高血压患者1 269例为调查对象。采 用一般情况调查表、高血压知识问卷、慢性病管理自我效能量表（SE-MCD）、健康教育情况问卷、社会支持问卷、 Morisky药物依从性量表（MMAS）对其进行调查。两变量间的相关性分析采用Pearson相关分析；采用线性回归分析探 讨高血压知识、自我效能、健康教育、社会支持对老年高血压患者服药依从性的作用路径。结果　共发放问卷1 269 份，回收有效问卷1 248份，有效回收率为98.35%。Pearson相关分析结果显示，老年高血压患者高血压知识与自我效 能、健康教育、社会支持、服药依从性均呈正相关，自我效能与健康教育、社会支持、服药依从性均呈正相关，健康 教育与社会支持、服药依从性均呈正相关，社会支持与服药依从性呈正相关（P＜0.05）。线性回归分析结果显示：高 血压知识、自我效能、社会支持均对老年高血压患者服药依从性有直接作用（P＜0.05），而健康教育对老年高血压患 者服药依从性无直接作用（P＞0.05）。健康教育对老年高血压患者高血压知识、服药依从性均有影响（P＜0.05）， 而校正高血压知识后，健康教育对老年高血压患者服药依从性无影响（P＞0.05）；健康教育对老年高血压患者服 药依从性、自我效能均有影响（P＜0.05），校正自我效能后，健康教育对老年高血压患者服药依从性仍然有影响 （P＜0.05）。社会支持对老年高血压患者高血压知识、服药依从性均有影响（P＜0.05），校正高血压知识后，社会 支持对老年高血压患者服药依从性仍然有影响（P＜0.05）；社会支持对老年高血压患者服药依从性、自我效能均有影 响（P＜0.05），校正自我效能后，社会支持对老年高血压患者服药依从性仍然有影响（P＜0.05）。社会支持对老年 高血压患者服药依从性、健康教育均有影响（P＜0.05），校正健康教育后，社会支持对老年高血压患者服药依从性仍 然有影响（P＜0.05）。结论　高血压知识、自我效能、社会支持对老年高血压患者服药依从性有直接作用；健康教育 可通过高血压知识、自我效能间接作用于患者服药依从性；社会支持可通过高血压知识、自我效能、健康教育间接作 用于患者服药依从性。

Abstract：

Objective Using the Green model to analyze the possible influencing factors of medication adherence in elderly hypertensive patients, and then dividing them into propensity factors, facilitation factors, and reinforcement factors, and analyzing the action path of these factors on medication compliance in elderly hypertensive patients. Methods Based on the Green model, hypertension knowledge and self-efficacy were considered as tendency factors for medication adherence in elderly hypertensive patients, health education was considered as a facilitating factor for medication adherence in elderly hypertensive patients, and social support was considered as a reinforcing factor for medication adherence in elderly hypertensive patients. The following hypotheses were made: (1) tendency factors, facilitating factors, and reinforcing factors had a direct effect on medication adherence; (2) facilitating factors indirectly affected medication adherence through tendency factors; (3) reinforcing factors indirectly affected medication adherence through tendency factors and facilitating factors respectively. A total of 1 269 elderly hypertensive patients treated in the Geriatric Department of Chongqing University Fuling Hospital from September to December 2020 were selected as the investigation objects. General Situation Questionnaire, Hypertension Knowledge Questionnaire, Self Efficacy for Managing Chronic Disease (SE-MCD) , Health Education Questionnaire, Social Support Questionnaire, Morisky Medication Adherence Scale (MMAS) were used to investigate the patients. Pearson correlation analysis was used to analyze the correlation between the two variables. Linear regression analysis was used to explore the pathways of hypertension knowledge, self-efficacy, health education, and social support on medication adherence in elderly hypertensive patients. Results A total of 1 269 questionnaires were sent out, and 1 248 were effectively collected, with an effective recovery rate of 98.35%. Pearson correlation analysis showed that hypertension knowledge was positively correlated with self-efficacy, health education, social support and medication compliance in elderly hypertensive patients, self-efficacy was positively correlated with health education, social support and medication compliance, health education was positively correlated with social support and medication compliance, and social support was positively correlated with medication compliance (P < 0.05) . The results of linear regression analysis showed that: hypertension knowledge, self-efficacy and social support had direct effects on medication compliance in elderly hypertensive patients (P < 0.05) , while health education didn't had direct effects on medication compliance in elderly hypertensive patients (P > 0.05) . Health education had influence on hypertension knowledge and medication compliance in elderly hypertensive patients (P < 0.05) , while after correcting for hypertension knowledge, health education had no effect on medication adherence in elderly hypertensive patients (P > 0.05) ; health education had an impact on medication adherence and self-efficacy in elderly hypertensive patients (P < 0.05) , after adjusting for self-efficacy, health education still had effect on medication adherence in elderly hypertensive patients (P < 0.05) . Social support had an impact on hypertension knowledge and medication adherence in elderly hypertensive patients (P < 0.05) ; after adjusting for hypertension knowledge, social support still had an impact on medication adherence in elderly hypertensive patients (P < 0.05) ; social support had an impact on medication adherence and self-efficacy in elderly hypertensive patients (P < 0.05) ; after adjusting for self-efficacy, social support still had an impact on medication adherence in elderly hypertensive patients (P < 0.05) . Social support had an impact on medication adherence and health education for elderly hypertensive patients (P < 0.05) ; after adjusting for health education, social support still had an impact on medication adherence in elderly hypertensive patients (P < 0.05) . Conclusion Hypertension knowledge, self-efficacy and social support have direct effect on medication compliance in elderly hypertensive patients. Health education can indirectly affect patients' medication compliance through hypertension knowledge and self-efficacy. Social support can indirectly influence patients' medication compliance through hypertension knowledge, self-efficacy and helth education.

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