作者：朱玲，方雪晖，王子娟

单位：

230022安徽省合肥市，安徽省胸科医院结核病区

Units：

Tuberculosis Area, Anhui Chest Hospital, Hefei 230022, China

关键词：

结核，肺；心理弹性；健康素养；病耻感；治疗依从性；中介分析

Keywords：

Tuberculosis, pulmonary; Psychological resilience; Health literacy; Stigma; Treatment adherence and compliance; Mediation analysis

CLC：

R 521

DOI：

10.12114/j.issn.1008-5971.2024.00.100

Funds：

安徽省卫生健康委科研项目（AHWJ2021b015）

摘要：

目的　探讨心理弹性和健康素养在肺结核患者病耻感和治疗依从性间的中介效应。方法　选取2020 年12月—2023年4月安徽省胸科医院收治的肺结核患者为调查对象。采用一般资料调查表、8项Morisky服药依从性量 表（MMAS-8）、Connor-Daridson韧性量表（CD-RISC）、居民健康素养能力量表、肺结核患者病耻感量表（TSS） 对患者进行问卷调查，采用结构方程模型分析心理弹性和健康素养在肺结核患者病耻感和治疗依从性间的中介效应。 结果　本研究共发放问卷190份，回收有效问卷170份，有效回收率为89.5%。肺结核患者中位MMAS-8评分为84分， 以≥84分为治疗依从性好，＜84分为治疗依从性差。治疗依从性差者CD-RISC的力量性、坚韧性、乐观性维度得分及 其总分，居民健康素养能力量表的健康素养认知、健康生活素养行为与方式、健康技能维度得分及其总分低于治疗依 从性好者（P＜0.05）；治疗依从性差者TSS的负面经历、情感反应、应对方式维度得分及其总分高于治疗依从性好者 （P＜0.05）。Pearson相关分析结果显示，肺结核患者MMAS-8评分与CD-RISC的力量性、坚韧性、乐观性维度得分 及其总分，居民健康素养能力量表的健康素养认知、健康生活素养行为与方式、健康技能维度得分及其总分呈正相关 （P＜0.05），与TSS的负面经历、情感反应、应对方式维度得分及其总分呈负相关（P＜0.05）；肺结核患者CD-RISC 的力量性、坚韧性、乐观性维度得分及其总分与居民健康素养能力量表的健康素养认知、健康生活素养行为与方式、 健康技能维度得分及其总分呈正相关（P＜0.05），与TSS的负面经历、情感反应、应对方式维度得分及其总分呈负相 关（P＜0.05）；肺结核患者居民健康素养能力量表的健康素养认知、健康生活素养行为与方式、健康技能维度得分 及其总分与TSS的负面经历、情感反应、应对方式维度得分及其总分呈负相关（P＜0.05）。结构方程模型分析结果显 示，中介效应模型的总效应为0.56〔95%CI（0.49～0.63）〕，直接效应为－0.45〔95%CI（－0.41～－0.50）〕，中 介效应为1.01〔95%CI（0.89～1.11）〕。心理弹性和健康素养在肺结核患者病耻感与治疗依从性间呈现正向中介效应 （β=0.65，P＜0.01），占总效应的69.18%，其中心理弹性占35.62%、健康素养占33.56%。结论　治疗依从性差的肺 结核患者心理弹性和健康素养水平较低，病耻感程度较重，心理弹性和健康素养在肺结核患者病耻感与治疗依从性间 呈现正向中介效应。

Abstract：

　Objective To explore the mediating effects of psychological resilience and health literacy on stigma and treatment compliance in patients with pulmonary tuberculosis. Methods Pulmonary tuberculosis patients admitted to Anhui Chest Hospital from December 2020 to April 2023 were selected as the survey subjects. The patients were surveyed by the General Information Questionnaire, Eight-item Morisky Medication Adherence Scale (MMAS-8) , Connor-Davidson Resilience Scale (CD-RISC) , Resident Health Literacy Ability Scale and Tuberculosis-Related Stigma Scale (TSS) . Structural equation model was used to analyze the mediating effects of psychological resilien ce and health literacy on stigma and treatment compliance in patients with pulmonary tuberculosis. Results In this study, a total of 190 questionnaires were distributed, and 170 valid questionnaires were collected, with an effective response rate of 89.5 %. The median score of MMAS-8 of patients with pulmonary tuberculosis was 84, MMAS-8 score ≥ 84 indicates good treatment compliance, while MMAS-8 score < 84 indicates poor treatment compliance. The strength dimension score, resilience dimension score, optimism dimension score and total score of CD-RISC, the health literacy cognitive dimension score, healthy life literacy behavior and style dimension score, health skill dimension score and total score of Resident Health Literacy Ability Scale of patients with poor treatment compliance were lower than those of patients with good treatment compliance (P < 0.05) ; the negative experience dimension score, emotional response dimension score, coping style dimension score and total score of TSS of patients with poor treatment compliance were higher than those of patients with good treatment compliance (P < 0.05) . Pearson correlation analysis showed that in the patients with pulmonary tuberculosis, the MMAS-8 score was positively correlated with the strength dimension score, resilience dimension score, optimism dimension score and total score of CD-RISC, the health literacy cognitive dimension score, healthy life literacy behavior and style dimension score, health skill dimension score and total score of Resident Health Literacy Ability Scale (P < 0.05) , and negatively correlated with the negative experience dimension score, emotional response dimension score, coping style dimension score and total score of TSS (P < 0.05) . In the patients with pulmonary tuberculosis, the strength dimension score, resilience dimension score, optimism dimension score and total score of CD-RISC were positively correlated with the health literacy cognitive dimension score, healthy life literacy behavior and style dimension score, health skill dimension score and total score of Resident Health Literacy Ability Scale (P < 0.05) , and negatively correlated with the negative experience dimension score, emotional response dimension score, coping style dimension score and total score of TSS (P < 0.05) . In the patients with pulmonary tuberculosis, the health literacy cognitive dimension score, healthy life literacy behavior and style dimension score, health skill dimension score and total score of Resident Health Literacy Ability Scale were negatively correlated with the negative experience dimension score, emotional response dimension score, coping style dimension score and total score of TSS (P < 0.05) . The structural equation model analysis showed that the total effect value of mediation effect model was 0.56 [95%CI (0.49-0.63) ] , the direct effect value was －0.45 [95%CI (－0.41-－0.50) ] , and the mediating effect value was 1.01 [95%CI (0.89-1.11) ] . Psychological resilience and health literacy presented a positive mediating effect between stigma and treatment compliance in patients with pulmonary tuberculosis (β=0.65, P < 0.01) , accounting for 69.18 % of the total effect, and the psychological resilience accounted for 35.62 %, health literacy accounted for 33.56%. Conclusion Pulmonary tuberculosis patients who have poor treatment compliance have lower levels of psychological resilience and health literacy, and a greater stigma. Psychological resilience and health literacy present a positive mediating effect between stigma and treatment compliance in patients with pulmonary tuberculosis.

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