社区老年高血压患者治疗依从性与污名感的相关性研究——基于上海市嘉定区南翔镇的调查

发布时间：2018-12-08 19:14

【摘要】：目的分析社区老年高血压患者治疗依从性与污名感现况及两者间的相关性,以期为社区老年高血压患者治疗依从性干预方案的有效制定提供建议。方法基于便利抽样原则,2016年5—7月在上海市嘉定区南翔镇选取老年高血压患者为调查对象。采用自制调查问卷对其进行调查,调查内容包括人口学特征、患病及用药情况、污名感量表(包括自我污名感量表和公众污名感量表)得分、治疗依从性量表得分。结果本研究共发放问卷1 024份,回收有效问卷1 006份,有效回收率为98.2%。患者自我污名感量表总分为35.0(23.0)分,公众污名感量表总分为18.0(11.0)分,治疗依从性量表总分为100.0(21.0)分。男性患者烟酒饮食维度得分低于女性(P0.05)。不同年龄、婚姻状况、职业、个人月均医疗费用支出、主要医疗付费方式、家庭人均月收入、高血压病史、服降压药不良反应、因高血压住院次数、慢性支气管炎患病情况、高脂血症患病情况患者治疗依从性量表各维度得分及其总分比较,差异均有统计学意义(P0.05)。不同文化程度患者不良服药、日常生活管理、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P0.05)。不同居住环境患者不良服药、遵医服药、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P0.05)。不同所服用降压药种类患者遵医服药、日常生活管理、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P0.05)。不同糖尿病患病情况患者不良服药、遵医服药、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P0.05)。不同心血管病患病情况患者日常生活管理、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P0.05)。不同关节炎患病情况患者不良服药维度得分及治疗依从性量表总分比较,差异有统计学意义(P0.05)。自我污名感量表总分、公众污名感量表总分均与治疗依从性量表总分呈负相关(rs=-0.705、-0.699,P0.001)。控制自我污名感量表总分后,公众污名感量表总分与治疗依从性量表总分呈负相关(rs=-0.441,P0.001);控制公众污名感量表总分后,自我污名感量表总分与治疗依从性量表总分呈负相关(rs=-0.290,P0.001)。结论社区老年高血压患者的自我污名感和公众污名感处于较低水平,社区老年高血压患者治疗依从性随着污名感的增强而降低,社区医务人员可在健康干预过程中对自我污名感强的老年高血压患者进行自我陈述的认知重构和增强个体的控制感,以改善其治疗依从性。
[Abstract]:Objective to analyze the status of treatment compliance and stigma in elderly hypertensive patients in community and the correlation between them so as to provide suggestions for effective intervention of treatment compliance in elderly hypertensive patients in community. Methods based on the principle of convenient sampling, elderly patients with hypertension were selected from Nanxiang Town, Jiading District, Shanghai from May to July 2016. The self-made questionnaire was used to investigate the characteristics of demography, disease and drug use, stigma scale (including self-stigma scale and public stigma scale), and therapeutic compliance scale. Results 1024 questionnaires were sent out and 1 006 valid questionnaires were collected. The effective recovery rate was 98.2%. The total score of self-stigma scale was 35.0 (23.0), the total score of public stigma scale was 18.0 (11.0), the total score of treatment compliance scale was 100.0 (21.0). The score of alcohol and tobacco diet in male patients was lower than that in women (P0.05). Age, marital status, occupation, medical expenses per month, main medical payment methods, monthly income per family, history of hypertension, adverse effects of antihypertensive drugs, frequency of hospitalization due to hypertension, prevalence of chronic bronchitis, The scores and total scores of the treatment compliance scale in patients with hyperlipidemia were statistically significant (P0.05). Patients with different education level of bad medication, daily life management, alcohol and tobacco dietetic dimension score and treatment compliance scale total score, the difference was statistically significant (P0.05). There were significant differences in the scores of alcohol and tobacco dietetic dimension and the total scores of therapeutic compliance scale in patients with different living environment (P0.05). Patients with different types of antihypertensive drugs took medicine, daily life management, alcohol and tobacco diet dimension scores and total scores of treatment compliance scale, the difference was statistically significant (P0.05). There were significant differences in the scores of alcohol and tobacco dietetic dimension and the total score of treatment compliance scale between the patients with different diabetes mellitus and the patients with different diabetes mellitus (P0.05). There were significant differences in daily life management, alcohol and tobacco dietetic dimension scores and total scores of therapeutic compliance scale in patients with different cardiovascular diseases (P0.05). The scores of bad drug taking and the total scores of treatment compliance scale were significantly different in patients with different arthritis (P0.05). The total score of self-stigma scale and the total score of public stigma scale were negatively correlated with the total score of treatment compliance scale (rs=-0.705,-0.699,P0.001). After controlling the total score of self-stigma scale, there was a negative correlation between the total score of public stigma scale and the total score of therapeutic compliance scale (rs=-0.441,P0.001). After controlling the total score of public stigma scale, the total score of self-stigma scale was negatively correlated with the total score of therapeutic compliance scale (rs=-0.290,P0.001). Conclusion the self-stigma and public stigma of elderly hypertensive patients in community are at a low level, and the treatment compliance of elderly hypertensive patients in community is decreased with the increase of stigma. Community medical staff can reconstruct the self-statement of elderly hypertension patients with strong self-stigma in the process of health intervention and enhance the individual sense of control in order to improve their therapeutic compliance.
【作者单位】：上海市嘉定区南翔镇社区卫生服务中心;
【基金】：上海市卫生和计划生育委员会科研课题(201540005)
【分类号】：R544.1

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