健康信念在初诊 2型糖尿病患者疾病感知与药物依从性间的纵向中介作用 [中文引用][英文引用]

目的  探讨初诊 2 型糖尿病患者疾病感知、健康信念及药物依从性的发展轨迹，并探讨健康信念在疾病感知及药物依从性间的纵向中介作用。方法  采用便利抽样法，选取 2023 年 2 月— 2024 年 10 月本院门诊就诊的 266 例初诊 2 型糖尿病患者为研究对象，采用简易疾病感知问卷（brief illness perception questionnaire，BIPQ）、Morisky 药物依从性量表（Moriskymedication adherence scale，MMAS）和 Champion健康信念量表（Champion’s health belief model scale，CHBMS），分别于 T1（确诊时）、T2（确诊后 3 月）、T3（确诊后 6 月）对其进行纵向调查。采用无条件潜变量增长模型分析各变量的发展趋势、使用 Bootstrap法进一步对中介效应进行验证。结果  251 例患者完成研究。确诊后 6 月内初诊 2 型糖尿病患者疾病感知、健康信念及药物依从性均呈现下降趋势。疾病感知的初始水平正向预测药物依从性的初始水平（β=0.411，P=0.005），疾病感知的变化速率正向预测药物依从性的初始水平（β=0.552，P<0.001）。纵向中介模型显示，疾病感知的初始水平正向预测健康信念的初始水平（β=0.410，P<0.001），疾病感知的变化速率正向预测健康信念的变化速率（β=0.558，P<0.001）。健康信念的初始水平能正向预测药物依从性的初始水平（β=0.566，P<0.001），并负向预测药物依从性的变化速率（β=-0.377，P=0.006）。健康信念的变化速率也能正向预测药物依从性的变化速率（β=1.385，P=0.003）。健康信念的起始水平和发展变化速率在疾病感知对药物依从性发展的影响机制中起完全纵向中介作用。结论  建议医护人员应针对患者的疾病感知、健康信念进行及时的评估和管理，合理利用其相互关系，尽可能改善患者的药物依从性水平。

Objective To explore the developmental trajectories of disease perception,health beliefs and medication adherence in patients with newly-diagnosed Type II diabetes,and to examine the longitudinal mediating role of health beliefs between the disease perception and medication adherence. Methods A convenience sampling method was used to recruit 266 patients who were newly diagnosed with Type II diabetes and visited the Outpatient Department of our hospital from February 2023 to October 2024. Data were collected using the brief illness perception questionnaire（BIPQ）,Morisky medication adherence scale（MMAS）and Champion’s health belief model scale（CHBMS）at three time points：at diagnosis（T1）,3 months after diagnosis（T2）and 6 months after diagnosis（T3）. Unconditional latent variable growth model was employed to analyse the development trends per variable,and the Bootstrap method was used to verify the significance of the mediating effect. Results Of all participants,251 responded validly. Over the 6-month period, disease perception,health beliefs and medication adherence demonstrated a decreasing trend. The initial level of disease perception positively predicted the initial level of medication adherence significantly（β=0.411,P=0.005）,and the development rate of disease perception positively predicted the initial level of medication adherence（β=0.552,P<0.001）. The longitudinal mediation model showed that the initial level of disease perception positively predicted the initial level of health beliefs significantly（β=0.410,P<0.001）and the development rate of disease perception positively predicted the development rate of health beliefs significantly（β=0.558,P<0.001）. The initial level of health beliefs positively predicted the initial level of medication adherence significantly（β=0.566,P<0.001）and negatively predicted the development rate of medication adherence significantly（β=-0.377,P=0.006）. The development rate of health beliefs also positively predicted the development rate of medication adherence significantly（β=1.385,P=0.003）. The initial level and development rate of health beliefs fully mediated the longitudinal relationship between disease perception and the development of medication adherence. Conclusion Healthcare professionals should timely assess and manage disease perceptions and health beliefs in patients with newly diagnosed Type II diabetes and rationally utilise their interrelationships to improve the medication adherence