The effects of trust in physician on self-efficacy, adherence and diabetes outcomes
The effects of trust in physician on self-efficacy, adherence and diabetes outcomes
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DOI：
10.1016/j.socscimed.2008.12.033
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发表时间：
2009-03-01
影响因子：
5.4
通讯作者：
Lin, Julia L.
中科院分区：
文献类型：
--
作者：
Lee, Yin-Yang;Lin, Julia L.
对医生的信任与一系列患者行为有关。然而，以前的研究并没有关注信任影响健康结果的机制，主要是利用了自我评估的健康状况。这项研究检验了影响信任与客观健康和自我评价健康关系的变量的理论模型，我们假设越信任医生的患者可能有更强的自我效能感和结果预期。我们预计，这反过来会与更好的治疗依从性和客观的健康结果相关。此外，我们假设高度信任的患者更有可能通过增强自我效能来报告更好的健康状况。这项研究的数据来自台湾480名成年2型糖尿病患者的样本。患者完成了信任、自我效能、结果期望、依从性和SF-12健康调查的测量。目的通过随访表回顾评估结果，包括体重指数、糖化血红蛋白、血脂和糖尿病相关并发症。结构方程分析是由LISREL VIII实施的，结果是一个适当的解，表现出充分的拟合。所有假设的路径都有统计学意义，并且都在预测的方向上。结构方程模型和Bootstrap分析的结果进一步证实了自我效能感和结果期望的中介作用。在多元回归中，虽然患者信任与血脂和自我评估健康的关系已得到证实，但信任与糖化血红蛋白的直接联系仅在双变量模型中显著。这项研究阐明了信任与不同类型的健康结果之间的关联，并提供了对医生的信任与自我评估的健康和治疗反应相关联的经验证据。然而，为了准确地确定这些关系的强度和因果关系，有必要进行更纵向的研究设计。(C)2008爱思唯尔有限公司。保留所有权利。
Trust in physicians has been associated with a range of patient behaviors. However, previous research has not focused on the mechanisms by which trust affects health outcomes and mostly has made use of self-rated health. This study tested a theoretical model of variables influencing the relations of trust to both objective and self-rated health, We hypothesized that patients who trust their physicians more were likely to have stronger self-efficacy and outcome expectations. We expected this, in turn, to be associated with better treatment adherence and objective health outcomes. In addition, we hypothesized that highly trusting patients would be more likely to report better health status through enhanced self-efficacy. Data for this research came from a sample of 480 adult patients with type 2 diabetes in Taiwan. Patients completed measures of trust, self-efficacy, outcome expectations, adherence, and the SF-12 health survey. Objective outcomes, including body mass index, glycosylated hemoglobin, blood lipid, and diabetes-related complications, were assessed by follow-up chart review. The structural equation analyses which were implemented by LISREL VIII resulted in a proper solution that exhibited adequate fit. All hypothesized paths were statistically significant and in the predicted directions. The mediation roles of self-efficacy and outcome expectations were further confirmed by the results of structural equation modeling and bootstrap analyses. In the multivariate regression, although the relations of patient trust to blood lipid and self-rated health were confirmed, the direct link of trust to glycosylated hemoglobin was only significant in the bivariate model. This study clarifies the association of trust with different types of health outcomes and provides the empirical evidence that trust in physicians is associated with both self-rated health and therapeutic response. However, a more longitudinal study design is necessary to precisely determine both the strength and causality of these relationships. (C) 2008 Elsevier Ltd. All rights reserved.