Literacy, self-efficacy, and HIV medication adherence
Literacy, self-efficacy, and HIV medication adherence
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DOI：
10.1016/j.pec.2006.08.006
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发表时间：
2007-02-01
影响因子：
3.5
通讯作者：
Makoul, Gregory
中科院分区：
文献类型：
--
作者：
Wolf, Michael S.;Davis, Terry C.;Makoul, Gregory
目的：我们研究了患者识字水平与自我报告的艾滋病病毒（HIV）药物依从性之间的关系，同时评估了治疗知识和自我效能在这种关系中的中介作用。
方法：在路易斯安那州什里夫波特和伊利诺伊州芝加哥的传染病诊所，对204名连续就诊的患者进行了结构化的患者访谈（包括识字能力评估），并辅以病历审查。使用医学成人快速识字评估（REALM）测量识字水平，使用患者药物依从性问卷（PMAQ）评估过去4天内的药物自我效能和对抗逆转录病毒治疗方案的依从性。
结果：大约三分之一的患者（30.4%）对其治疗方案的依从性低于100%，31.4%的患者识字能力处于边缘水平到较低水平。在多变量分析中，识字水平低的患者不依从抗逆转录病毒治疗方案的可能性是其他患者的3.3倍（p < 0.001）。患者的自我效能（而非知识）介导了识字水平低对药物依从性的影响（调整优势比为7.4，95%置信区间为2.7 - 12.5）。
结论：在我们的研究中，虽然识字水平低是不恰当依从HIV药物治疗方案的一个重要风险因素，但自我效能介导了这种关系。
实践意义：可能需要超越知识传授的综合干预策略，以解决所有识字水平患者的自我效能问题，从而在管理困难的用药时间表方面取得成功。（c）2006年由爱思唯尔爱尔兰有限公司出版
Objective: We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship.Methods: Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while the Patient Medication Adherence Questionnaire (PMAQ) was used to assess medication self-efficacy and adherence to antiretroviral regimens in the past 4 days.Results: Approximately one-third of patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal to low literacy skills. In multivariate analyses, low literate patients were 3.3 times more likely to be non-adherent to their antiretroviral regimen (p < 0.001). Patients' self-efficacy, but not knowledge, mediated the impact of low literacy on medication adherence (AOR 7.4, 95% CI 2.7-12.5).Conclusion: While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship.Practice implications: Comprehensive intervention strategies that go beyond knowledge transfer may be needed to address self-efficacy among patients across all literacy levels to be successful in the management of difficult medication schedules. (c) 2006 Published by Elsevier Ireland Ltd.