Health beliefs, disease severity, and patient adherence - A meta-analysis
Health beliefs, disease severity, and patient adherence - A meta-analysis
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DOI：
10.1097/mlr.0b013e318032937e
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发表时间：
2007-06-01
期刊：
影响因子：
3
通讯作者：
Williams, Summer L.
中科院分区：
文献类型：
--
作者：
DiMatteo, M. Robin;Haskard, Kelly B.;Williams, Summer L.
背景：通过对健康状况和疾病严重程度的主观和客观评估来预测患者的依从性，存在大量的经验数据。目标：对患者依从性和患者依从性之间关系的r效应大小和调节变量进行检索和汇总分析：(1)对疾病威胁的信念；(2)(医生、自己或父母)对健康状况的评价；(3)客观的疾病严重性。方法：全面检索已发表的文献(19482005)，得到116篇文章，143个不同的效应大小。计算稳健的、可推广的随机效应模型统计，并用调节变量分析对研究多样性进行详细检验。结果：坚持与患者对要预防或治疗的疾病的严重程度(疾病威胁)的信念显著正相关。更好的患者依从性与客观上较差的健康相关，只有经历了严重程度较低的疾病的患者(根据疾病严重程度评分表)。在严重程度较高的疾病中，坚持较差的情况客观上与较差的健康有关。在儿科样本中，当健康状况由患者自己和父母评估时，也存在类似的模式。结论：结果表明，患者病情的客观严重程度以及他们对这种严重程度的认识，可以预测他们的依从性。患有严重疾病的重病患者可能面临不坚持治疗的最大风险。研究结果有助于提供者更好地认识到患者不遵守规定的可能性，并更好地针对提供者的健康信息和治疗建议。
Background: A large body of empirical data exists on the prediction of patient adherence from subjective and objective assessments of health status and disease severity. This work can be summarized with meta-analysis.Objectives: Retrieval and summary analysis of r effect sizes and moderators of the relationship between patient adherence and patients': (1) beliefs in disease threat; (2) rated health status (by physician, self, or parent); and (3) objective disease severity.Methods: Comprehensive search of published literature (19482005) yielding 116 articles, with 143 separate effect sizes. Calculation of robust, generalizable random effects model statistics, and detailed examination of study diversity with moderator analyses.Results: Adherence is significantly positively correlated with patients' beliefs in the severity of the disease to be prevented or treated ("disease threat"). Better patient adherence is associated with objectively poorer health only for patients experiencing disease conditions lower in seriousness (according to the Seriousness of Illness Rating Scale). Among conditions higher in seriousness, worse adherence is associated with objectively poorer health. Similar patterns exist when health status is rated by patients themselves, and by parents in pediatric samples.Conclusions: Results suggest that the objective severity of patients' disease conditions, and their awareness of this severity, can predict their adherence. Patients who are most severely ill with serious diseases may be at greatest risk for nonadherence to treatment. Findings can contribute to greater provider awareness of the potential for patient nonadherence, and to better targeting of health messages and treatment advice by providers.