目的:与长期肾脏替代治疗相比,肾移植是治疗终末期肾病(end-stage renal disease,ESRD)最为理想的方法,能够显著延长患者生命,提高患者的生活质量.肾移植患者需要终身规范服用免疫抑制药物,与其他器官移植患者相比,肾移植患者服药依从性差.服药依从性与药物素养、心理状态密切相关,而相关研究较少.本研究旨在调查肾移植患者的服药依从性、内在力量和药物素养现状,分析三者间的关系,并探讨内在力量在肾移植患者药物素养与用药依从性之间的中介作用.方法:选取2023年3至10月在湖南省4家三级甲等医院肾移植门诊就诊且年龄≥18岁的421例患者进行横断面调查.分别采用内在力量量表(Inner Strength Scale,ISS)、中文版用药素养评估量表(Chinese version of medication Literacy Assessment in Spanish and English,MedLitRxSE)和中文版 Morisky 用药依从性量表-8(Chinese version of the Morisky Medication Adherence Scale-8,C-MMAS-8)对肾移植患者的内在力量、药物素养和服药依从性进行评估.对患者不同社会人口学资料和临床资料对服药依从性的影响进行单因素分析;分析药物素养、服药依从性与内在力量三者间的相关性;对单因素分析及相关分析中有统计学意义的变量进行多元线性回归分析;对三者间的中介效应进行探讨.结果:在回收的421份调查问卷中,408份调查问卷为有效问卷,有效率为96.91％.肾移植患者C-MMAS-8、MedLitRxSE、ISS得分依次为6.64±1.16、100.63±14.67、8.47±4.03.408例患者中仅86例(21.08％)患者服药依从性水平高,230例(56.37％)患者服药依从性为中等水平,92例(22.55％)患者服药依从性水平较低.单因素分析结果显示:年龄、婚姻状况、受教育程度、肾移植手术年限、肾移植术后住院次数及药物不良反应对患者服药依从性的影响均有统计学意义(均P＜0.05).相关性分析结果显示:内在力量与药物素养(r=0.183,P＜0.001)和服药依从性(r=0.201,P＜0.001)呈显著正相关,药物素养与服药依从性也呈正相关(=0.236,P＜0.001).内在力量在肾移植患者用药素养与用药依从性的中介效应关系中占总效应的13.22％.结论:肾移植患者的药物依从性水平有待改善,制订相应的干预措施势在必行.内在力量在肾移植患者药物素养与服药依从性之间起中介效应,医护人员应注重提高肾移植患者药物素养,同时关注患者内在力量,提高肾移植患者的服药依从性.
Mediating role of inner strength in the relationship between medication literacy and medication adherence among kidney transplant patients
Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens,but their medication adherence is generally poor compared with other organ transplant recipients.Medication adherence is closely related to medication literacy and psychological status,yet related studies are limited.This study aims to investigate the current status of medication adherence,inner strength,and medication literacy in kidney transplant patients,analyze the relationships among these 3 factors,and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence.Methods:A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province.The inner strength,medication literacy,and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale(ISS),the Chinese version of the Medication Literacy Assessment in Spanish and English(MedLitRxSE),and the Chinese version of the Morisky Medication Adherence Scale-8(C-MMAS-8),respectively.Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence.Correlation analysis was conducted to explore the relationships among medication literacy,medication adherence,and inner strength.Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression,and the mediating effect of inner strength was explored.Results:Among the 421 questionnaires collected,408 were valid,with an effective rate of 96.91％.The scores of C-MMAS-8,MedLitRxSE,and ISS were 6.64±1.16,100.63±14.67,and 8.47±4.03,respectively.Among the 408 patients,only 86(21.08％)patients had a high level of medication adherence,whereas 230(56.37％)patients had a medium level of medication adherence,and 92(22.55％)patients had poor medication adherence.Univariate analysis indicated that the kidney transplant patients'age,marital status,education levels,years since their kidney transplant operation,number of hospitalizations after the kidney transplant,and adverse drug reactions showed significant differences in medication adherence(all P＜0.05).Correlation analysis showed that inner strength positively correlated with both medication literacy(r=0.183,P＜0.001)and medication adherence(r=0.201,P＜0.00l).Additionally,there was a positive correlation between medication adherence and medication literacy(r=0.236,P＜0.00l).Inner strength accounted for 13.22％of the total effect in the mediating role between medication literacy and medication adherence.Conclusion:The level of medication adherence among kidney transplant patients needs improvement,and targeted intervention measures are essential.Inner strength mediates the relationship between medication literacy and medication adherence in these patients.Healthcare professionals should focus on enhancing medication literacy and supporting patients'inner strength to improve medication adherence.
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