Self-efficacy as a moderator in relationship between medication adherence and quality of life among patients with type 2 diabetes
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摘要:
目的 探究2型糖尿病患者用药依从性与生存质量的关联及自我效能在两者关系中的调节作用。 方法 选取符合条件的2型糖尿病患者728人，采用8条目Morisky用药依从性量表、糖尿病特异性生存质量量表和自编糖尿病自我效能量表收集数据。利用多元线性回归分析模型分析药物依从性与生活质量之间的关系，并进一步探讨自我效能的调节作用。 结果 用药依从性好的患者仅125人(占17.2%)。与基线相比，随访9个月后生存质量的社会维度得分显著上升(t=-3.668, P=0.001)。基线用药依从性与基线生存质量总分(β=-0.161, P < 0.001)和第9个月生存质量总分(β=-0.148, P=0.002)负向相关。较高的自我效能会增强用药依从性与第9个月治疗维度生存质量(β=0.150, P=0.010)和总生存质量(β=0.110, P=0.044)间的关系。 结论 2型糖尿病患者的用药依从性与未来短期生存质量有显著关联；提高自我效能能够增强用药依从性对生存质量的正向影响，尤其是疾病治疗维度的生存质量。 Abstract:Objective To explore the association between medication adherence and quality of life among patients with type 2 diabetes and the moderating role of self-efficacy on the relationship above. Methods A total of 728 eligible patients with type 2 diabetes were included and data were collected based on the 8-item Morisky medication adherence scale (MMAS-8), diabetes specific quality of life scale (DSQL), and the self-administered diabetes self-efficacy scale. Multiple linear regression models were established to analyze the associations between medication adherence and quality of life and further explored the moderating effect of self-efficacy. Results Among them, 125 patients (17.2%) had good medication adherence. Compared with baseline, scores of DSQL social dimension increased significantly after 9 months of follow-up (t=-3.668, P=0.001). Medication adherence was negatively associated with baseline total DSQL score (β=-0.161, P < 0.001) and month 9 total DSQL score (β=-0.148, P=0.002). Higher self-efficacy enhanced the relationship between medication adherence and DSQL cure dimension (β=0.150, P=0.010) and overall DSQL (β=0.110, P=0.044) at month 9. Conclusions Medication adherence is significantly associated with short-term future quality of life of patients with type 2 diabetes. Improving self-efficacy enhances the positive effect of medication adherence on quality of life, especially on the cure dimension of life quality. -
Key words:
- Medication adherence /
- Quality of life /
- Self-efficacy /
- Type 2 diabetes
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表 1 基线不同人口学特征患者的用药依从性比较
Table 1. Baseline characteristics of respondents by medication adherence
变量 Variable 人数 ①
Number of people ①用药依从性人数(构成比/%)
Medication adherence [Number of people (proportion/%)]χ2值
valueP值
value好 Good 中等 Moderate 差 Worse 糖化血红蛋白/% HemoglobinA1c/% 7.17±1.25 0.228 0.892 < 6.5 214(29.4) 35(16.4) 88(41.1) 91(42.5) ≥6.5 514(70.6) 90(17.5) 214(41.6) 210(40.9) 年龄组/岁 Age group/years 59.72±7.47 14.028 0.007 ≤50 75(10.3) 12(16.0) 24(32.0) 39(52.0) ＞50~60 266(36.5) 42(15.8) 98(36.8) 126(47.4) ＞60 387(53.2) 71(18.4) 180(46.5) 136(35.1) 性别 Gender 2.781 0.249 男性 Male 346(47.5) 51(14.7) 149(43.1) 146(42.2) 女性 Female 382(52.5) 74(19.4) 153(40.0) 155(40.6) 受教育程度 Educational level 10.723 0.030 小学 Primary school 82(11.3) 19(23.2) 38(46.3) 25(30.5) 中学 Middle school 517(71.0) 93(18.0) 212(41.0) 212(41.0) 大学及以上 University/college or above 129(17.7) 13(10.1) 52(40.3) 64(49.6) 婚姻状态 Marital status 0.536 0.765 已婚 Married 648(94.0) 119(17.4) 284(41.5) 281(41.1) 其他 Other 44(6.0) 6(13.6) 18(40.9) 20(45.5) 人均月收入/元 Personal monthly income/yuan 10.270 0.114 ＜3 000 216(29.7) 49(22.7) 89(41.2) 78(36.1) 3 000~＜5 000 307(42.2) 49(16.0) 133(43.3) 125(40.7) 5 000~＜100 000 152(20.9) 19(12.5) 60(39.5) 73(48.0) ≥100 000 53(7.3) 8(15.1) 20(37.7) 25(47.2) 病程/年 Course of disease/years 1.416 0.841 ≤5 500(68.7) 86(17.2) 203(40.6) 211(42.2) 6~10 189(26.0) 34(18.0) 80(42.3) 75(39.7) ≥11 39(5.4) 5(12.8) 19(48.7) 15(38.5) 并发症 Complication 0.610 0.737 否 No 135(18.5) 24(17.8) 52(38.5) 59(43.7) 是 Yes 593(81.5) 101(17.0) 250(42.2) 242(40.8) 体质指数/(kg·m-2) Body mass index/(kg·m-2) 13.551 0.035 偏瘦 Thin 2(0.3) 2(100.0) 0(0.0) 0(0.0) 正常 Normal 152(20.9) 32(21.1) 61(40.1) 59(38.8) 超重 Overweight 324(44.5) 47(14.5) 134(41.4) 143(44.1) 肥胖 Obesity 250(34.3) 44(17.6) 107(42.8) 99(39.6) 注：①以人数(占比/%)或x±s表示。
Note: ① Number of people(proportion/%) or x±s.
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表 2 DSQL分量表得分及基线与第9个月随访后的得分比较
Table 2. Scores and paired t-test of DSQL subscales from baseline to month 9
变量 Variable 基线 Baseline (n=728) 第9个月 Month 9 (n=476) t值 ①
valueP值
valuex s x s DSQL总分 DSQL total 45.22 13.42 45.75 15.85 -1.692 0.091 DSQL生理维度 DSQL physical dimension 21.47 7.51 21.79 8.85 -1.713 0.087 DSQL心理维度 DSQL psychological dimension 13.30 5.06 13.11 5.47 -0.034 0.979 DSQL社会维度 DSQL social dimension 5.86 2.20 6.23 2.36 -3.668 0.001 DSQL治疗维度 DSQL therapeutic dimension 4.59 2.02 4.63 2.22 -0.430 0.667 注：DSQL，糖尿病特异性生存质量量表。
①采用配对t检验。
Note：DSQL，diabetes specific quality of life scale.
①Paired sample t test.
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表 3 多元线性回归分析用药依从性、自我效能与生存质量之间的关系
Table 3. Multiple linear regression analysis for the relationship between MA, SE and DSQL
变量 Variable 模型1基线DSQL总分
Model 1 baseline DSQL模型2第9个月DSQL总分
Model 2 month 9 DSQLβ值
valueβadj值value
(95% CI)P值
valueβ值
valueβadj值value
(95% CI)P值
value基线用药依从性MA (baseline) -1.357 -0.161(-2.024~-0.690) < 0.001 -1.449 -0.148(-2.357~-0.541) 0.002 基线自我效能SE (baseline) -0.297 -0.057(-0.709~0.116) 0.158 0.143 0.023(-0.412~0.697) 0.613 基线DSQL总分DSQL baseline 0.516 0.419(0.413~0.620) < 0.001 注：DSQL，糖尿病特异性生存质量量表。
1.所有模型均纳入包括糖化血红蛋白、年龄、性别、教育程度、婚姻状态、人均月收入、病程、并发症、吸烟饮酒和体质指数在内的混杂变量。
Note：DSQL，diabetes specific quality of life scale.
1.Confounding variables including hemoglobinA1c, age groups, gender, education, marital status, personal monthly income, course of diseases, complications and body mass index were included in all models.
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表 4 多元线性回归分析自我效能对用药依从性与生存质量之间关系的调节作用
Table 4. Multiple linear regression analysis for the relationship between medication adherence*self-efficacy and DSQL
变量 Variable β值
valueβadj值value
(95% CI)P值
value模型1第9个月DSQL总分 Model 1 month 9 DSQL total 基线用药依从性MA (baseline) -1.418 -0.145(-2.324~-0.512) 0.002 基线自我效能SE (baseline) 0.573 0.094(-0.120~1.265) 0.105 基线用药依从性×基线自我效能MA (baseline)*SE (baseline) 1.095 0.110(0.032~2.159) 0.044 模型2第9个月DSQL治疗维度 Model 2 month 9 DSQL cure 基线用药依从性MA (baseline) -0.231 -0.169(-0.366~-0.097) 0.001 基线自我效能SE (baseline) 0.100 0.117(-0.003~0.203) 0.058 基线用药依从性×基线自我效能MA (baseline)*SE (baseline) 0.210 0.150(0.051~0.369) 0.010 注：MA，用药依从性；SE，自我效能；DSQL，糖尿病特异性生存质量量表。所有模型均纳入包括糖化血红蛋白、年龄、性别、教育程度、婚姻状态、人均月收入、病程、并发症、吸烟饮酒、体质指数和相应维度的基线DSQL得分。
Note，MA，medication adherence；SE，self-efficacy；DSQL，diabetes specific quality of life scale. Confounding variables including hemoglobinA1c, age groups, gender, education, marital status, personal monthly income, course of diseases, complications, body mass index and corresponding baseline DSQL scores were included in all models.
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