目的 分析社区老年高血压患者治疗依从性与污名感现况及两者间的相关性,以期为社区老年高血压患者治疗依从性干预方案的有效制定提供建议.方法 基于便利抽样原则,2016年5-7月在上海市嘉定区南翔镇选取老年高血压患者为调查对象.采用自制调查问卷对其进行调查,调查内容包括人口学特征、患病及用药情况、污名感量表(包括自我污名感量表和公众污名感量表)得分、治疗依从性量表得分.结果 本研究共发放问卷1 024份,回收有效问卷1 006份,有效回收率为98.2%.患者自我污名感量表总分为35.0(23.0)分,公众污名感量表总分为18.0(11.0)分,治疗依从性量表总分为100.0(21.0)分.男性患者烟酒饮食维度得分低于女性(P<0.05).不同年龄、婚姻状况、职业、个人月均医疗费用支出、主要医疗付费方式、家庭人均月收入、高血压病史、服降压药不良反应、因高血压住院次数、慢性支气管炎患病情况、高脂血症患病情况患者治疗依从性量表各维度得分及其总分比较,差异均有统计学意义(P<0.05).不同文化程度患者不良服药、日常生活管理、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P<0.05).不同居住环境患者不良服药、遵医服药、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P<0.05).不同所服用降压药种类患者遵医服药、日常生活管理、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P<0.05).不同糖尿病患病情况患者不良服药、遵医服药、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P<0.05).不同心血管病患病情况患者日常生活管理、烟酒饮食维度得分及治疗依从性量表总分比较,差异有统计学意义(P<0.05).不同关节炎患病情况患者不良服药维度得分及治疗依从性量表总分比较,差异有统计学意义(P<0.05).自我污名感量表总分、公众污名感量表总分均与治疗依从性量表总分呈负相关(rs=-0.705、-0.699,P<0.001).控制自我污名感量表总分后,公众污名感量表总分与治疗依从性量表总分呈负相关(rs=-0.441,P<0.001);控制公众污名感量表总分后,自我污名感量表总分与治疗依从性量表总分呈负相关(rs=-0.290,P<0.001).结论 社区老年高血压患者的自我污名感和公众污名感处于较低水平,社区老年高血压患者治疗依从性随着污名感的增强而降低,社区医务人员可在健康干预过程中对自我污名感强的老年高血压患者进行自我陈述的认知重构和增强个体的控制感,以改善其治疗依从性.%Objective To analyze the current status and relationship of treatment compliance and perceived stigma in community elderly hypertensive patients,in order to provide recommendations for the effective interventions on treatment compliance for community elderly hypertensive patients.Methods Based on the principle of convenience sampling,the elderly patients with hypertension were selected as study subjects from May 2016 to July 2016 in Nanxiang Town,Jiading District,Shanghai.The survey was conducted by self-designed questionnaires,including demographic characteristics,prevalence and medication status,score of stigma scale(including self-stigma scale and public stigma scale),score of treatment compliance scale.Results In this study,1 024 questionnaires were distributed and 1 006 valid questionnaires were retrieved.The effective recovery rate was 98.2%.It found that the score of perceived self-stigma was 35.0(23.0),the score of perceived public stigma was 18.0(11.0),and the score of treatment compliance was 100.0(21.0).The score of alcohol,tobacco and diet management in male patients was lower than that in female(P<0.05).There were statistically significant differences in the score of each dimension and total score of treatment compliance scale among patients with different age,marital status,occupation,personal monthly medical expense,the main medical payment method,family monthly income per capita,history of hypertension,adverse antihypertensive medicine reactions,the number of hospitalization due to hypertension,chronic bronchitis prevalence or hyperlipidemia prevalence(P<0.05).There were statistically significant differences in the scores of bad medication,daily life management and alcohol,tobacco and diet management and the total score of the treatment compliance scale among patients with different educational level(P<0.05).There were statistically significant differences in the scores of bad medication,medication compliance,and alcohol,tobacco and diet management and the total score of the treatment compliance scale among patients with different living environment(P<0.05).There were statistically significant differences in the scores of medication compliance,daily life management and alcohol,tobacco and diet management and the total score of the treatment compliance scale among patients with different kinds of antihypertensive drugs(P<0.05).There were statistically significant differences in the scores of bad medication,medication compliance,alcohol,tobacco and diet management and the total score of the treatment compliance scale between patients with different diabetes prevalence(P<0.05).There were statistically significant differences in the scores of daily life management,and alcohol,tobacco and diet management and the total score of the treatment compliance scale between patients with different cardiovascular disease prevalence(P<0.05).There were statistically significant differences in the score of bad medication and the total score of the treatment compliance scale between patients with different arthritis prevalence(P<0.05).The total score of the self-stigma scale and the total score of public stigma were negatively correlated with the total score of the treatment compliance scale(rs=-0.705,-0.699;P<0.001).After controlling the total score of the self-stigma scale,the total score of public stigma was negatively correlated with the total score of the treatment compliance scale(rs=-0.441,P<0.001).After controlling the total score of the public stigma scale,the total score of self-stigma was negatively correlated with the total score of the treatment compliance scale(rs=-0.290,P<0.001).Conclusion The perceived self-stigma and perceived public stigma of elderly patients with hypertension in community are at a low level.The therapeutic adherence of elderly patients with hypertension in community decreases with the increase of perceived stigma.Medical staff in community can help elderly hypertensive patients with high perceived self-stigma reconstruct cognitive of self-statement and enhance the sense of individual control during the process of health intervention process,so as to improve their treatment compliance.
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