Moderated-mediating effect of influencing factors and coping styles of treatment adherence in pulmonary tuberculosis patients based on knowledge-attitude-practice model

Jin LI; Quan YUAN; Jiani ZHOU; Rui ZHANG; Liwen ZHANG; Xinyu FENG; Geng WANG; Shili LIU; Yong CHEN; Jiaqing LIU; Ying LI

doi:10.16016/j.2097-0927.202112240

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Moderated-mediating effect of influencing factors and coping styles of treatment adherence in pulmonary tuberculosis patients based on knowledge-attitude-practice model

Public Health and Preventive Medicine | 更新时间：2026-01-09

- Moderated-mediating effect of influencing factors and coping styles of treatment adherence in pulmonary tuberculosis patients based on knowledge-attitude-practice model
- Journal of Army Medical University Vol. 44, Issue 12, Pages: 1292-1298(2022)
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)军事预防医学：社会医学与卫生事业管理教研室
  2.400036 重庆，重庆市公共卫生医疗救治中心
  3.409699 重庆，彭水苗族土家族自治县结核病防治所
- 作者简介：
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(81773489);the Project of Natural Science Foundation for Outstanding Young Scholars of Chongqing(cstc2020jcyj-jqX0007)
- DOI：10.16016/j.2097-0927.202112240
  CLC： R195.4;R45;R521
- Received：28 December 2021，
  
  Revised：2022-02-03，
  
  Published：30 June 2022
- 稿件说明：
移动端阅览
Jin LI, Quan YUAN, Jiani ZHOU, et al. Moderated-mediating effect of influencing factors and coping styles of treatment adherence in pulmonary tuberculosis patients based on knowledge-attitude-practice model[J]. Journal of Army Medical University, 2022, 44(12): 1292-1298.
DOI：

Jin LI, Quan YUAN, Jiani ZHOU, et al. Moderated-mediating effect of influencing factors and coping styles of treatment adherence in pulmonary tuberculosis patients based on knowledge-attitude-practice model[J]. Journal of Army Medical University, 2022, 44(12): 1292-1298. DOI： 10.16016/j.2097-0927.202112240.

摘要

目的

基于知信行模型探讨肺结核患者治疗依从行为的影响因素以及应对方式对治疗依从行为的调节作用。

方法

于2021年4月8日至6月9日，从重庆市公共卫生医疗救治中心结核病门诊招募231名肺结核患者，男性133名，女性98名，年龄(26.97±8.57)岁。通过线上问卷调查，收集患者的一般人口学资料，治疗依从认知、信念以及行为水平，应对方式类型(面对、逃避、屈服)及水平。

结果

① 依从认知(

=3.014)、依从信念(

=0.505)对依从行为均有正向预测作用(

0.01)。②依从认知对依从信念有正向预测作用(

=2.587，

0.01)。③屈服在较低水平(

-1s)和平均水平(

)时，依从信念对依从行为的预测作用均有意义(

=0.483，95%

：0.293~0.674，

0.01；

=0.271，95%

：0.170~0.373，

0.01)，而屈服达到较高水平(

+1s)时，依从信念对依从行为的预测作用无意义(

=0.059，95%

：-0.071~0.189)。④回避与依从认知的交互作用对依从信念有负向预测作用(

=-0.144，

0.05)，面对与依从认知的交互作用对依从信念有正向预测作用(

=0.066，

0.05)。

结论

依从认知和信念的提升均可促进结核患者依从行为的发生；屈服应对程度的降低，有利于肺结核患者增强依从信念，建立依从行为。

Abstract

Objective

To explore the influencing factors of patient adherence behavior to tuberculosis treatment based on knowledge-attitude-practice (KAP) model and investigate the moderating effect of coping styles on the behaviors.

Methods

A total of 231 pulmonary tuberculosis patients were recruited from the Tuberculosis Clinic of Chongqing Public Health Medical Center from April 8 to June 9

2021. There were 133 males and 98 females

with an average age of 26.97±8.57 years. A cross-sectional survey was conducted using a Web-based questionnaire to collect their demographic data

knowledge

attitudes and self-reported practice behaviors related to treatment compliance

and coping styles (confrontation

avoidance and acceptance-resignation).

Results

① Adherence knowledge and attitudes showed positive predictive effect on adherence behavior (

=3.014

=0.505

0.01); ② Adherence knowledge had positive predictive effect on adherence attitudes (

=2.587

0.01); ③ Adherence attitudes still showed significant predictive effect on adherence behavior even when acceptance-resignation at lower level(

-1s)and average level(

)(

=0.483

95%

: 0.293~0.674

0.01;

=0.271

95%

: 0.170~0.373

0.01)

but the effect was not significant when acceptance-resignation at high level(

±1s)(

=0.059

95%

: -0.071~0.189); ④ The interaction between avoidance and adherence knowledge showed negative predictive effect on adherence attitudes (

=-0.144

0.05)

while the interaction between confrontation and adherence knowledge was positive predictor for adherence attitudes (

=0.066

0.05).

Conclusion

Improvement of adherence knowledge and attitudes contribute to adherence behavior. A decreased acceptance-resignation level can help the pulmonary tuberculosis patients enhance adherence attitude and promote their adherence behavior.

关键词

Keywords

references

World Health Organization. Global tuberculosis report 2020[EB/OL]. [2021-10-17]. https://apps.who.int/iris/bitstream/handle/10665/336069/9789240013131-eng.pdf.

UPLEKAR M, WEIL D, LONNROTH K, et al . WHO's new end TB strategy[J ] . Lancet, 2015, 385(9979): 1799-1801. DOI: 10.1016/S0140-6736(15)60570-0.

SAGBAKKEN M, FRICH J C, BJUNE G. Barriers and enablers in the management of tuberculosis treatment in Addis Ababa, Ethiopia: a qualitative study[J]. BMC Public Health, 2008, 8: 11. DOI: 10.1186/1471-2458-8-11.

HORSBURGH C R Jr, BARRY C E Ⅲ, LANGE C. Treatment of tuberculosis[J]. N Engl J Med, 2015, 373(22): 2149-2160. DOI: 10.1056/nejmra1413919.

ADANE A A, ALENE K A, KOYE D N, et al . Non-adherence to anti-tuberculosis treatment and determinant factors among patients with tuberculosis in northwest Ethiopia[J ] . PLoS One, 2013, 8(11): e78791. DOI: 10.1371/journal.pone.0078791.

马骁. 健康教育学[M]. 2版. 北京: 人民卫生出版社, 2012: 59.

MA X. Health education[M]. 2nd ed. Beijing: People's Health Publishing House, 2012: 59.

张林, 车文博, 黎兵. 大学生心理压力应对方式特点的研究[J]. 心理科学, 2005, 28(1): 36-41. DOI: 10.16719/j.cnki.1671-6981.2005.01.009.

ZHANG L, CHE W B, LI B. A research on college students' coping styles of psychological stress[J]. Psychol Sci, 2005, 28(1): 36-41. DOI: 10.16719/j.cnki.1671-6981.2005.01.009.

ZIMMERMAN B J, MARTINEZ-PONS M. Construct validation of a strategy model of student self-regulated learning[J]. J Educ Psychol, 1988, 80(3): 284-290. DOI: 10.1037/0022-0663.80.3.284.

中华人民共和国国家卫生和计划生育委员会. 肺结核诊断标准(WS 288-2017)[J]. 新发传染病电子杂志, 2018, 3(1): 59-61. DOI: 10.19871/j.cnki.xfcrbzz.2018.01.017.

National Health and Family Planning Commission of the Peoples' Republic of China. Diagnosis for pulmonary tuberculosis(WS 288-2017)[J]. Electronic J Emerging Infect Dis, 2018, 003(001): 59-61. DOI: 10.19871/j.cnki.xfcrbzz.2018.01.017.

邹喜荣, 尹凤鸣. 行为转变干预模式在肺结核患者自我管理中的应用[J]. 中国护理管理, 2015, 15(6): 744-746, 747. DOI: 10.3969/j.issn.1672-1756.2015.06.032.

ZOU X R, YIN F M. The application of the intervention model of behavior change on self-management in patients with pulmonary tuberculosis[J]. Chin Nurs Manag, 2015, 15(6): 744-746, 747. DOI: 10.3969/j.issn.1672-1756.2015.06.032.

王可, 左利君, 郭立平, 等. 互联网情境下肺结核病人自我健康管理能力的调查研究[J]. 全科口腔医学电子杂志, 2019, 6(30): 187-188. DOI: 10.16269/j.cnki.cn11-9337/r.2019.30.137.

WANG K, ZUO L J, GUO L P, et al . Investigation on self-health management ability of pulmonary tuberculosis patients in internet context[J ] . Electron J Gener Stomatol, 2019, 30: 187-188.

LI Y, EHIRI J, HU D Y, et al . Framework of behavioral indicators for outcome evaluation of TB health promotion: a Delphi study of TB suspects and Tb patients[J ] . BMC Infect Dis, 2014, 14: 268. DOI: 10.1186/1471-2334-14-268.

沈晓红, 姜乾金. 医学应对方式问卷中文版701例测试报告[J]. 中国行为医学科学, 2000(1): 18-20. DOI: CNKI:SUN:ZGXX.0.2000-01-007.

SHEN X H, JIANG Q J. Report on application of Chinese version of MCMQ in 701 patients[J]. Chin J Behav Med Sci, 2000(1): 18-20. DOI: CNKI:SUN:ZGXX.0.2000-01-007.

FEIFEL H, STRACK S, NAGY V T. Coping strategies and associated features of medically ill patients[J]. Psychosom Med, 1987, 49(6): 616-625. DOI: 10.1097/00006842-198711000-00007.

BEA S, LEE H, KIM J H, et al . Adherence and associated factors of treatment regimen in drug-susceptible tuberculosis patients[J ] . Front Pharmacol, 2021, 12: 625078. DOI: 10.3389/fphar.2021.625078.

XING W, ZHANG R, JIANG W X, et al . Adherence to multidrug resistant tuberculosis treatment and case management in Chongqing, China: a mixed method research study[J ] . Infect Drug Resist, 2021, 14: 999-1012. DOI: 10.2147/IDR.S293583.

ADAMSONS J, SELLMAN J D, FRAMPTON C M A. Patient predictors of alcohol treatment outcome: a systematic review[J]. J Subst Abuse Treat, 2009, 36(1): 75-86. DOI: 10.1016/j.jsat.2008.05.007.

ASCHEMANN-WITZEL J, DE HOOGE I, AMANI P, et al . Consumer-related food waste: causes and potential for action[J ] . Sustainability, 2015, 7(6): 6457-6477. DOI: 10.3390/su7066457.

谈迪心, 王斌, 李绪辉, 等. 老年结核病患者自我健康管理评定量表的信效度研究[J]. 中国全科医学, 2017, 20(34): 4299-4303. DOI: 10.3969/j.issn.1007-9572.2017.34.017.

TAN D X, WANG B, LI X H, et al . Reliability and validity of health self-management assessment scale for elderly patients with tuberculosis[J ] . Chin Gen Pract, 2017, 20(34): 4299-4303. DOI: 10.3969/j.issn.1007-9572.2017.34.017.

何文忠, 周洁. 护理健康促进[M]. 上海: 上海科学技术出版社, 2013: 36-38.

HE W Z, ZHOU J. Nursing health promotion[M]. Shanghai: Shanghai Science&Technology Press, 2013: 36-38.

丁燕, 刘杰, 刘立珍, 等. 肺结核病人抑郁与应对方式的相关性研究[J]. 护理研究, 2018, 32(6): 993-995. DOI: 10.3969/j.issn.1009-6493.2018.06.050.

DING Y, LIU J, LIU L Z, et al . Correlation study between depression and coping style in patients with pulmonary tuberculosis[J ] . Nurs Res China, 2018, 32(6): 993-995. DOI: 10.3969/j.issn.1009-6493.2018.06.050.

EL-DIN M A T, HALIM H A A E, EL-TANTAWY A M. Adverse reactions among patients being treated for multi-drug resistant tuberculosis in Egypt from July 2006 to January 2009[J]. Egypt J Chest Dis Tuberc, 2015, 64(3): 657-664. DOI: 10.1016/j.ejcdt.2015.05.011.

BARAL S C, KARKI D K, NEWELL J N. Causes of Stigma and discrimination associated with tuberculosis in Nepal: a qualitative study[J]. BMC Public Health, 2007, 7: 211. DOI: 10.1186/1471-2458-7-211.

KIM J H, SHIN H S. Validation of a Korean version of fertility problem inventory[J]. Asian Nurs Res, 2014, 8(3): 207-212. DOI: 10.1016/j.anr.2014.03.004.

KARTALOVA-O'DOHERTY Y, DOHERTY D T. Coping strategies and styles of family carers of persons with enduring mental illness: a mixed methods analysis[J]. Scand J Caring Sci, 2008, 22(1): 19-28. DOI: 10.1111/j.1471-6712.2007.00583.x.

林奕. 肺结核患者的心理健康与应对方式的相关性研究[D]. 广州: 中山大学, 2008.

LIN Y. Study on the correlation between mental health and coping style of patients with pulmonary tuberculosis[D]. Guangzhou: Sun Yat Sen University, 2008

陆璐, 王烈. 应对方式和自我效能对糖尿病患者治疗依从性的影响[J]. 中国初级卫生保健, 2008, 22(3): 75-77. DOI: 10.3969/j.issn.1001-568X.2008.03.033.

LU L, WANG L. Effects of coping style and self-efficacy on compliance in diabetics[J]. Chin Prim Heal Care, 2008, 22(3): 75-77. DOI: 10.3969/j.issn.1001-568X.2008.03.033.

SHI C H, ZHU H L, LIU J, et al . Barriers to self-management of type 2 diabetes during COVID-19 medical isolation: a qualitative study[J ] . Diabetes Metab Syndr Obes, 2020, 13: 3713-3725. DOI: 10.2147/DMSO.S268481.

姜顾礼, 汤慧, 王一任, 等. 结核病患者医学应对方式及其影响因素[J]. 中国感染控制杂志, 2018, 17(5): 385-390. DOI: 10.3969/j.issn.1671-9638.2018.05.004.

JIANG G L, TANG H, WANG Y R, et al . Medical coping mode among tuberculosis patients and its influencing factors[J ] . Chin J Infect Control, 2018, 17(5): 385-390. DOI: 10.3969/j.issn.1671-9638.2018.05.004.

TEIXEIRAC A B, LASIUK G, BARTON S, et al . An exploration of addiction in adults experiencing early-life stress: a metasynthesis[J ] . Rev Lat Am Enfermagem, 2017, 25: e2939. DOI: 10.1590/1518-8345.2026.2939.

ROTHS, COHEN L J. Approach, avoidance, and coping with stress[J]. Am Psychol, 1986, 41(7): 813-819. DOI: 10.1037/0003-066x.41.7.813.

PALIWAL R. Can DOT improve treatment-seeking behavior of TB patients?[J]. Lung India, 2010, 27(2): 49-50. DOI: 10.4103/0970-2113.63604.

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