肺结核患者抗结核治疗期间病耻感对遵医行为的影响:健康信念的纵向中介作用

doi:10.19982/j.issn.1000-6621.20250158

摘要/Abstract

摘要：

目的: 探讨肺结核患者病耻感、健康信念及遵医行为的发展轨迹,并检验健康信念在病耻感及遵医行为间的纵向中介作用机制。 方法: 采用便利抽样法连续纳入2023年3月至2024年6月江苏省南通市第六人民医院收治的295例肺结核患者作为研究对象,采用社会影响量表、遵医依从性评定量表及Champion健康信念量表分别于T1(抗结核治疗1个月)、T2(抗结核治疗3个月)、T3(抗结核治疗6个月)阶段对患者进行追踪调查。使用无条件潜在增长模型、结构方程及Bootstrap法进行统计分析。结果: T1至T3阶段肺结核患者病耻感得分呈上升趋势、健康信念及遵医行为得分呈现下降趋势。病耻感的截距显著负向预测遵医行为的截距(β=-0.405,P<0.001),病耻感的斜率正向预测遵医行为的斜率(β=0.521,P=0.005)。纵向中介模型显示,病耻感的截距显著负向预测健康信念的截距(β=-0.433,P<0.001),病耻感的斜率显著正向预测健康信念的斜率(β=0.562,P<0.001)。健康信念的截距能显著正向预测遵医行为的截距(β=0.580,P<0.001),并显著负向预测遵医行为的斜率(β=-0.363,P=0.009)。健康信念的斜率也能显著正向预测遵医行为的斜率(β=1.334,P=0.006)。结论: 健康信念在病耻感和遵医行为关系中存在纵向中介作用,即病耻感的发展速度会通过削弱健康信念进而加速遵医行为的恶化。

关键词: 结核,肺, 病耻感, 遵医行为, 纵向研究, 因素分析,统计学

Abstract:

Objective: To examine the dynamic interplay among stigma, health beliefs, and treatment adherence over time in pulmonary tuberculosis patients, with particular focus on the longitudinal mediating mechanism of health beliefs between stigma and treatment adherence. Methods: A consecutive sample of 295 pulmonary tuberculosis patients admitted to the Sixth People’s Hospital of Nantong City, Jiangsu Province between March 2023 and June 2024 was enrolled with convenience sampling method. Longitudinal assessments were conducted at three timepoints: T1 (1 month post-treatment initiation), T2 (3 months), and T3 (6 months). At each interval, three standardized instruments were administered: the Social Impact Scale (assessing stigma), the Medication Adherence Report Scale, and Champion’s Health Belief Model Scale. Data analysis was conducted using the unconditional latent growth model, structural equation and Bootstrap method. Results: The stigma score of pulmonary tuberculosis patients at stage T1 to T3 was on the rise, while the scores of health belief and treatment adherence showed a downward trend. The intercept of stigma significantly negatively predicted the intercept of treatment adherence (β=-0.405, P<0.001), and the slope of stigma positively predicted the slope of treatment adherence (β=0.521, P=0.005). The longitudinal mediation model showed that the intercept of stigma significantly negatively predicted the intercept of health beliefs (β=-0.433, P<0.001) and the slope of stigma significantly positively predicted the slope of health beliefs (β=0.562, P<0.001). The intercept of health beliefs significantly positively predicted the intercept of treatment adherence (β=0.580, P<0.001) and significantly negatively predicted the slope of treatment adherence (β=-0.363, P=0.009). The slope of health beliefs also significantly positively predicted the slope of treatment adherence (β=1.334, P=0.006). Conclusion: Health beliefs play a longitudinal mediating role in the relationship between stigma and treatment adherence, that is, the development of stigma will deteriorate the treatment adherence by weakening health beliefs.

Key words: Tuberculosis, pulmonary, Stigma, Treatment adherence, Longitudinal study, Factor analysis, statistics

中图分类号:

R47
R473.52

成小清, 袁丹, 彭新景. 肺结核患者抗结核治疗期间病耻感对遵医行为的影响:健康信念的纵向中介作用[J]. 中国防痨杂志, 2025, 47(9): 1154-1161. doi: 10.19982/j.issn.1000-6621.20250158

Cheng Xiaoqing, Yuan Dan, Peng Xinjing. The influence of stigma on treatment adherence in patients with pulmonary tuberculosis during anti-tuberculosis treatment: the longitudinal mediating role of health beliefs[J]. Chinese Journal of Antituberculosis, 2025, 47(9): 1154-1161. doi: 10.19982/j.issn.1000-6621.20250158

图/表 7

表1

表2

表3

图1

图2

表4

纵向中介模型中的直接路径

直接路径	β值	B值	s $x ˉ$ 值	P值
病耻感截距→健康信念截距	-0.433	-0.302	0.067	<0.001
病耻感截距→健康信念斜率	0.165	0.056	0.141	0.199
病耻感斜率→健康信念斜率	0.562	0.347	0.137	<0.001
病耻感截距→遵医行为截距	0.157	0.120	0.081	0.092
病耻感截距→遵医行为斜率	-0.136	-0.039	0.236	0.664
病耻感斜率→遵医行为斜率	-0.232	-0.164	0.212	0.133
健康信念截距→遵医行为截距	0.580	0.349	0.063	<0.001
健康信念截距→遵医行为斜率	-0.363	-0.122	0.132	0.009
健康信念斜率→遵医行为斜率	1.334	1.226	1.103	0.006

表4

表5

纵向中介模型中的间接路径

直接路径	β值	s $x ˉ$ 值	95%CI
病耻感截距→健康信念截距→遵医行为截距	0.251	0.067	0.156~0.322
病耻感截距→健康信念截距→遵医行为斜率	0.157	0.140	0.090~0.211
病耻感斜率→健康信念斜率→遵医行为斜率	0.715	1.104	0.563~0.969

表5

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项目	例数	构成比(%)	项目	例数	构成比(%)
年龄组(岁)			月收入(元)
<60	104	39.69	<3000	105	40.08
≥60	158	60.31	3000~6000	132	50.38
性别			6001~10000	23	8.78
男性	155	59.16	>10000	2	0.76
女性	107	40.84	体质量指数(kg/m²)
婚姻状况			<18.5	115	43.89
未婚/离异/丧偶	36	13.74	18.5~23.9	132	50.38
已婚	226	86.26	>24	15	5.73
子女状况			高血压
有子女	251	95.80	有	64	24.43
无子女	11	4.20	无	198	75.57
学历水平			糖尿病
小学及以下	84	32.06	有	50	19.08
初中	96	36.64	无	212	80.92
高中	64	24.43	冠心病
大专及以上	18	6.87	有	56	21.37
居住地			无	206	78.63
城市	70	26.72
乡镇/农村	192	73.28
居住方式
独居	34	12.98
与家人共同居住	228	87.02

项目	均值±标准差	病耻感 T1	病耻感 T2	病耻感 T3	遵医行为T1	遵医行为T2	遵医行为T3	健康信念T1	健康信念T1	健康信念T3
病耻感T1	56.32±8.57	1
病耻感T2	58.27±9.26	0.721^a	1
病耻感T3	58.70±8.18	0.634^a	0.693^a	1
遵医行为T1	6.83±1.40	-0.364^a	-0.367^a	-0.397^b	1
遵医行为T2	6.02±1.32	-0.415^a	-0.432^a	-0.415^a	0.727^a	1
遵医行为T3	5.54±1.36	-0.361^b	-0.425^a	-0.413^a	0.510^a	0.596^a	1
健康信念T1	112.24±20.14	-0.373^a	-0.297^a	-0.277^b	0.463^a	0.378^a	0.268^b	1
健康信念T2	106.36±19.27	-0.381^a	-0.336^a	-0.296^b	0.317^a	0.461^a	0.309^a	0.523^a	1
健康信念T3	103.15±19.06	-0.314^b	-0.352^a	-0.348^a	0.283^b	0.306^a	0.345^a	0.412^a	0.407^a	1

变量	χ²/df值	P值	CFI	TLI	RMSEA	SRMR	平均数		斜相关
变量	χ²/df值	P值	CFI	TLI	RMSEA	SRMR	截距	斜率	斜相关
病耻感	0.982	0.133	1.000	1.000	0.000	0.012	0.982	0.15^a	0.08
健康信念	0.892	0.267	1.000	1.000	0.001	0.011	0.892	-0.28^a	0.05
遵医行为	0.331	0.596	1.001	1.010	0.000	0.009	0.331	-0.23^a	0.09