| ObjectivesThe present study aimed to investigate the situation of personality traits,coping styles,protection motivation and medication adherence among tuberculosis(TB)patients,to analyze the influence of personality traits,coping styles and protection motivation on medication adherence and to explore the mediating role of coping styles and protection motivation between personality traits and medication adherence,for providing scientific evidence for taking effective interventions based on personality psychological characteristics to improve medication adherence of TB patients.MethodsA face to face interview was conducted among 400 TB patients recruited from the tuberculosis designated hospital of Yiling District from March 2017 to December 2017.The self-designed questionnaire was used to collect the demographic characteristics,disease and drug-use status of participants.The Chinese Big Five Personality Inventory brief version(CBF-PI-B),the Chinese version of Medical Coping Modes Questionnaire(MCMQ),the Protection Motivation Theory(PMT)Questionnaire and the Chinese version of Morisky Medication Adherence Scale(MMAS-8)were used to measure personality traits,coping styles,protection motivation and medication adherence,respectively.The database was established by EpiData 3.0 software,and SPSS 21.0 software was used for univariate analysis,multivariate analysis and correlation analysis.Mplus7.1 software was performed to analyze mediation effects.Results1.General characteristics of participants:The age of participants ranged from 18 to 89 and the average age was 53.99(SD=16.98).71.97%were male,76.34%were rural residents,61.11%were farmer,78.03%obtained junior high school or under education,63.80%of them earned below 2000 yuan per month and most participants(60.86%)reported an average economic status.68.68%of patients paid their medical expense by rural cooperative medical care.Among participants,67.42%were diagnosed TB for less than one year,84.30%were initially treated patient,5.81%were drug resistant patients and 38.38%reported adverse drug reactions.2.Personality traits of TB patients:The personality traits scores of neuroticism,conscientiousness,agreeableness,openness and extraversion dimensions were 22.29±8.77,32.38±7.36,34.73±7.11,26.92±7.36 and 28.43±7.22,respectively.Female had higher level of neuroticism and lower level of extraversion(P<0.05).Those aged 45～64 had higher level of neuroticism,lower level of openness and extraversion(P<0.05).The patients whose monthly income was less than 500 yuan had higher level of neuroticism,lower level of agreeableness and openness(P<0.05).Those patients with high school and above education degree had higher level of conscientiousness,agreeableness and extraversion(P<0.05).The married had higher level of conscientiousness(P<0.05).Compared with initially treated patients,retreatment patients had higher level of neuroticism and lower level of agreeableness(P<0.05).3.Coping styles and protection motivation of TB patients:The coping styles scores of confrontive coping,avoidant coping and resigned coping dimensions were 15.14±4.04,14.48±3.52 and 7.56±3.44,respectively.The scores of both confrontive coping and resigned coping dimensions were lower than the domestic norm(P<0.05).Those patients married or having high school and above education degree were more likely to choose confrontive coping(P<0.05).Retreatment patients and those who were not clear about their own drug-resistance status,suffered from other chronic diseases,regularly taking other drugs had lower level of confrontive coping(P<0.05).Those patients aged 45～64 years,lower monthly income,retreatment,suffered from other chronic diseases and reporting adverse drug reactions tended to choose resigned coping(P<0.05).Retreatment patients also tended to choose avoidant coping(P<0.05).The total score of protection motivation scale was 78.75±11.24.The protection motivation scores of severity,vulnerability,intrinsic reward,extrinsic reward,response efficacy,self-efficacy,response cost domains were 8.70±1.18,8.63± 1.29,11.99±2.51,11.01 ±2.43,12.98±1.79,12.88±2.14,12.57±3.95,respectively.Those having high school and above education degree had higher protection motivation.Retreatment patients and those who reported having adverse drug reactions had lower level of protection motivation(P<0.05).Those who were not clear about their own drug-resistance status had lower level of protection motivation than non-drug resistant patients(P<0.05).4.Medication adherence status of TB patients:The score of medication adherence scale among TB patients ranged from 0 to 8,the average score was 6.65±2.21.66.07%,6.08%,and 27.85%patients were in high,moderate and low medication adherence level,respectively.Retreatment patients had lower medication adherence level than initial treated patients(β=-0.782,P<0.05),Compared to non-drug resistant patients,those who were not clear about own drug-resistance status had lower medication adherence(β=-0.557,P<0.05).Patients having adverse drug reactions had lower medication adherence(β=-1.097,P<0.05).5.The mediating effect of coping styles between personality traits and medication adherence:Personality traits and coping styles were highly correlated,neuroticism positively predicted avoidant coping(β=0.170,P<0.001)and resigned coping(β=0.231,P<0.001),while conscientiousness(β=0.092,P=0.011)and agreeableness(P=0.124,P<0.001)positively predicted confrontive coping.Personality traits and coping styles both had impacts on medication adherence.Conscientiousness(β=0.075,P<0.001)and agreeableness(β=0.068,P<0.001)positively predicted medication adherence,while openness(β=-0.060 P=0.007)and resigned coping(β=-0.184,P<0.001)negatively predicted it.The results of the mediating effect test showed that neuroticism indirectly influenced medication adherence through resigned coping.The mediating effect of resigned coping was-0.223(95%CI:-0.305～-0.142).6.The mediating effect of protection motivation between personality traits and medication adherence:Personality traits and protection motivation were also correlated.Neuroticism negatively predicted the total score of protection motivation theory scale(β=-0.336,P<0.001).Conscientiousness(β=0.193,P=0.037)and agreeableness(P=0.522,P<0.001)positively predicted the total score of protection motivation scale.Protection motivation also had impact on medication adherence.Self-efficacy(β=0.608,P<0.001)positively predicted medication adherence,while intrinsic reward(β=0.217,P<0.001)and response efficacy(β=-0.209,P=0.002)negatively predict it.The results of the mediating effect test showed that neuroticism,conscientiousness and agreeableness indirectly influenced medication adherence through protection motivation.The mediating effect of protection motivation was-0.188(95%CI:-0.276～-0.100),0.134(95%CI:0.041～0.226)and 0.237(95%CI:0.148～0.326),respectively.Conclusions1.A considerable number of TB patients had lower medication adherence,retreated patients,those who were not clear about own drug-resistance status and those who reported adverse drug reactions were more likely had lower medication adherence.2.Female,the elder,retreatment patients and those patients with lower monthly income had higher level of neuroticism.Retreatment patients and those with lower education degree or lower monthly income had low level of conscientiousness or agreeableness.Those patients with lower education degree,retreatment patients,those who were not clear about their own drug-resistance status and reported adverse drug reactions tended to choose negative coping style,and also had lower level of protection motivation.Personality traits were closely associated with both coping styles and protection motivation.3.Coping styles and protection motivation played mediating roles between personality traits and medication adherence.Neuroticism impacted medication adherence through resigned coping.Neuroticism,conscientiousness and agreeableness impacted medication adherence through protection motivation.4.In the medication adherence intervention of TB patients based on psychological behavior,the elder,those patients with lower education level or lower monthly income,retreatment patients,those who were not clear about their own drug-resistance status and reported adverse drug reactions should be focused on.Their personality traits should be paid attention and may improve their protection motivation level or guide them to take positive coping styles to promote their medication adherence. |
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