Association Between Health Literacy And Medication Adherence Among Pulmonary Tuberculosis Patients In Continuation Phase:Stigma As A Mediator

Objective:To investigate the current situation of medication adherence among pulmonary tuberculosis patients in continuation phase,and to explore the influence of health literacy,stigma,demographic characteristics,disease characteristics on medication adherence;to study the mediating effect of stigma in the relationship between health literacy and medication adherence on controlling for confounding factors,so as to provide basis for improving medication adherence of pulmonary tuberculosis patients in continuation phaseMethods:This study was designed as a cross-sectional study.309 patients were selected from a Class A specialized tertiary hospital in Ji'nan from November 2019 to July 2020.The demographic information and disease information were collected by self-designed general information questionnaire,medication adherence,stigma and health literacy were measured by Eight-item Medication Adherence Scale,Tuberculosis-related Stigma Scale and Chinese Health Literacy Scale for Tuberculosis respectively.Multiple linear regression was used to analyze the influence factors of Medication Adherence,and the mediating effect of Stigma on health literacy and medication adherence was tested.SPSS 22.0 was used to input and analyze all data,and the PROCESS v3.2 plug-in was conducted to complete the mediating effect.Results:1.The medication adherence score of 309 pulmonary tuberculosis patients in continuation phase was 5.93±1.46,37.5%of the patients had low,55.7%had moderate,and 6.8%had good medication adherence.The number of patients with moderate medication adherence was the most2.The medication adherence of pulmonary tuberculosis patients in continuation phase was affected by multiple factors,the medication adherence of patients aged 36?50 years old(?=0.676,P<0.001)were higher than other groups;With the improvement of education background(?=0.370,P<0.001),medication adherence increased;With the duration of treatment prolonged(?=-0.076,P=0.001),the medication adherence gradually decreased.3.After controlling for other covariates,the total effect of health literacy in medication compliance was 0.035(?<0.001),the direct effect was 0.0315(P<0.001),the indirect effect was 0.0036(P=0.002),the mediating effect was tested,the indirect effect of patient perspectives was 0.0069(P<0.001),the mediating effect was tested,and the indirect effect of community perspectives was 0.0008(P>0.05),the mediating effect was not significantConclusion1.The medication adherence among pulmonary tuberculosis patients in continuation phase still needs to be improved,and attention should be paid to patients aged over 50 years old,under 36 years old,with low education background,and with long treatment time2.The stigma among pulmonary tuberculosis patients in continuation phase can negatively affect medication adherence,and health literacy can positively affect medication adherence,and health literacy can indirectly affect medication adherence through stigma(patient perspectives).Stigma plays a mediating effect in the relationship between health literacy and medication adherence.Subgroup analysis shows that patient perspectives mediate the relationship between health literacy and medication adherence.