Baseline patient characteristics.

Background and aimsMedication adherence is a determinant of managing chronic disease. Failure to adhere to treatment can result in disease progression, increased hospitalizations, and a higher risk of complications and mortality. This study aimed to determine the level of medication adherence in older adults with type 2 diabetes based on the Health Action Process Approach (HAPA).MethodsThis study is a descriptive-analytical cross-sectional study that was conducted on 179 older adults with type 2 diabetes. Data were collected using the Morisky Medication Adherence Scale (MMAS-8-Item) and the HAPA questionnaire. We used the chi-square test to compare adherence to medication by demographic characteristics and multiple binary logistic regression analysis to predict factors related to medication adherence based on the HAPA dimensions.ResultsA total of 179 participants (87 men and 92 women) with a mean age of 64.65 ± 4.99 years were enrolled. Low medication adherence was reported by 62% of participants. No significant associations were found between socio-demographic factors (gender, marital status, education, employment, and income) and adherence levels. Logistic regression analysis revealed that smoking (OR = 4.309, 95% CI [1.18, 15.67], p = 0.027) and perceived barriers to adherence (OR = 1.036, 95% CI [1.01, 1.06], p = 0.001) were significantly associated with increased odds of medication non-adherence. Conversely, higher recovery self-efficacy (OR = 0.924, 95% CI: 0.86–0.99, p = 0.027) and coping planning (OR = 0.963, 95% CI: 0.93–0.99, p = 0.022) were associated with reduced odds of non-adherence. The most common self-reported reasons for suboptimal adherence were lack of affordability (17.5%), lack of family support (10%), and poor understanding of the disease (9.4%).ConclusionThis study highlights that older people had suboptimal adherence to medication. Smoking and perceived barriers were significant risk factors, increasing the likelihood of poor adherence. Conversely, higher levels of recovery self-efficacy and coping planning served as protective factors, reducing the risk of non-adherence. Policymakers and planners should consider the mentioned factors in designing interventions to change behavior for chronic diseases like diabetes.

研究背景与目的
药物依从性是慢性疾病管理的核心决定因素。未遵循既定治疗方案可导致疾病进展、住院频次增加，以及并发症与死亡风险升高。本研究旨在基于健康行动过程取向模型（Health Action Process Approach, HAPA），评估老年2型糖尿病患者的药物依从性水平。

研究方法
本研究为描述性分析类横断面研究，共纳入179名老年2型糖尿病患者。研究采用莫里斯基8条目药物依从性量表（Morisky Medication Adherence Scale-8 Item, MMAS-8）与HAPA问卷收集研究数据。本研究通过卡方检验，比较不同人口学特征下的药物依从性差异，并采用多元二元logistic回归分析，基于HAPA维度预测与药物依从性相关的影响因素。

研究结果
本研究共纳入179名参与者（男性87名，女性92名），平均年龄为64.65±4.99岁。其中62%的参与者存在药物依从性不佳的情况。人口社会学因素（性别、婚姻状况、受教育程度、就业状态与收入水平）与药物依从性水平未发现显著关联。二元logistic回归分析显示，吸烟（比值比OR=4.309，95%置信区间CI[1.18, 15.67]，p=0.027）与服药依从性感知障碍（OR=1.036，95%CI[1.01, 1.06]，p=0.001）与药物不依从的发生风险升高显著相关。反之，较高的康复自我效能感（OR=0.924，95%CI: 0.86–0.99，p=0.027）与应对计划（OR=0.963，95%CI: 0.93–0.99，p=0.022）则与药物不依从风险降低相关。参与者自我报告的依从性不佳最常见原因依次为无法承担药物费用（17.5%）、缺乏家庭支持（10%）以及疾病认知不足（9.4%）。

研究结论
本研究表明，老年群体的药物依从性整体欠佳。吸烟与感知到的依从障碍为显著危险因素，可升高不良药物依从的发生概率；而较高的康复自我效能感与应对计划则为保护因素，可降低不依从风险。政策制定者与规划者在设计针对糖尿病等慢性疾病的行为干预方案时，应将上述因素纳入考量。