慢性病患者用药依从性影响因素研究

doi:10.12114/j.issn.1007-9572.2025.0165

摘要/Abstract

摘要： 背景对慢性病患者用药依从性进行全面而准确的评估，不仅能延缓疾病本身的进展，也会使家庭和社会获益。现有关于慢性病患者用药依从性影响因素的综述，主要针对单一疾病或某几种具体慢性病患者，或老年、农村慢性病患者，研究对象范围有限；理论支撑相对不足，因素归纳的系统性有待提升。目的探讨慢性病患者用药依从性的关键影响因素，为相关研究提供参考。方法检索PubMed、Web of Science、Embase、Cochrane Library、中国生物医学文献数据库、中国知网、维普网、万方数据知识服务平台等数据库，检索时限为2010-01-01—2024-11-30。通过文献回顾，系统梳理慢性病患者用药依从性的影响因素，并以能力、机会、动机-行为（COM-B）模型为分析框架进行整合。结果共纳入79篇中/英文文献（英文51篇，中文28篇），从能力、机会和动机因素单一方面探究对慢性病用药依从性影响的文献分别有6篇、9篇和16篇，48篇文献从其中2个或3个因素展开研究。慢性病患者用药依从性受3类因素直接或间接的影响：生理及认知功能状态、疾病和药物知识水平、习惯等能力因素，信息获取、学习机会、社会影响、重要人物及经济支持等机会因素，自我效能、目标、疾病感知、对药物的态度等动机因素。结论慢性病患者的用药依从性受到多维度因素影响。对影响因素的研究维度从单一向多维拓展，研究方法从观察性研究向干预性研究转变。应针对不同主体从多个维度构建用药依从性的提升策略。

关键词: 慢性病, 服药依从性, 影响因素分析, 能力、机会、动机-行为模型

Abstract:

Background

A comprehensive and accurate assessment of medication adherence among chronic disease patients not only delays disease progression but also benefits families and society. Existing reviews on factors influencing medication adherence in chronic disease patients have limited scope, focusing primarily on single diseases, specific chronic conditions, or elderly and rural patients. Theoretical underpinnings remain relatively weak, and the systematic categorization of influencing factors requires improvement.

Objective

To study the key influencing factors of medication adherence in patients with chronic diseases and to provide reference for related research.

Methods

We searched multiple databases including PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, VIP Network, and Wanfang Data Knowledge Service Platform from January 1, 2010 to November 30, 2024. The influencing factors of medication adherence in patients with chronic diseases were systematically sorted out through literature review and integrated with the capacity, opportunity, motivation-behavior (COM-B) model as the analytical framework.

Results

A total of 79 Chinese and English literature sources were included (51 English and 28 Chinese). Six studies examined the impact of capability factors alone, nine focused solely on opportunity factors, and 16 investigated motivation factors exclusively. Forty-eight studies explored the influence of two or three of these factors in combination. Medication adherence in patients with chronic diseases is directly or indirectly influenced by 3 types of factors: capacity factors such as physiological and cognitive functional status, disease and medication knowledge levels and habits, opportunity factors such as information acquisition, learning opportunities, social influence, significant others and financial support, and motivation factors such as self-efficacy, goals, disease perception, and attitudes toward medications.

Conclusion

Medication adherence of chronic disease patients is affected by multidimensional factors, the research dimension of influencing factors expands from single to multidimensional, the research methodology changes from observational to interventional research, and the strategy of medication adherence enhancement should be constructed from multiple dimensions for different subjects.

Key words: Chronic disease, Medication adherence, Root cause analysis, Capacity, opportunity, motivation-behavior model

张佳雯,胡佳,郑英,等. 慢性病患者用药依从性影响因素研究[J]. 中国全科医学, 2026, 29(13): 1753-1758. DOI: 10.12114/j.issn.1007-9572.2025.0165.
ZHANG Jiawen,HU Jia,ZHENG Ying, et al. Research Review on Factors Affecting Medication Adherence in Patients with Chronic Diseases[J]. Chinese General Practice, 2026, 29(13): 1753-1758. DOI: 10.12114/j.issn.1007-9572.2025.0165.

图/表 3

图1 基于COM-B模型的慢性病患者用药依从性影响因素概念框架注：COM-B模型=基于能力、机会、动机-行为模型。

Figure 1 Conceptual framework of factors influencing medication adherence in patients with chronic diseases based on the COM-B model

图2 文献筛选流程及结果

Figure 2 Literature screening process and results

表1 慢性病患者用药依从性的影响因素

Table 1 Influencing factors of medication adherence in patients with chronic diseases

COM-B模型核心因素	维度	指标
能力因素	身体能力因素	身体素质
		肢体功能
		记忆力
	心理能力因素	情绪状态
		用药习惯
		生活方式
		心理健康状况
机会因素	物质机会因素	药物获取的便利性
		医疗资源的可获得性
		设备和技术支持
	社会机会因素	社会支持与群体互动
		社会文化规范
		患者的经济状况
动机因素	反省性动机因素	自我效能
		健康素养
		疾病感知
	自发性动机因素	用药信念
	自发性动机因素	健康目标与期望

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