The importance of phase Ⅰ cardiac rehabilitation after percutaneous coronary intervention (PCI) has been confirmed, but there is suboptimal adherence among patients. Therefore, investigating the adherence of PCI patients to phaseⅠ cardiac rehabilitation and the influencing factors can provide a theoretical foundation for improving the adherence of patients.

To clarifythe influencing factors of the adherence of PCI patients to phaseⅠ cardiac rehabilitation and the effect pathways by the structural equation model construction, in order to provide the oretical support for improving the adherence of PCI patients to phase Ⅰ cardiac rehabilitation.

Patients with PCI enrolled in the Cardiac Rehabilitation Center of the Second Hospital of Harbin Medical University from August to December in 2021 were selected as the research objects by convenience sampling. The general demographic information questionnaire, therapy adherence questionnaire, health belief of coronary heart disease questionnaire, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiexy Disorde-7 (GAD-7), Family Adaptability and Cohesion Evaluation Scale (FACES), Chronic Illness Resource Survey (CIRS), Gensini score were used to investigate the patients by the end of phaseⅠ cardiac rehabilitation. Spearman rank correlation analysis was used to verify the correlations between health belief, depression, anxiety, family adaptability and cohesion, chronic illness resource utilization and cardiac rehabilitation adherence, respectively. Based on correlation analysis, the hypothetical model of the influencing factors of the adherence of PCI patients to phaseⅠ cardiac rehabilitation was constructed combined with Anderson's model of health service utilization. Maximum likelihood method was used to fit and modify the model constantly. Structural equation model was used to analyze the relationship among influencing factors.

A total of 443 questionnaires were distributed and 430 valid questionnaires were returned, with a valid return rate of 97.06%. The results of multiple linear regression analysis showed that health belief (β=0.427), depression (β=-0.057), anxiety (β=-0.130), family adaptability and cohesion (β=0.242), chronic illness resource (β=0.140) were independent factors of the adherence to phaseⅠcardiac rehabilitation of PCI patients (P<0.05). The results of the correlation analysis showed that cardiac rehabilitation adherence score of PCI patients was positively correlated with health beliefs, family adaptability and cohesion, chronic illness resource utilization (P<0.05) and negatively correlated with depression and anxiety (P<0.05). A structural equation model of the adherence of PCT patients to phaseⅠ cardiac rehabilitation was constructed using health belief, depression, anxiety, family adaptability and cohesion, chronic illness resource and the model fits well: χ²/df=3.092<5, standardized root mean square residual (SRMR) =0.070<0.080, goodness of fit indices (GFI) =0.981, adjusted goodness of fitindices (AGFI) =0.936, comparative fit index (CFI) =0.992, normed fit indexes (NFI) =0.989, with all of them>0.9. The results of the intermediate effects test showed that health belief, family adaptability and cohesion, chronic illness resource had positive direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation (β=0.395, 0.277, 0.152, P<0.01) ; health belief, family adaptability and cohesion had a positive indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through chronic disease resource utilization (β=0.057, 0.065, P<0.01). Depression and anxiety had a direct negative effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation (β=-0.055, -0.116, P<0.05) .

The adherence of PCI patients to phaseⅠ cardiac rehabilitation is influenced by multiple factors. There are complex pathway relationships among the influencing factors. Health belief, family adaptability and cohesion, chronic illness resource have a positive direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation; depression and anxiety have a negative direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation; health beliefs, family adaptability and cohesion have a positive indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through chronic illness resource utilization, and have a negative indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through anxiety and depression.

经皮冠状动脉介入治疗（PCI）术后进行Ⅰ期心脏康复的重要性已得到证实，但目前患者依从性不佳。因此，探究PCI患者Ⅰ期心脏康复依从性及影响因素可为提高患者依从性提供理论基础。

通过构建结构方程模型明确PCI患者Ⅰ期心脏康复依从性影响因素及各因素之间的作用路径，为提高PCI患者Ⅰ期心脏康复依从性提供理论支持。

采用便利抽样法，选取2021年8—12月哈尔滨医科大学附属第二医院心脏康复中心收治的PCI患者为研究对象。在Ⅰ期心脏康复结束后，采用一般人口学资料调查表、治疗依从性问卷、冠心病健康信念问卷、患者健康抑郁量表、广泛性焦虑量表、家庭亲密度和适应性量表、慢性病资源调查问卷、冠状动脉评分（Gensini评分）对患者进行调查。采用多元线性回归分析探究PCI患者Ⅰ期心脏康复依从性的影响因素。采用Spearman秩相关分析验证健康信念、抑郁、焦虑、家庭亲密度和适应性、慢性病资源利用与心脏康复依从性之间的相关性。在相关分析的基础上，结合安德森卫生服务利用模型，构建PCI患者Ⅰ期心脏康复依从性影响因素假设模型，通过极大似然法对模型进行不断拟合与修正。利用结构方程模型分析影响因素间的关系。

共发放调查问卷443份，回收有效问卷430份，有效问卷回收率为97.06%。多元线性回归分析结果显示，健康信念（β=0.427）、抑郁（β=-0.057）、焦虑（β=-0.130）、家庭亲密度和适应性（β=0.242）、慢性病资源利用（β=0.140）是PCI患者Ⅰ期心脏康复依从性的独立影响因素（P<0.05）。相关性分析结果显示，PCI患者心脏康复依从性评分与健康信念、家庭亲密度和适应性、慢性病资源利用呈正相关（P<0.05），与抑郁、焦虑呈负相关（P<0.05）。利用健康信念、抑郁、焦虑、家庭亲密度和适应性、慢性病资源构建PCI患者Ⅰ期心脏康复依从性影响因素假设模型，且模型拟合良好：χ²/df=3.092<5，标准化残差均方根（RMSEA）=0.070<0.080，拟合优度指数（GFI）=0.981，调整拟合优度指数（AGFI）=0.936，比较拟合指数（CFI）=0.992，赋范拟合指数（NFI）=0.989，均>0.9。中介效应检验结果显示，健康信念、家庭亲密度和适应性、慢性病资源利用对PCI患者Ⅰ期心脏康复依从性具有直接正向作用（β=0.395、0.277、0.152，P<0.01）；健康信念、家庭亲密度和适应性可通过慢性病资源利用对PCI患者Ⅰ期心脏康复依从性产生间接正向作用（β=0.057、0.065，P<0.01）；抑郁、焦虑对PCI患者Ⅰ期心脏康复依从性具有直接负向作用（β=-0.055、-0.116，P<0.05）。

PCI患者Ⅰ期心脏康复依从性受众多因素影响，各因素之间存在复杂的路径关系，健康信念、家庭亲密度和适应性、慢性病资源利用对PCI患者Ⅰ期心脏康复依从性具有直接正向作用；抑郁、焦虑对PCI患者Ⅰ期心脏康复依从性具有直接负向作用；健康信念、家庭亲密度和适应性可通过慢性病资源利用对PCI患者Ⅰ期心脏康复依从性产生间接正向作用，也可通过作用于焦虑、抑郁对PCI患者Ⅰ期心脏康复依从性产生间接负向作用。