Predicting medication adherence among children with epilepsy: Application of the protection motivation theory
Chunsong Yang1, Weiqi Deng2, Linan Zeng1
1Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
Purpose:
Based on the protection motivation theory (PMT), which is an extension of the health belief model that takes the "reward" brought by behavior in the long-term process as a consideration factor and considering the influence of environmental and social factors on behavior patterns, this cross-sectional study evaluated medication adherence among children with epilepsy using structural equation modeling.
Methods:
Children with epilepsy from pediatric neurology clinics were consecutively sampled at West China Second Hospital of Sichuan University from July 2021 to January 2024. According to PMT, we designed the 23-item questionnaire, which included seven factors, namely severity, susceptibility, external return, internal returns, self-efficacy, reaction efficiency, and reaction cost. Medication adherence was assessed using the Morisky Medication Adherence Scale. The reliability and validity of the scale were tested by confirmatory factor analysis, and path analysis was used to conduct hypothesis testing and calculate standardized path coefficients.
Results:
We enrolled 1357 children with epilepsy (mean age, 8.36 ± 4.04 years). Younger age, being an only child, caregivers' unemployment, and comorbidities were associated with high medication adherence scores. The designed scale of PMT displayed good reliability and validity. Through path analysis of the structural equation model, self-efficacy, susceptibility, and severity exerted significant positive effects on adherence, and external return, internal returns, and reaction cost had significant negative effects on adherence.
Conclusions:
Medication adherence in children with epilepsy is relatively poor. PMT can explain and predict the medication adherence behavior and behavior intention of patients with epilepsy. It is recommended to increase the health education, personalize medication guidance, and provide telephone interventions to caregivers of children with epilepsy to enhance medication adherence and further improve therapeutic efficacy.
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