저소득층 고혈압 노인의 약물복용행위와 자가간호 예측 경로모형 = A Path Model Predicting Medication Adherence and Self-care of Low-income Older Adults with Hypertension

다국어 초록 (Multilingual Abstract)

The purpose of this study was to identify the factors that influence medication adherence and self-care among low-income older adults with hypertension. Methods: A sample of 297 low-income older adults with hypertension was recruited from June 30 to July 30, 2010. Data collection was done using a face-to-face interview with structured questions. The data were analyzed using descriptive statistics, Pearson's correlation coefficient,and path analysis. Results: Subjective health status, duration of hypertension, number of drugs excluding antihypertensives, body mass index, knowledge about hypertension, sense of coherence, benefit, barrier, and self-efficacy were identified as significant predictors. Subjective health status and duration of hypertension,knowledge, depression, and self-care showed direct effects on medication adherence. Depression had the strongest direct influence on medication adherence. Body mass index, benefit, self-efficacy, and depression showed a direct effect on self-care. Sense of coherence was a strong predictor of depression which significantly influenced on medication adherence and self-care. Conclusion: For enhancing medication adherence and self-care, it is suggested that a psycho-education program reducing depression and increasing knowledge about hypertension should be provided into low-income older adults with hypertension.

참고문헌 (Reference)

1 김동배, "한국노인의 우울 관련변인에 관한 메타분석" 한국노년학회 25 (25): 167-187, 2005

2 허재헌, "서울시 노인의 사회경제적 수준별 활동제한 및 건강행태" 한국노년학회 28 (28): 87-104, 2008

3 이태화, "빈곤층 노인의 건강상태, 건강인식 및 건강증진행위 실천 간의 관계- 보건소 방문간호 대상자 중심으로 -" 한국간호과학회 35 (35): 252-261, 2005

4 김현숙, "보건소 방문보건 대상 노인들의 투약 지시이행에 영향을 미치는 영향요인 분석" 지역사회간호학회 18 (18): 5-13, 2007

5 전해옥, "노인본태성고혈압 환자의 자가간호에 영향을 미치는 요인" 지역사회간호학회 19 (19): 66-75, 2008

6 김옥수, "노인 고혈압환자의 인지기능, 우울, 사회적 지지 및 자가간호에 관한 연구" 성인간호학회 20 (20): 675-684, 2008

7 성기월, "고혈압을 가진 저소득층 여성노인의 자가간호 행위와 우울증상 -초기노인과 후기노인의 비교" 한국간호과학회 38 (38): 593-602, 2008

8 Gascon, J., "Why hypertensive patients do not comply with the treatment" 21 (21): 125-130, 2004

9 Ministry of Health and Welfare Data, "Welfare policy for low-income group"

10 Chen, G., "Validation of a new general self-efficacy scale" 4 (4): 62-83, 2001

11 Sieglen, E., "The influence of cancer-related distress and sense of coherence on anxiety and depression in patients with hereditary cancer" 16 : 607-615, 2007

12 Eze-Nliam, C. M., "The association of depression with adherence to antihypertensive medication: A systematic review" 28 : 1785-1795, 2010

13 Hoelter, J. W., "The analysis of covariance structures: Goodness-of-fit Indices" 11 : 325-344, 1983

14 Radolff, L. S., "The CES-D scale: A self-report depression scale for research in the general population" 1 : 385-401, 1977

15 Chobanian, A. V., "Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure" 42 : 1206-1252, 2003

16 Chon, K. K., "Preliminary development of Korean version of CES-D" 11 (11): 65-76, 1992

17 Balkrishnan, R., "Predictors of medicaton adherence in the elderly" 20 (20): 764-771, 1998

18 Wang, P. S., "Noncompliance with antihypertensive medications: The impact of depressive symptoms and psychological factors" 17 : 504-511, 2002

19 Krousel-Wood, M., "Medication adherence: A key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients" 4 : 357-362, 2004

20 Coppin, A. K., "Low socioeconomic status and disability in old age: Evidence from the inchianti study for the mediating role of physiological impairments" 61 (61): 86-91, 2005

21 Antonovsky, A., "How people manage stress and stay well, Unraveling the mystery of health" Jossey-Bass 1987

22 Jin, J., "Factors affecting therapeutic compliance: A review from the patient's perspective" 4 (4): 269-286, 2008

23 Ricardson, M. A., "Effect of perceived barriers on compliance with antihypertensive medication" 20 : 489-503, 1993

24 Dimatteo, M. R., "Depression is a risk factor for noncompliance with medical treatment" 160 : 2101-2107, 2000

25 Kim, S. W., "Concurrent validity of the Korean version of self-reported questionnaire" 16 (16): 172-180, 1995

26 Morisky, D. E., "Concurrent and predictive validity of a self-reported measure of medication adherence" 24 (24): 67-74, 1986

27 Konttinen, H., "Comparing sense of coherence, depression symptoms and anxiety, and their relationships with health in a population-based study" 66 : 2401-2412, 2008

28 Park, Y. I., "An effect of the self-regulation program for hypertensives" Seoul National University 1994

29 Moon, J. S., "A study of instrument development for health belief of Korean adults" Yonsei University 1990

30 Oh, P. J., "A model for health promoting behaviors and quality of life in people with stomach cancer" Seoul National University 1994