The relationship between Illness Perception, Self-efficacy and medication adherence in patients with coronary artery disease reffered to Cardiology Clinic of Tabriz University of Medical Sciences in 2020

Abstract

Abstract Title: The relationship between Illness Perception, Self-efficacy and medication adherence in patients with coronary artery disease referred to Cardiology Clinic of Tabriz University of Medical Sciences in 2020. Introduction: Coronary artery disease as a chronic and life-threatening disease imposes a heavy burden on the health care system all over the world. Cardiovascular diseases, including coronary artery disease, are predicted to be the leading cause of death and disability worldwide by 2030. Medication adherence is a modifiable, important, and cornerstone of coronary artery disease management, and among these, how to adhere to medication regimen in coronary artery disease as a chronic, progressive and lifelong disease is one of the important challenges in disease management in this It is a group of patients. Non-adherence to the medication regimen can cause adverse consequences such as re-hospitalization, increased use of medical services and care costs, reduced quality of life and increased mortality. Purpose: The aim of this study was to investigate the relationship between illness perception, self-efficacy and medication adherence in patients with coronary artery disease referred to the specialized heart clinic of Tabriz University of Medical Sciences. Materials and Methods: In this descriptive-correlation study, 259 eligible patients were included in the study based on the inclusion criteria. In order to access the research units referred to Shahid Madani Heart Training Center of Tabriz. The participants were selected based on the entry criteria, using available sampling method. The questionnaire used in this study had 6 sections: questions related to demographic characteristics, (Brief-IPQ), (SCSES), (MARS_10), Charlson's Comorbidity Index (CCI) to assess the presence of comorbid disorders and diseases and Hodkinson's Cognitive Status Questionnaire (AMT) to evaluate the participants' cognitive status (related to one of the inclusion criteria). Data analysis was done in SPSS version 26 and a significant level of P < 0.05 was considered. Results: In this study, 259 eligible patients diagnosed with coronary artery disease were included in the study based on the inclusion criteria. The average age of the participants was 63.05 ± 6.31. More than half of the participants were men (68.7%) and 97.3% of the participants were married. 93.8% of the participants had post-graduate education and less than that, and others had bachelor's and MA. Most of the participants in the study were self-employed (45.9%). Most of the participants lived in cities (93.1%) and 6.9% lived in villages. 75.7% of people did not have good financial conditions. Among the underlying diseases, among the three diseases of hypertension, diabetes and hyperlipidemia, the most cases were related to hypertension (65.3%). Antiplatelet drugs (78.8%) were the most common and most used drugs among the participants. 29.7% of the participants had a family history of coronary artery disease. All the participants had a history of hospitalization at least once due to cardiovascular disease, among which the most cases were 2 hospitalizations (49%). 67.2% of the participants were involved with the disease for less than 2 years and 32.8% of the people were involved with the disease for more than 2 years (duration of the disease). 38.6% had a history of angiography and 8.1% had a history of heart bypass surgery. The ejection fraction in most of the participants (62.5%) was in the range of 40-50. In this study, according to the results of the illness perception questionnaire, the total score of the illness perception was 44.45 ± 3.22 and the illness perception was at an average level in participants. The total score of this questionnaire is from 0 to 80, and the scores in the range of 28 to 55 indicate an average level. Self-efficacy of the participants according to the results was 34.06 ± 7.57, which showed a high and favorable level of self-efficacy among the participants. The total score of this questionnaire is in the range of 0 to 64, and the scores in the range of 33 to 64 indicate a high level of self-efficacy. In this study, 59.4% of the participants were at a high level of self-efficacy. Also, according to the results, 61.8% of the participants were compliant with the medication regimen and the average score of medication adherence in this study was 6.01 ± 1.09. The evaluation score of medication adherence using this questionnaire is between 0 to 10, and scores of 6 and above indicate adherence to medication regimen and scores of 5 and below indicate non-adherence to medication regimen. In this study, a significant and positive statistical relationship was observed between the illness perception and self-efficacy, which means that those patients who considered their disease as a serious and threatening disease had more confidence and abilities in relation to behaviors related to self-efficacy (p = 0.008 / r = 0.164). Also, a significant and positive statistical relationship was observed between the illness perception and medication adherence; This means that those patients who considered their disease as a serious and threatening disease had more adherence to medication (p = 0.006 / r = 0.171). Among the dimensions related to the B-IPQ questionnaire except two dimension (identity and emotions), others dimensions (consequences, timeline, personal control, treatment control, concern and illness comprehensibility) had a significant and positive statistical relationship medication adherence and self efficacy. In addition, a significant and positive statistical relationship was observed between self-efficacy and medication adherence (p < 0.001 / r = 0.818). Conclusion: In this study, illness perception was at an average level, self-efficacy was at a high and favorable level, and more than half of the participants also followed the drug regimen. The results of this study showed that illness perception, self-efficacy and medication adherence can be influenced by each other as three important variables. In this study, based on the results of data analysis, it was determined that there was a significant and positive relationship between illness perception and self-efficacy and medication adherence, and self-efficacy with medication adherence, among which the greatest and strongest effect and relationship between Self-efficacy and adherence to medication regimen. Based on this, the members of the care team, especially nurses, can play an important role in promoting and maintaining the independence of patients in self-care by promoting and improving illness perception, knowledge and awareness of the conditions related to their disease and providing necessary interventions. Improving health-related behaviors, including adherence to medication regimens.