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北京大学学报（医学版） ›› 2021, Vol. 53 ›› Issue (3): 530-535. doi: 10.19723/j.issn.1671-167X.2021.03.015

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基于大五人格理论应用潜在剖面分析探究2型糖尿病患者的用药依从性

陈平1,黎泽明1,郭怡1,孙昕霙1,Δ(),Edwin B.FISHER2   

  1. 1.北京大学公共卫生学院社会医学与健康教育系,北京 100191
    2.Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, North Carolina 27599-7440, USA
  • 收稿日期:2021-03-01 出版日期:2021-06-18 发布日期:2021-06-16
  • 通讯作者: 孙昕霙 E-mail:xysun@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(71673009)

To explore medication adherence of patients with type 2 diabetes mellitus using the latent profile analysis based on the Big Five personality theory

CHEN Ping1,LI Ze-ming1,GUO Yi1,SUN Xin-ying1,Δ(),Edwin B. FISHER2   

  1. 1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
    2. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, North Carolina 27599-7440, USA
  • Received:2021-03-01 Online:2021-06-18 Published:2021-06-16
  • Contact: Xin-ying SUN E-mail:xysun@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(71673009)

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摘要：

目的: 探究2型糖尿病 (type 2 diabetes mellitus, T2DM)患者的人格画像,探讨其与用药依从性的关系及用药依从性的影响因素。方法: 选取北京市通州区、顺义区中4个社区卫生服务中心所属的22个社区卫生服务站的T2DM患者作为研究对象,采用自行设计的问卷收集人口学信息,采用大五人格量表简式版收集人格信息,运用潜在剖面分析探究人格画像。采用用药依从性量表评估用药依从性,运用方差分析探究不同人格画像的用药依从性是否有差异,应用有序多分类Logistic回归探究用药依从性的影响因素。结果: 751例T2DM患者被纳入研究,潜在剖面分析结果显示,本研究中的T2DM患者可分为4类人格画像,包括内敛稳定型(42.7%)、消极型(12.7%)、焦虑型(15.3%)和活泼负责型(29.3%),其中75例患者表示自己不用药也不打胰岛素,5例患者数据缺失,最终671例患者被纳入用药依从性的相关分析。方差分析结果显示,人格画像为焦虑型的患者其用药依从性得分(5.55±1.65)与消极型患者得分(5.94±1.53)差异无统计学意义(P=0.089),但显著低于内敛稳定型(6.17±1.46,P=0.001)和活泼负责型(6.09±1.65,P=0.004)。将人格画像为焦虑型和消极型的患者合并为焦虑消极型纳入有序多分类Logistic回归,结果显示,相比焦虑消极型患者,人格画像为活泼负责型、内敛稳定型是用药依从性好的保护因素(OR=1.567,95%CI:1.096~2.237;OR=1.774,95%CI:1.214~2.591),且受教育程度也影响患者的用药依从性。结论: 基于大五人格理论,T2DM患者可分为4类人格画像,将焦虑型和消极型合并后的焦虑消极型是患者用药依从性差的独立危险因素;此外,受教育程度也是用药依从性的影响因素。

关键词: 2型糖尿病, 人格画像, 大五人格, 用药依从性, 潜在剖面分析

Abstract:

Objective: To explore the personality portraits of patients with type 2 diabetes mellitus (T2DM), its relationship with medication adherence and the influencing factors of medication adherence. Methods: T2DM patients from 22 community health service stations of 4 community health service centers in Tongzhou district and Shunyi district in Beijing were selected as the research objects. A self-designed questionnaire was used to collect demographic information. The short version of Big Five personality scale was used to collect personality information, and latent profile analysis was used to explore their personality portraits. The medication adherence was evaluated by medication adherence scale, and the difference of medication adherence among the different personality portraits was explored by analysis of variance. The influencing factors of medication adherence were explored by the ordinal Logistic regression model. Results: In the study, 751 T2DM patients were included. Latent profile analysis showed that the T2DM patients in this study could be divided into four types of personality portraits, including introverted and stable type (42.7%), negative type (12.7%), anxiety type (15.3%) and active and responsible type (29.3%). Among them, 75 patients said that they did not use medicine or insulin, 5 patients were lack of data, and finally 671 patients with T2DM were included in the analysis about medication adherence. The analysis of variance showed that there was no significant difference in medication adherence between anxiety type (5.55±1.65) and negative type (5.94±1.53, P=0.089), but the medication adherence score of anxiety type was significantly lower than that of introverted and stable type (6.17±1.46, P=0.001) and active and responsible type (6.09±1.65, P=0.004). Anxiety type and negative type were seen as a whole in the ordinal Logistic regression model named anxiety and negative type. The results showed that compared with anxiety and negative type, the active and responsible type or introverted and stable type was the protective factor for good medication adherence (OR=1.567, 95%CI: 1.096-2.237; OR=1.774, 95%CI: 1.214-2.591), and the education level also affected the medication adherence. Conclusion: T2DM can be classified into four types of personality portraits based on Big Five personality theory. The anxiety and negative type after the combination of anxiety type and negative type is the independent risk factor for poor medication adherence. In addition, education level is also the influencing factor of medication compliance.

Key words: Type 2 diabetes mellitus, Personality portrait, Big Five personality theory, Medication adherence, Latent profile analysis

中图分类号: 

  • R195.4

表1

潜在剖面分析各指标结果"

Number of profiles AIC BIC aBIC Entropy P value of LMRT
1 25 944.66 25 990.87 25 959.12
2 25 582.64 25 656.58 25 605.77 0.64 <0.001
3 25 392.42 25 494.09 25 424.23 0.70 0.243
4 25 284.08 25 413.48 25 324.57 0.72 0.002
5 25 231.59 25 388.72 25 280.76 0.73 0.168
6 25 191.82 25 376.68 25 249.67 0.75 0.480

图1

T2DM患者人格画像潜在剖面分析"

表2

T2DM患者不同人格画像的基本特征比较"

Items Introverted and stable
(n=321)		 Negative(n=95) Anxiety(n=115) Active and responsible
(n=220)		 F P
Gender, n(%) 0.558 0.643
Male 147 (45.8) 46 (48.4) 54 (47.0) 113 (51.4)
Female 174 (54.2) 49 (51.6) 61 (53.0) 107 (48.6)
Age/years, n(%) 6.246 <0.001
≤50 20 (6.2) 6 (6.3) 12 (10.4) 14 (6.4)
>50-60 81 (25.2) 27 (28.4) 52 (45.2) 64 (29.1)
>60 220 (68.6) 62 (65.3) 51 (44.4) 142 (64.5)
Education level, n(%) 3.450 0.016
Primary school 43 (13.4) 10 (10.5) 9 (7.8) 20 (9.1)
Middle school 145 (45.2) 51 (53.7) 54 (47.0) 93 (42.3)
High school 85 (26.4) 21 (22.1) 29 (25.2) 57 (26.0)
University/College 48 (15.0) 13 (13.7) 23 (20.0) 42 (19.1)
Graduate school 0 0 0 8 (3.5)
Course of disease/years, n(%) 0.825 0.480
≤5 219 (68.2) 66 (69.5) 79 (68.7) 161 (73.2)
>5-10 81 (25.2) 25 (26.3) 32 (27.8) 51 (23.2)
>10 21 (6.6) 4 (4.2) 4 (3.5) 8 (3.6)
Complications, n(%) 0.466 0.706
Yes 265 (82.6) 76 (80.0) 99 (86.1) 180 (81.8)
No 56 (17.4) 19 (20.0) 16 (13.9) 40 (18.2)
Medical insurance, n(%)
Urban employee 139 (43.3) 42 (44.2) 57 (49.6) 116 (52.7) 1.627 0.182
Urban resident 120 (37.4) 26 (27.4) 33 (28.7) 62 (28.2) 1.448 0.228
New rural cooperative 39 (12.2) 11 (11.6) 11 (9.6) 20 (9.1) 0.560 0.642
Public health care 9 (2.8) 3 (3.2) 2 (1.7) 6 (2.7) 0.161 0.923
Commercial 0 0 0 1 (0.5) 0.792 0.498
Others 2 (0.6) 3 (3.2) 3 (2.6) 5 (2.3) 1.409 0.239
Unclear 12 (3.7) 10 (10.4) 9 (7.8) 10 (4.5) 0.060 0.807
Noncompliance of medication, n(%) 41 (12.8) 8 (8.4) 12 (10.4) 14 (6.7) 1.822 0.142

表3

四类人格画像用药依从性得分及依从率结果"

Personality types Medication adherence score, $\bar{x} \pm s$ Medication adherence,n(%)
Good Moderate Worse
Introverted and stable (n=277) 6.17±1.46 51 (18.4) 124 (44.8) 102 (36.8)
Negative (n=86) 5.94±1.53 14 (16.3) 34 (39.5) 38 (44.2)
Anxiety (n=101) 5.55±1.65 7 (6.9) 42 (41.6) 52 (51.5)
Active and responsible (n=207) 6.09±1.65 44 (21.3) 88 (78.7) 75 (36.2)

表4

用药依从性有序多分类Logistic回归结果"

Variables β SE P OR 95%CI
Gender
Male -0.111 0.148 0.455 0.895 0.670-1.197
Female
Age
>60 years old 0.181 0.154 0.241 1.198 0.886-1.623
≤60 years old
Education level
Middle school and lower 0.334 0.151 0.027 1.397 1.039-1.876
Higher than middle school
Course of disease
≤5 years -0.012 0.328 0.970 0.988 0.519-1.879
>5 years
Personality profile
Active and responsible 0.449 0.182 0.014 1.567 1.096-2.237
Introverted and stable 0.573 0.193 0.003 1.774 1.214-2.591
Negative and anxiety
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ISSN 1671-167X
CN 11-4691/R
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