다약제 복용 노인의 약물에 대한 염려와 복약 이행과의 관계에서 원격간호 상호작용과 복약 자기효능감의 순차적 매개효과

Abstract

Purpose Significant correlations among concerns about medicines, healthcare provider interactions, medication self-efficacy, and medication adherence have been identified in the literature on polypharmacy among older adults. However, there is a lack of research on whether telenursing interactions and medication self-efficacy have single or sequential mediation effects on the relationship between medication concerns and medication adherence among older adults with polypharmacy. This study aimed to identify the single and sequential multiple mediation effects of telenursing interactions and medication self-efficacy on the relationship between medication concerns and medication adherence in this population. Method A survey conducted in August 2024 was used to obtain data from 197 adults aged 65 years and older who underwent chronic disease management through care coordinators at a general hospital in Busan. The measures used were the concern subscale in Beliefs about Medicines Questionnaire-Specific, psychometric evaluation of the Telenursing Interaction and Satisfaction Scale, Self-efficacy for Appropriate Medication Use Scale, and Adherence to the Refills and Medication Scale. Data were analyzed using SPSS 27.0, and the PROCESS macro for SPSS v4.1. We performed a hypothesis test using Model 6, as proposed by Hayes. Result Medication self-efficacy showed a single mediating effect on the relationship between concerns about medication and medication adherence. Interactions between telenursing and medication self-efficacy showed significant sequential mediation effects on the relationship between concerns about medication and medication adherence. When comparing mediation effects, the single mediation effect of medication self-efficacy on the relationship between concerns about medicines and medication adherence was greater than the sequential mediation effect of the telenursing interaction and medication self-efficacy. Conclusion This study found that, in the relationship between concerns about medicines and medication adherence in older adults with polypharmacy, the simple mediation effect of medication self- efficacy was greater than the sequential mediation effect through telenursing interactions and medication self-efficacy. Hence, strategies to enhance telenursing interactions are required to strengthen patients' self-efficacy in medication adherence. Key words: Medication adherence, Telenursing interaction, Medication self-efficacy, Concerns about medicines