媒体暴露、健康素养与慢性病老年患者服药依从性的关系：一项中介分析

The Relationship between Media Exposure, Health Literacy, and Medication Adherence among Older Patients with Chronic Diseases: A Mediation Analysis

摘要: 目的：慢性病的防控效果在很大程度上取决于患者的服药依从性。现有文献已关注媒体暴露与服药依从性之间的关联，但尚缺乏对其内在作用机制(即“为何会产生这一关联”)的探讨。方法：本研究采用便利抽样法，于2025年6月至2026年3月，从宁夏5个县级医院收集资料，最终纳入1221名慢性病成年患者。采用自行填写的用药依从性评定量表(MARS)评估研究对象的服药依从性，采用健康素养简式量表(HLS-SF12)测评健康素养水平，并采用自编问卷评价媒体暴露情况。运用描述性统计、相关性分析与回归分析检验健康素养的中介作用。结果：媒体暴露与健康素养呈显著正相关(r = 0.359, P < 0.001)，与服药依从性亦呈正相关(r = 0.091, P < 0.01)；健康素养得分与服药依从性呈显著正相关(r = 0.146, P < 0.001)。健康素养在媒体暴露对服药依从性的影响中发挥部分中介作用，中介效应占总效应的17.9%。结论：媒体暴露与慢性病成年患者的服药依从性呈正相关，健康素养在这一关联中发挥部分中介作用。基于媒体的健康素养干预或有助于改善该人群的服药依从性，其实际效果尚需干预研究进一步验证。

Abstract: Objective: The prevention and control of chronic diseases depend largely on patients’ medication adherence. Existing literature has examined the association between media exposure and medication adherence, but the underlying mechanism (i.e., “why this association occurs”) remains underexplored. Methods: This study used convenience sampling to collect data from five county-level hospitals in Ningxia between June 2025 and March 2026, and finally included 1221 adult patients with chronic diseases. Medication adherence was assessed using the self-administered Medication Adherence Report Scale (MARS), health literacy was measured using the Health Literacy Short-Form Scale (HLS-SF12), and media exposure was evaluated using a self-designed questionnaire. Descriptive statistics, correlation analysis, and regression analysis were used to examine the mediating role of health literacy. Results: Media exposure was significantly positively correlated with health literacy (r = 0.359, P < 0.001) and with medication adherence (r = 0.091, P < 0.01). Health literacy scores were significantly positively correlated with medication adherence (r = 0.146, P < 0.001). Health literacy partially mediated the effect of media exposure on medication adherence, and the mediating effect accounted for 17.9% of the total effect. Conclusion: Media exposure was positively associated with medication adherence in adult patients with chronic diseases, and health literacy partially mediated this association. Media-based health literacy interventions may help improve medication adherence in this population; however, their actual effectiveness needs to be further verified by intervention studies.