内科

目的基于计划行为理论探讨社区老年慢性病共病患者服药意向的影响因素，为加强其服药依从性与自我管理能力提供实证依据。方法采用目的抽样法，选取2024年6月～7月在南宁市西乡塘区北湖南棉社区卫生服务中心随访的11例老年慢性病共病患者进行半结构化访谈。以计划行为理论为指导，运用Colaizzi七步分析法对访谈资料进行整理与分析。结果关于社区老年慢性病共病患者服药意向影响因素，共提炼出3个主题及10个亚主题。（1）行为态度：服药可有效控制病情进展、缓解不适症状等对服药获益的信念可提升服药意向；担忧副作用等对服药风险的信念则会降低服药意向；因长期规律服药而产生的身心疲惫感，进而将每日服药视作负担的负性情感体验可降低服药意向。（2）主观规范：家庭环境中，家人的反复提醒与监督会形成一种隐性的遵从压力进而增强服药意向，部分独居患者因缺乏这种来自亲密关系的压力感知，服药意向往往较低；社会环境中，病友的成功经验会转化为一种隐性的群体规范压力，可影响其服药意向。（3）知觉行为控制：服药种类的影响受年龄与习惯调节，复杂服药规则、出行需求、药品可及性不足、用药经济成本高均会降低患者感知到的服药行为可控性，进而降低服药意向。结论社区老年慢性病共病患者的服药意向受行为态度、主观规范与知觉行为控制三重因素交互影响。未来应重点关注高龄、独居等弱势群体，从简化用药方案、优化基层药品供应、完善医疗保障及加强家庭与社会支持等多维度入手，提升患者的服药意向与长期服药依从性。

Objective To explore the factors influencing medication adherence intention in community‑dwelling elderly patients with multimorbidity from the perspective of the Theory of Planned Behavior, so as to provide empirical evidence for enhancing their medication adherence and self‑management ability. Methods By purposive sampling, 11 elderly patients with multimorbidity who were followed up at the Beihu Nanmian Community Health Service Center in Xixiangtang District, Nanning City from June to July 2024 were selected for semi‑structured interviews. Guided by the Theory of Planned Behavior, the interview data were organized and analyzed using Colaizzi's seven‑step analysis method. Results Three themes and ten sub‑themes regarding the factors influencing medication adherence intention in community‑dwelling elderly patients with multimorbidity were extracted. (1) Attitude toward behavior: Beliefs about medication benefits—for example medication can effectively control disease progression and relieve uncomfortable symptoms—enhanced medication adherence intention; beliefs about medication risks, including concerns about side effects, weakened medication adherence intention; negative emotional experiences, such as physical and mental fatigue from long‑term regular medication and perceiving daily medicine-taking as a burden, also reduced medication adherence intention. (2) Subjective norm: In the family setting, repeated reminders and supervision from family members created implicit compliance pressure that strengthened medication adherence intention, whereas some patients living alone lacked such intimate relationship pressure and thus tended to have lower medication adherence intention; in the social environment, successful experiences of fellow patients translated into implicit group normative pressure that could influence their medication adherence intention. (3) Perceived behavioral control: The impact of number of medications was moderated by age and habits; complex dosing rules, travel needs, insufficient drug accessibility, and high economic cost of medication all reduced patients' perceived controllability over medication‑taking, thereby lowering medication adherence intention. Conclusion Medication adherence intention in community‑dwelling elderly patients with multimorbidity is interactively influenced by attitude toward behavior, subjective norm, and perceived behavioral control. Future efforts should focus on vulnerable groups such as the elderly and those living alone, and adopt multidimensional approaches—including medication regimen simplification, optimization of primary‑care drug supply, improved medical insurance coverage, and strengthened family and social support—to enhance patients' medication adherence intention and long‑term medication adherence.

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