Compliance of oral nutritional supplements in postoperative patients with digestive tract cancer:an analysis based on COM-B model

doi:10.3969/j.issn.1674-8115.2024.10.001

Abstract

Abstract:

Objective ·To explore the influencing factors of oral nutritional supplement compliance in postoperative patients with digestive tract cancer based on COM-B model, and to analyze the mediating role of medication belief and self-efficacy in oral nutritional supplement. Methods ·A total of 300 postoperative gastrointestinal cancer patients were selected by convenience sampling method. The General Information Questionnaire, Morisky Medication Adherence Scale, Digestive Cancer Patients Nutrition Knowledge, Attitude and Practice Questionnaire, Multidimensional Scale of Perceived Social Support, Beliefs about Medicines Questionnaire and General Self-Efficacy Scale were used. A mediating effect model was used to analyze the influencing factors of compliance with oral nutritional supplements. Results ·The score of Morisky Medication Adherence scale was 1.61±1.38, which was at a low level. Oral nutritional supplement compliance was significantly positively correlated with nutrition knowledge, social support, medication belief and self-efficacy (r=0.391, 0.401, 0.438, 0.410, all P<0.01). Medication belief had a partial mediating effect between nutrition knowledge and adherence to oral nutritional supplements (effect size =0.097, accounting for 18.00% of the total effect). Self-efficacy had a partial mediating effect between nutrition knowledge and oral nutritional supplement compliance (effect size =0.044, accounting for 8.16% of the total effect). Self-efficacy had a partial mediating effect between social support and oral nutritional supplement compliance (effect size =0.044, accounting for 16.67% of the total effect). Conclusion ·The compliance of oral nutritional supplements in postoperative patients with gastrointestinal cancer is at a low level. The individualized nursing intervention can increase the nutritional knowledge of patients, improve the social support, reduce the concerns of patients about oral nutrition, and improve the self-efficacy of patients, so as to promote the compliance of patients with oral nutritional supplements.

Key words: digestive tract cancer, enteral nutrition, compliance, mediating effect

CLC Number:

R473.73

SU Liqing, ZHANG Jie, DOU Wenyue, LI Mengxue, ZHANG Yumeng, CHANG Jian. Compliance of oral nutritional supplements in postoperative patients with digestive tract cancer:an analysis based on COM-B model[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1213-1220.

Figures/Tables 4

TrendMD

References 33

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Item		MMAS score	Number/n (%)	t/F value	P value
Age	<65 years	1.82±1.39	154(51.3)	2.755	0.006
Age	≥65 years	1.38±1.34	146(48.7)	2.755	0.006
Gender	Male	1.66±1.38	176(58.7)	0.769	0.443
Gender	Female	1.54±1.38	124(41.3)	0.769	0.443
BMI	<24 kg/m²	1.54±1.44	161(53.7)	-0.986	0.325
BMI	≥24 kg/m²	1.69±1.31	139(46.3)	-0.986	0.325
Marital status	Single	1.03±0.89	30(10.0)	2.823	0.025
	Married	1.70±1.41	260(86.7)
	Divorced	1.40±1.34	5(1.7)
	Widowed	0.60±0.89	5(1.7)
Living arrangement	Single	2.27±1.10	11(3.7)	1.109	0.353
	With spouse	1.48±1.40	201 (67.0)
	With family	1.81±1.31	86 (28.7)
	With others	2.50±2.12	2 (0.7)
Education background	Not educated	1.32±1.06	19 (6.3)	3.108	0.016
	Primary school	1.47±1.38	96 (32.0)
	Middle school	1.56±1.28	97 (32.3)
	High school	1.62±1.42	55 (18.3)
	College/University	2.36±1.56	33 (11.0)
Monthly income	<2 000 yuan	1.52±1.30	93 (31.0)	3.924	0.004
	2 000‒2 999 yuan	1.45±1.31	87 (29.0)
	3 000‒3 999 yuan	1.56±1.33	66 (22.0)
	4 000‒5 000 yuan	1.81±1.55	33 (11.0)
	>5 000 yuan	2.57±1.60	21 (7.0)
Employment status	Unemployed	1.57±1.32	37 (12.3)	2.287	0.060
	Employed	2.12±1.38	59 (19.7)
	Retired	1.48±1.36	204 (68.0)
Medical payment	Publicly funded medical insurance	1.46±1.33	39 (13.0)	0.269	0.898
	Employee health insurance	2.02±1.42	82 (27.3)
	Urban medical insurance	1.39±1.23	69 (23.0)
	New rural cooperative medical insurance	1.45±1.41	97 (32.3)
	Self-paying	1.85±1.34	13 (4.3)
Adverse reaction	Diarrhea	1.69±1.42	59 (19.7)	2.523	0.041
	Abdominal distension	1.22±1.11	74 (24.7)
	Nausea	0.68±0.84	22 (7.3)
	Vomiting	1.57±1.40	7 (7.0)
	None	1.94±1.45	138 (46.0)

Item		MMAS score	Number/n (%)	t/F value	P value
Age	<65 years	1.82±1.39	154(51.3)	2.755	0.006
Age	≥65 years	1.38±1.34	146(48.7)	2.755	0.006
Gender	Male	1.66±1.38	176(58.7)	0.769	0.443
Gender	Female	1.54±1.38	124(41.3)	0.769	0.443
BMI	<24 kg/m²	1.54±1.44	161(53.7)	-0.986	0.325
BMI	≥24 kg/m²	1.69±1.31	139(46.3)	-0.986	0.325
Marital status	Single	1.03±0.89	30(10.0)	2.823	0.025
	Married	1.70±1.41	260(86.7)
	Divorced	1.40±1.34	5(1.7)
	Widowed	0.60±0.89	5(1.7)
Living arrangement	Single	2.27±1.10	11(3.7)	1.109	0.353
	With spouse	1.48±1.40	201 (67.0)
	With family	1.81±1.31	86 (28.7)
	With others	2.50±2.12	2 (0.7)
Education background	Not educated	1.32±1.06	19 (6.3)	3.108	0.016
	Primary school	1.47±1.38	96 (32.0)
	Middle school	1.56±1.28	97 (32.3)
	High school	1.62±1.42	55 (18.3)
	College/University	2.36±1.56	33 (11.0)
Monthly income	<2 000 yuan	1.52±1.30	93 (31.0)	3.924	0.004
	2 000‒2 999 yuan	1.45±1.31	87 (29.0)
	3 000‒3 999 yuan	1.56±1.33	66 (22.0)
	4 000‒5 000 yuan	1.81±1.55	33 (11.0)
	>5 000 yuan	2.57±1.60	21 (7.0)
Employment status	Unemployed	1.57±1.32	37 (12.3)	2.287	0.060
	Employed	2.12±1.38	59 (19.7)
	Retired	1.48±1.36	204 (68.0)
Medical payment	Publicly funded medical insurance	1.46±1.33	39 (13.0)	0.269	0.898
	Employee health insurance	2.02±1.42	82 (27.3)
	Urban medical insurance	1.39±1.23	69 (23.0)
	New rural cooperative medical insurance	1.45±1.41	97 (32.3)
	Self-paying	1.85±1.34	13 (4.3)
Adverse reaction	Diarrhea	1.69±1.42	59 (19.7)	2.523	0.041
	Abdominal distension	1.22±1.11	74 (24.7)
	Nausea	0.68±0.84	22 (7.3)
	Vomiting	1.57±1.40	7 (7.0)
	None	1.94±1.45	138 (46.0)

Item	DCNKAPQ	MSPSS	BMQ	GSES	MMAS
DCNKAPQ	1.000	0.274 ^①	0.275 ^①	0.204 ^①	0.391 ^①
MSPSS	0.274 ^①	1.000	0.176 ^①	0.322 ^①	0.401 ^①
BMQ	0.275 ^①	0.176 ^①	1.000	0.231 ^①	0.438 ^①
GSES	0.204 ^①	0.322 ^①	0.231 ^①	1.000	0.410 ^①
MMAS	0.391 ^①	0.401 ^①	0.438 ^①	0.410 ^①	1.000

Item	DCNKAPQ	MSPSS	BMQ	GSES	MMAS
DCNKAPQ	1.000	0.274 ^①	0.275 ^①	0.204 ^①	0.391 ^①
MSPSS	0.274 ^①	1.000	0.176 ^①	0.322 ^①	0.401 ^①
BMQ	0.275 ^①	0.176 ^①	1.000	0.231 ^①	0.438 ^①
GSES	0.204 ^①	0.322 ^①	0.231 ^①	1.000	0.410 ^①
MMAS	0.391 ^①	0.401 ^①	0.438 ^①	0.410 ^①	1.000

Dependent variable	Pathway	Effect	S.E.	95%CI	P value	Proportion/%
Nutritional knowledge	Total effect	0.539	0.136	0.302‒0.843	0.000	100.00
	Direct effect(Nutritional knowledge→ Compliance of ONS)	0.398	0.168	0.103‒0.769	0.008	73.84
	Mediating effect
	Nutritional knowledge →Self-efficacy	0.247	0.106	0.034‒0.453	0.027	‒
	Nutritional knowledge →Self-efficacy →Compliance of ONS	0.044	0.006	0.001‒0.019	0.019	8.16
	Nutritional knowledge →Medication belief	0.452	0.076	0.292‒0.592	0.001	‒
	Nutritional knowledge →Medication belief →Compliance of ONS	0.097	0.013	0.003‒0.032	0.017	18.00
	Total mediating effect	0.141	0.052	0.053‒0.257	0.006	26.16
Social support	Total effect	0.264	0.106	0.039‒0.442	0.028	100.00
	Direct effect (Social support →Compliance of ONS)	0.220	0.102	0.002‒0.392	0.049	83.33
	Mediating effect
	Social Support →Self-efficacy	0.247	0.086	0.063‒0.397	0.015	‒
	Social support →Self-efficacy →Compliance of ONS	0.044	0.026	0.006‒0.112	0.022	16.67
	Total mediating effect	0.044	0.026	0.006‒0.112	0.022	16.67
Self-efficacy	Direct effect (Self-efficacy →Compliance of ONS)	0.180	0.180	0.022‒0.320	0.026	100.00
Medication belief	Direct effect (Medication belief →Compliance of ONS)	0.215	0.215	0.020‒0.372	0.025	100.00