| Objective To investigate the relationship between medication adherence and health literacy and social support in CTDPAH patients, and to construct a column-line graphical model for predicting medication adherence in CTD-PAH patients. Methods A total of 248 patients with CTD-PAH admitted to the Department of Rheumatology and Immunology, the First Affiliated Hospital of Nanjing Medical University, from July 1, 2022 to June 30, 2024 were enrolled as the research subjects. A general information questionnaire, the Health Literacy Scale for Chronic Disease Patients, the Medical Social Support Scale and the Morisky Medication Adherence Scale were adopted for investigation to collect the clinical data, health literacy level, social support level and medication adherence level of the subjects. According to the medication adherence status, the subjects were divided into the poor medication adherence group (n=28) and the good medication adherence group (n=220). The differences in clinical data, health literacy level and social support level between the two groups were compared. Multivariate logistic regression analysis was performed to identify the independent risk factors for poor medication adherence in patients with CTD-PAH, on the basis of which a predictive model was constructed and a nomogram was plotted. The ROC curve was plotted and the AUC was calculated to evaluate the discriminative ability of the model, while the Hosmer-Lemeshow test and calibration plot were used to assess the calibration of the model. Results The 248 CTD-PAH patients had a medication adherence score of (6.04±0.56), a health literacy score of (78.63±8.59), and a social support score of (63.87±7.27). Separation/retirement (OR: 5.471，95%CI:1.497~20.002), medication frequency < 2 times/d(OR: 5.029， 95%CI: 1.341~18.860), no pharmacist guidance (OR: 6.984，95%CI: 1.775~27.475), low health literacy score (OR: 0.806，95%CI：0.723~ 0.898), and low social support score (OR: 0.768，95%CI: 0.689~0.857) were independent risk factors for poor medication adherence in CTDPAH patients. Medication adherence in CTD-PAH patients was positively correlated with health literacy and social support (P<0.05). The results of model validation showed that the calibration curve converged to the ideal curve, with a C-index of 0.966 and an AUC of 0.821. Conclusion Separation/retirement, medication frequency <2，times/d, no pharmacist guidance, low health literacy scores, and low social support scores are significantly associated with poor medication adherence in patients with CTD-PAH, and have good predictive value based on the column-line graphical modeling of medication adherence in patients with CTD-PAH. |
