父母健康素养与青少年过敏性鼻炎治疗依从性及临床结局的关联：一项对照纵向研究

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中文摘要

背景： 父母健康素养可能与青少年过敏性鼻炎（AR）的治疗依从性和临床结局相关，但关于这些关系的证据仍然有限。目的：评估父母健康素养与青少年AR治疗依从性和临床结局的关联，并比较AR青少年与健康对照之间父母健康素养及基线睡眠相关症状负担。方法：在这项对照纵向观察性研究中，纳入132名AR青少年和120名健康对照。使用土耳其健康素养量表-32（TSOY-32）评估父母健康素养。AR青少年在基线（T0）、第4周（T1）和第8周（T2）接受评估。使用总鼻症状评分（TNSS）和视觉模拟量表（VAS）评估鼻部症状，使用儿童睡眠问卷（PSQ）评估睡眠相关症状。治疗依从性在T2时被分类为覆盖整个8周随访期的单一二分类指标。进行了多变量线性回归和Firth惩罚逻辑回归分析。结果：与健康对照相比，AR青少年的PSQ总分和子量表得分显著更高，PSQ定义的高风险患病率也更高（所有p < 0.001）。随访期间，PSQ、TNSS和VAS评分显著下降（所有p < 0.001），治疗依从的青少年改善更大。父母健康素养与治疗依从性（p < 0.001）以及TNSS和VAS的改善相关。然而，调整后，治疗依从性——而非父母健康素养——仍与T2时的PSQ、TNSS和VAS评分独立相关。多变量依从性模型在研究样本中显示出高表观区分度（AUC = 0.969）。结论：较高的治疗依从性与AR青少年更有利的临床结局一致相关。父母健康素养与治疗依从性相关，但在多变量调整后与T2临床结局无独立关联。治疗依从性是否代表连接父母健康素养与临床结局的路径，无法从本观察性研究中确定。

英文摘要

Background: Parental health literacy may be associated with treatment adherence and clinical outcomes in adolescents with allergic rhinitis (AR), but evidence regarding these relationships remains limited. Objective: To evaluate the associations of parental health literacy with treatment adherence and clinical outcomes in adolescents with AR and to compare parental health literacy and baseline sleep-related symptom burden between adolescents with AR and healthy controls. Methods: In this controlled longitudinal observational study, 132 adolescents with AR and 120 healthy controls were enrolled. Parental health literacy was assessed using the Turkish Health Literacy Scale-32 (TSOY-32). Adolescents with AR were evaluated at baseline (T0), week 4 (T1), and week 8 (T2). Nasal symptoms were assessed using the Total Nasal Symptom Score (TNSS) and Visual Analog Scale (VAS), and sleep-related symptoms using the Pediatric Sleep Questionnaire (PSQ). Treatment adherence was classified at T2 as a single binary measure covering the entire 8-week follow-up period. Multivariable linear regression and Firth penalized logistic regression analyses were performed. Results: Adolescents with AR had significantly higher PSQ total and subscale scores and a greater prevalence of PSQ-defined high risk than healthy controls (all p < 0.001). During follow-up, PSQ, TNSS, and VAS scores decreased significantly (all p < 0.001), with greater improvements among treatment-adherent adolescents. Parental health literacy was associated with treatment adherence (p < 0.001) and with improvements in TNSS and VAS. However, after adjustment, treatment adherence-but not parental health literacy-remained independently associated with T2 PSQ, TNSS, and VAS scores. The multivariable adherence model showed high apparent discrimination within the study sample (AUC = 0.969). Conclusions: Higher treatment adherence was consistently associated with more favorable clinical outcomes in adolescents with AR. Parental health literacy was associated with treatment adherence but was not independently associated with T2 clinical outcomes after multivariable adjustment. Whether treatment adherence represents a pathway linking parental health literacy to clinical outcomes cannot be determined from the present observational study.