摘要
目的基于健康信念模式构建冠心病患者自我管理行为模型并进行实证研究。方法采用横断面调查的方法,使用一般情况调查表、社会支持评定量表、冠心病健康素养调查问卷、慢性病自我效能量表和冠心病自我管理量表,于2017年11月至2018年4月对重庆市3家三级甲等医院的280例住院冠心病患者进行问卷调查,并基于结构方程模型分析验证冠心病患者自我管理行为理论模型中各因素间的作用机制。结果回收有效问卷276份(98.57%),冠心病患者自我管理行为总分为(81.49±13.83)分;相关性分析显示:社会支持、健康素养、自我效能得分与自我管理得分均呈正相关(r=0.229、0.499、0.341,P<0.001);结构方程模型显示:冠心病患者自我管理行为模型拟合较好,影响自我管理行为的因素按作用大小排序为:健康素养(0.533)、自我效能(0.431)、社会支持(0.398)、合并症数目(0.257)、文化程度(0.165)、年龄(-0.115)、个人月平均收入(0.079),提示社会支持对自我管理行为仅有间接正向效应(β=0.398),健康素养对自我管理行为有直接(β=0.452,P<0.001)和间接正向效应(β=0.081),自我效能对自我管理行为有直接正向效应(β=0.431,P<0.001)。结论冠心病患者自我管理行为处于中等偏下水平,基于健康信念模式的冠心病患者自我管理行为模型具有较好的解释和预测作用。
Objective To establish a model of self-management behaviors for patients with coronary atherosclerotic heart disease based on the theory of health belief model and conduct an empirical study to verify the validity and performance of the model. Methods We conducted a cross-sectional questionnaire survey among 280 patients with coronary heart disease from 3 general hospitals in Chongqing during the period from November, 2017 to April, 2018. The general condition questionnaire, social support rating scale, coronary heart disease health literacy questionnaire, chronic disease self-efficacy scale and coronary heart disease self-management scale were used in the survey. The factors in the theoretical model that potentially affected self-management behaviors of the patients were analyzed based on the structural equation model. Results Based on 276 valid questionnaires retrieved(98.57%), the total mean score of self-management behaviors of the patients with coronary heart disease was 81.49±13.83. Correlation analysis revealed that the scores for social support, health literacy and self-efficacy were positively correlated with the scores for self-management(r=0.229, 0.499, and 0.341, respectively;P<0.001). The structural equation model demonstrated that the model of self-management behaviors was well fitted in patients with coronary heart disease. The factors affecting self-management behaviors included health literacy(0.533), self-efficacy(0.431), social support(0.398), number of complications(0.257), education level(0.165), age(-0.115), and average monthly personal income(0.079). The model also showed that social support had only an indirect positive effect(β=0.398), health literacy had both direct(β=0.452, P<0.001) and indirect positive effects(β=0.081), and self-efficacy had a direct positive effect on self-management behaviors(β=0.431, P<0.001). Conclusion The patients with coronary heart disease have moderate to low levels of self-management behaviors. The self-management behavior model constructed based on the health belief model has good interpretative and predictive effects in patients with coronary heart disease.
作者
刘玮楚
王攀
罗业涛
王俊
赵庆华
LIU Weichu;WANG Pan;LUO Yetao;WANG Jun;ZHAO Qinghua(Department of Gynecology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016;Institute of Health Science Research,Renmin University of China,Beijing,100872;Institute of Pediatrics,Children’s Hospital of Chongqing Medical University,Chongqing,400014,China;Department of Nursing,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400014)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2020年第9期953-962,F0003,共11页
Journal of Third Military Medical University
基金
重庆市卫生计生委医学科研计划项目重点项目(2015ZDXM009)
中国研究型医院学会临床护理研究项目(2017-20-19)。
关键词
健康信念模式
冠心病
自我管理
影响因素分析
结构方程模型
health belief model
coronary atherosclerotic heart disease
self-management
root cause analysis
structural equation model
