基于COM-B模型的慢性心衰患者自护行为阻碍与促进因素研究

发布时间：2018-01-05 10:41

本文关键词：基于COM-B模型的慢性心衰患者自护行为阻碍与促进因素研究　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:依据能力、机会、动机—行为(COM-B)模型,探讨慢性心衰患者自护行为(包括自护维持和自护管理)的水平及其阻碍与促进因素,为制定干预策略,改善其自护行为提供借鉴。方法:本研究采用横断面研究设计。2015年11月至2016年4月,从某三级甲等医院心内科病房抽取321例慢性心衰患者开展问卷调查。数据收集采用心力衰竭自护指数、杜克活动状态指数、心衰疾病知识测试、慢性病患者健康素养量表、多维度感知社会支持量表、主观社会经济地位量表和自行设计的一般资料问卷。数据整理后,采用IBM SPSS 20.0软件包与Mplus7.0软件进行统计分析。结果:1.慢性心衰患者自护维持得分范围为10.00～93.32分,平均为(48.42±15.86)分,低于70分者298例(92.8%);自护管理得分范围为10.00～95.00分,平均为(54.35±19.32)分,低于 70 分者 243 例(75.7%)。2.慢性心衰患者的社会人口学和临床资料特征与自护行为有关。年龄、左室射血分数(LVEF)与自护维持得分正相关,教育水平较低、从事体力劳动、人均月收入较低、居住于农村、心衰病程6个月、心衰住院次数3次、合并疾病数量3个的患者自护维持得分低于教育水平较高、从事脑力劳动或退休/自由职业、人均月收入较高、居住于城镇、心衰病程≥6个月、心衰住院次数≥3次、合并疾病数量≥3个的患者(P0.05或P0.01)。LVEF与自护管理得分负相关,从事体力劳动、居住于农村、心衰病程6个月、心衰住院次数3次、NYHA心功能Ⅱ级的患者自护管理得分低于从事脑力劳动或退休/自由职业、居住于城镇、心衰病程≥6个月、心衰住院次数≥3次、NYHA心功能Ⅲ级和Ⅳ级的患者(P0.05或P0.01)。3.慢性心衰患者功能状态平均得分为(18.27±1.90),与自护管理得分正相关(r=0.163,P0.01)。心衰疾病知识平均得分为(4.02±2.05),与自护维持和自护管理得分均正相关(r=0.218,0.453,均P0.01)。健康素养平均得分为(99.53±12.51),与自护维持和自护管理得分均正相关(r=0.407,0.161,均P0.01)。社会支持平均得分为(64.71±7.41),与自护维持得分正相关(r=0.223,P0.01)。社会经济地位平均得分为(9.84±2.95),与自护维持得分正相关(r=0.189,P0.01)。自护信心平均得分为(57.09±13.42),与自护维持和自护管理得分均正相关(r=0.260,0.400,均P0.01)。4.路径分析结果显示,健康素养、社会支持、自护信心和年龄对自护维持有直接影响,直接效应值依次为0.265、0.159、0.128和0.139;功能状态、心衰疾病知识、自护信心和LVEF对自护管理有直接影响,直接效应值依次为0.115、0.303、0.324和-0.133。心衰疾病知识、健康素养和社会支持还可以通过自护信心间接影响自护维持和自护管理。该模型可以解释自护维持27.2%的变异量和自护管理 34.9%的变异量(R2=0.272,0.349)。5.拔靴法中介效应检验结果表明,自护信心在心衰疾病知识、健康素养、社会支持与自护维持关系中的中介效应值分别为0.032、0.023和0.025;在心衰疾病知识、健康素养、社会支持与自护管理关系中的中介效应值分别为0.075、0.054和0.058。以上中介效应均呈显著性。结论:1.慢性心衰患者的自护维持和自护管理水平较低,大多数患者的自护行为不足。2.慢性心衰患者的功能状态较差,心衰疾病知识较缺乏,健康素养和社会支持处于中等水平,自护信心水平较低,多数患者缺乏自护信心。3.慢性心衰患者的健康素养、社会支持、自护信心和年龄直接影响自护维持水平;患者的功能状态、心衰疾病知识、自护信心和LVEF直接影响自护管理水平。此外,心衰疾病知识、健康素养和社会支持间接影响(通过自护信心的中介作用)自护维持和自护管理水平。4.心衰疾病知识不足和自护信心缺乏是自护维持的阻碍因素;功能状态受损、心衰疾病知识不足和自护信心缺乏是自护管理的阻碍因素。高水平的健康素养和社会支持是自护维持和自护管理的促进因素。5.医护人员可采用COM-B模型为理论框架,将以上因素作为切入点,采取针对性的干预措施,提高慢性心衰患者的自护维持和自护管理水平。
[Abstract]:Objective: on the basis of ability, opportunity, motivation and behavior (COM-B) model, to investigate the self-care behavior of patients with chronic heart failure (including self-care maintenance and self-care management) level and hindering and promoting factors, for the development of intervention strategies to improve their self-care behaviors and provide reference. Methods: This study used a cross-sectional study design of.2015 from November to April 2016. From a grade three hospital department of cardiology ward from 321 cases of patients with chronic heart failure to carry out the survey. The data was collected by heart failure self-care index, the Duke activity status index test, disease knowledge, health literacy scale for patients with chronic disease, multiple dimensions of perceived social support scale, subjective social status questionnaire and self-designed general information questionnaire. Data, statistical analysis was performed using IBM SPSS 20 software and Mplus7.0 software. Results: 1. chronic heart failure patients self-care maintenance score ranged from 10 to 93.32, the average (48.42 + 15.86), 298 cases of less than 70 points (92.8%); the scope of self-management score of 10 to 95, the average (54.35 + 19.32), 243 cases of less than 70 points (75.7%) social demographic and clinical data characteristics of.2. in patients with chronic heart failure related to self nursing behavior. Age, left ventricular ejection fraction (LVEF) were positively correlated with self-care maintenance, the low level of education, engaged in manual labor, the per capita monthly income is low, live in rural areas, the duration of heart failure 6 months of hospitalization for heart failure for 3 times, with the number of 3 patients with disease score lower than the level of education to maintain self-care high, engaged in mental labor or retirement / free occupation, per capita monthly income is higher, living in the urban areas, more than 6 months duration of heart failure, heart failure hospitalization more than 3 times, more than 3 of the number of disease patients (P0.05 or P0.01) and the.LVEF score is negatively related to self-care management, engage in manual labor, living in Yu Nong Village, the duration of heart failure in 6 months, 3 times the number of hospitalization for heart failure, NYHA heart function grade II patients self-care management score lower than engaged in mental labor or retirement / freedom of occupation, living in the urban areas, the duration of heart failure aged 6 months, more than 3 times of hospitalization for heart failure, heart function NYHA III and IV patients (P0.05 or P0.01.3.) function in patients with heart failure of chronic condition the average score was (18.27 + 1.90), positive correlation with the score of self-care management (r=0.163, P0.01). The average score for heart failure disease knowledge (4.02 + 2.05), were positively correlated with self-care maintenance and self-care management score (r= 0.218,0.453, P0.01). The average health literacy score (99.53 + 12.51), were positively correlated with self-care maintenance and self-care management score (r=0.407,0.161, P0.01). The average score of social support (64.71 + 7.41), the score was positively correlated with self-care maintenance (r=0.223, P0.01). The social economic status of the average score was (9.84 + 2.95), and self maintenance The score was positively correlated (r=0.189, P0.01). The average score for self-care confidence (57.09 + 13.42), were positively correlated with self-care maintenance and self-care management score (r=0.260,0.400, P0.01).4. path analysis showed that health literacy, social support, self confidence and age have a direct impact on the self maintained, direct effect values were 0.265,0.159,0.128 and 0.139; functional status, disease knowledge, self-care confidence and LVEF has a direct effect on self-care management, direct effect values were 0.115,0.303,0.324 and -0.133. heart disease knowledge, health literacy and social support can also indirectly affect self-care maintenance and self-care management through self-care confidence. The model can explain the variance of self-care to sustain 27.2% variation the amount and self-care management 34.9% (R2=0.272,0.349).5. bootstrap mediating effect test results show that the self confidence in the disease knowledge, health literacy, social support And maintain the mediating effect in the relationship between self-care values were 0.032,0.023 and 0.025 respectively; health literacy in heart failure disease knowledge, mediating effect between social support and self-care management values were 0.075,0.054 and 0.058. showed a significant mediating effect. Conclusion: 1. chronic heart failure patients self-care maintenance and self-care management level is low. Most patients with.2. deficiency of self-care behavior in patients with chronic heart failure function is poor, lack of disease knowledge, health literacy and social support in the middle level, self confidence level is low, most of the patients were lack of self confidence in patients with chronic heart failure.3. health literacy, social support, self confidence and age directly influence the self-care level to maintain function; patients with heart failure, disease knowledge, self-care confidence and LVEF directly affect self-care management level. In addition, disease knowledge, health literacy and social support Indirect effects (through the intermediary role of self confidence and self management level of self-care) maintain.4. disease knowledge and self-care deficiency of heart failure is lack of confidence factors hindering self-care maintenance; function damage, heart disease and lack of confidence is the lack of knowledge of self-care barriers self-care management. High levels of health literacy and social support is to maintain self-care and self-care management of the promoting factors of.5. medical personnel can use the COM-B model as the theoretical framework, the above factors as a starting point, take targeted interventions to improve self-care in patients with chronic heart failure and maintain self nursing management level.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.54

【参考文献】