基于健康行为过程取向（HAPA）理论的脑卒中患者跌倒预防行为意向研究

发布时间：2018-08-12 12:12

【摘要】：目的:本研究通过循证的方法,探索最有效、最广泛的跌倒预防措施,并基于循证结果,进一步应用德尔菲法编制脑卒中患者跌倒风险认知和行为意向问卷并调查其现状,构建结构方程模型分析各相关变量的影响路径。方法:计算机检索Cochrane library、PubMed、CNKI等国内外数据库中有关脑卒中成年人跌倒预防的随机对照试验,对符合纳入与排除标准的文献进行系统评价,采用RevMan5.3软件进行统计分析;基于循证结果和认知理论,运用德尔菲(Delphi)法编制《跌倒风险认知和行为意向问卷》,并进行信效度检验;采用便利抽样法选取脑卒中患者,使用编制的问卷调查其跌倒风险认知和行为意向的现状并构建结构方程模型,分析、评价其变量间路径,探讨行为意向前因变量对行为意向的解释力及在意向阶段行为意向与自我效能变量对执行意向变量的中介作用。所得数据采用SPSS17.0及AMOS17.0统计软件进行数据处理及分析。结果:1 22项随机对照试验的meta分析显示:与空白或常规干预相比,不同形式的干预对脑卒中成年人跌倒发生人数综合效果差异无统计学意义[OR=0.80,95%CI 0.61-1.05],但多因素干预与对照组相比,脑卒中跌倒发生的人数的下降存在显著差异[OR=0.33,95%CI0.16-0.68];不同干预时长下,干预对脑卒中成年人跌倒发生人数影响的差异无统计学意义[OR=1.00,95%CI0.77-1.30];干预对脑卒中成年人跌倒率影响的差异无统计学意义[OR=0.79,95%CI0.39-1.62],且结果均稳定可信。2经2轮德尔菲专家函询,预调查,正式调查后形成《跌倒风险认知和行为意向问卷》共包括57个条目,探索性因子分析提取10个公因子,累积方差贡献率为75.17%,提取的公因子与预先根据理论框架设计的结构假设的组成相符,组成6个理论变量,分别为风险认知、结果预期、跌倒自我效能、行为意向、执行意向、应对自我效能。量表整体Cronbach's a系数为0.934,各个变量的a系数分别为0.897、0.822、0.979、0.892、0.929、0.940,问卷内部一致性良好。3脑卒中跌倒风险认知和行为意向修正模型拟合良好,可被接受(χ2=5.737,P=0.676,χ2/df=0.7172,NFI=0.991,RFI=0.968,IFI=1.004,TLI=1.013,CFI=1.000,RMSEA=0.0000.08),模型可解释行为意向的47%,行为计划的41%和应对计划的51%。跌倒自我效能、风险认知是行为意向的决定因素,存在直接正预测效应,同时应对自我效能对跌倒自我效能、风险认知和行为意向、执行意向起部分中介作用;行为意向在跌倒自我效能、风险认知和执行意向之间起完全中介作用。结论:将HAPA理论引入脑卒中跌倒预防研究制定的《跌倒风险认知和行为意向问卷》有良好的信效度且与假设理论框架相一致;HAPA模型可有效描述、解释、预测跌倒预防行为的转变过程。
[Abstract]:Objective: to explore the most effective and extensive measures for the prevention of falls through the evidence-based method. Based on the results of the study, the Delphi method was used to compile the questionnaire on the cognition and behavior intention of stroke patients' fall risk, and to investigate the present situation of the questionnaire. The structural equation model is constructed to analyze the influence path of each related variable. Methods: a randomized controlled trial on the prevention of cerebral apoplexy in adults with cerebral apoplexy was searched by computer in Cochrane library.PubMedi and other databases at home and abroad. The literatures that met the criteria of inclusion and exclusion were systematically evaluated, and the statistical analysis was carried out with RevMan5.3 software. Based on the evidence-based results and cognitive theory, Delphi (Delphi) method was used to compile the questionnaire of cognition and behavior intention of fall risk, and the reliability and validity of questionnaire were tested, and the convenience sampling method was used to select patients with cerebral apoplexy. The current situation of cognition and behavior intention of fall risk was investigated by questionnaire, and the structural equation model was constructed to analyze and evaluate the path between variables. This paper discusses the explanatory power of behavioral intention dependent variables to behavior intention and the mediating effect of behavior intention and self-efficacy variables on executive intention variables. The data are processed and analyzed by SPSS17.0 and AMOS17.0 software. Results the meta analysis of 22 randomized controlled trials showed that there was no significant difference in the comprehensive effect of different forms of intervention on the incidence of stroke in adults with stroke compared with blank or routine intervention [ORO 0.8095 CI 0.61-1.05], but the multivariate intervention was compared with the control group. There was a significant difference in the number of people who fell down after stroke [ORO 0.339 95 CI 0.16-0.68]; There was no significant difference in the effect of intervention on the incidence of stroke in adults with stroke [OR1. 00 and 95 CI0.77-1.30], but there was no significant difference in the effect of intervention on the fall rate of adults with stroke [OR0.79 ~ 95CI0.39-1.62], and the results were stable and reliable. A total of 57 items were included in the questionnaire on perceived and Behavioral intention of falling risk after formal investigation. Ten common factors were extracted by exploratory factor analysis. The contribution rate of cumulative variance was 75.17. The common factors extracted were consistent with the composition of the structural assumptions designed in advance according to the theoretical framework. The six theoretical variables were risk cognition, result expectation, fall self-efficacy, behavioral intention, executive intention, respectively. Coping with self-efficacy. The overall Cronbach's a coefficient of the scale was 0.934, and the a coefficient of each variable was 0.897 / 0.8220.9790.8920.8920.9290.940 respectively. The internal consistency of the questionnaire was good. 3 the models of cognition and behavior intention correction of stroke fall risk were well fitted. It is acceptable (蠂 ~ 2 / dfr ~ (5.737) / p ~ (0.676), 蠂 ~ 2 / d ~ (dfU) 0.7172NFI ~ (0.991N) ~ (0.96) ~ (1.004) ~ (-1) TLI ~ (1.013) CFI ~ (1) 1.000 RMSEAE ~ (0.0008). The model can explain the behavior intention 471% of the behavior plan, the behavior plan (41%) and the coping plan (51). Fall self-efficacy, risk cognition is the decisive factor of behavior intention, there is direct positive predictive effect, and coping self-efficacy plays a part of intermediary role in fall self-efficacy, risk cognition and behavioral intention. Behavioral intention plays a complete intermediary role between fall self-efficacy, risk cognition and executive intention. Conclusion: the questionnaire on cognition and behavior intention of fall risk developed by the study of HAPA in the study of stroke prevention has good reliability and validity and is consistent with the hypothetical theoretical framework. The model can be effectively described and explained. Predict the course of change in fall prevention behavior.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.74

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