尼日利亚癌症生存者生活方式咨询指导的可行性研究

发布时间：2018-07-29 14:45

【摘要】：背景癌症是一种威胁人类生命健康的疾病,在许多国家肆虐,当然,尼日利亚也不例外。国家的癌症统计数据令人揪心,大多数类型的癌症很少或几乎没有幸存者。目前,生活方式的改变已被证实是癌症管理的救生索,不仅可以改善病人的生理指标结果,减轻疾病症状,而且有机会延长生命。目的本文主要试图为尼日利亚的癌症控制提供政策建议,寻找可行的自我管理策略,探究与医生为癌症生存者提供生活方式咨询有关的因素,从而在癌症管理项目中,为最终制定改善癌症病人的生存状况的干预计划提供理论依据。方法研究内容：①癌症患者自我管理对提高患者生存质量的必要性和可行性；②医生的咨询对于提高癌症患者自我管理能力的重要性；③尼日利亚医生对癌症患者提供咨询指导的意愿和影响因素；④确定计划行为理论(TPB)作为行为改变理论模型用来研究该行为的合理性。资料的来源与分析方法： ;1)文献研究：通过文献研究探讨在尼日利亚对癌症患者进行生活方式自我管理的重要性和可能性。①收集有关合理的自我管理策略可以改善癌症治疗的资料；②收集生活方式咨询是自我管理策略中一项非常经济有效的方式的资料和证据；③确定TPB的特点及其用于本研究的合理性。 (2)问卷调查：应用TPB探讨尼日利亚医生为癌症生存者提供咨询的可能性。①问卷设计：按TPB模型设计医生咨询的行为和意愿调查问卷；②预实验,对问卷的信度效度进行质量分析；③横断面调查：在尼日利亚埃努古州的两大政府医院对医生进行自填式问卷调查。 (3)统计分析：应用结构方程模型(SEM)和SPSS进行数据分析。结果 (1)文献研究确定了生活方式行为的改变是一种有效的控制癌症的策略。在尼日利亚,由于贫穷和缺乏政府资金,生活方式咨询是非常经济有效的控制癌症的方法。 (2)本次研究按TPB设计的调查医生为患者提供咨询的意愿的调查问卷具有较好的效度和信度。组内相关系数具有统计学意义,大多数变量的克朗巴哈系数大于0.7。 (3)此次调查共纳入210名调查对象,其中7.1%的调查对象为肿瘤学家,16.2%的调查对象为全科医生(GP),76.7%的调查对象为其他专业医生。 (4)在结构方程模型的分析中,拟合指数表明最终的结构模型合理。在最终的直接TPB模型中,只有态度(标准估计值为0.44,p0.001)对提供生活方式咨询意愿的影响具有统计学意义,主观规范和知觉行为控制对提供生活方式咨询意愿的影响不具有统计学意义。在间接TPB模型中,行为信念(标准估计值为0.40,p0.001)和主观信念(标准估计值为0.27,p=0.004)对意愿的影响有统计学意义,知觉行为控制对意愿的影响不具有统计学意义。同时,意愿(OR=2.231,95%CI:1.058-4.706)对咨询行为的预测具有统计学意义。结论从TPB模型的研究结果来看,尼日利亚医生向癌症病人提供生活方式咨询合理性的意向受其态度及主观规范的影响。该结果证实了在尼日利亚为癌症康复者提供生活方式咨询的可行性,也为国家癌症管理项目中进行加强生活方式咨询的干预计划提供了依据。任何改善医生态度和主观规范的措施都会促进医生更多地对癌症患者提供生活方式咨询服务,进而提高患者的自我管理能力。创新点和局限性本研究首次评估了在尼日利亚医生为癌症生存者进行生活方式咨询的重要性和可行性。采用计划行为理论对医生为患者提供生活方式咨询意愿和行为的研究结果提示态度和主观规范是医生咨询行为的潜在的促进因素或障碍因素。由于受到资金和时间的限制,目前该研究的研究对象仅纳入了尼日利亚一个城市的医生。今后,需要在多个城市进行调查以提高结果的普遍性。
[Abstract]:background
Cancer is a disease that threatens the health of human life. In many countries, of course, Nigeria is no exception. National cancer statistics are worrying, most types of cancer are rare or almost no survivors. The changes in lifestyle are now proven to be cancer management lifeline, not only to improve the physiology of patients. The results reduce the symptoms of disease and prolong life.
objective
This article mainly attempts to provide policy recommendations for cancer control in Nigeria, to find a feasible self-management strategy, to explore the factors associated with doctors to provide lifestyle counseling for cancer survivors, and to provide a theoretical basis for the eventual development of an intervention plan to improve the survival of cancer patients in cancer management projects.
Method
The research contents: (1) the necessity and feasibility of self management of cancer patients to improve the quality of life of the patients; (2) the importance of doctor's consultation to improve the self management ability of cancer patients; (3) the willingness and influence factors of consultation guidance for cancer patients in Nigeria; (4) determine the theory of planned behavior (TPB) as a behavior change. The variable theory model is used to study the reasonableness of the behavior.
Sources and analytical methods of data:
1) literature research: the importance and possibility of the life style self management of cancer patients in Nigeria through literature study. (1) collecting reasonable self management strategies can improve cancer treatment data; 2. Collection of lifestyle counseling is a very economical and effective way of self management strategy. And evidence; determine the characteristics of TPB and its rationality for this study.
(2) questionnaire survey: the application of TPB to explore the possibility of consulting Nigeria doctors for cancer survivors. (1) questionnaire design: questionnaire design on the behavior and willingness of doctors according to the TPB model; (2) pre experiment, quality analysis of the reliability and validity of the questionnaire; (3) cross section investigation: two major government doctors in the state of the state of Nigeria. The hospital conducted a self-administered questionnaire to the doctors.
(3) statistical analysis: using structural equation modeling (SEM) and SPSS for data analysis.
Result
(1) literature studies have identified changes in lifestyle behavior as an effective strategy for cancer control. In Nigeria, lifestyle counseling is a very economic and effective way to control cancer because of poverty and lack of government funds.
(2) the questionnaire based on TPB designed by investigators to provide counseling for patients has a good validity and reliability. The intra group correlation coefficient is statistically significant, and the Kron Baja coefficient of most variables is greater than that of 0.7.
(3) a total of 210 subjects were included in the survey, of which 7.1% were oncologists, 16.2% were the general practitioner (GP), and 76.7% of the respondents were other professional doctors.
(4) in the analysis of the structural equation model, the fitting index indicates that the final structure model is reasonable. In the final direct TPB model, only attitude (standard estimated value of 0.44, p0.001) has a statistically significant impact on the willingness to provide lifestyle counseling, and the influence of subjective norms and awareness behavior control on the willingness to provide lifestyle counseling is not significant. In the indirect TPB model, behavioral beliefs (standard estimated value 0.40, p0.001) and subjective beliefs (standard estimated values of 0.27, p=0.004) have statistical significance on willingness, and the effect of perceived behavioral control on willingness is not statistically significant. At the same time, the prediction of willingness (OR=2.231,95%CI:1.058-4.706) is a predictor of counseling behavior. It has statistical significance.
conclusion
According to the results of the TPB model, the intention of Nigeria doctors to provide life style counseling to cancer patients was influenced by their attitudes and subjective norms. The results confirmed the feasibility of providing lifestyle counseling for cancer patients in Nigeria, and enhanced lifestyle counseling for national cancer management projects. The intervention plan provides a basis. Any measures to improve doctors' attitudes and subjective norms will help doctors to provide more lifestyle counseling to cancer patients and improve their self-management ability.
Innovation point and limitation
This study was the first to assess the importance and feasibility of living style counseling for cancer survivors in Nigeria.
Due to capital and time constraints, the research is currently only included in a city of Nigeria doctors. In the future, many cities need to be investigated in order to improve the universality of the results.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R73-31

【相似文献】