1.400016 重庆,重庆医科大学附属第一医院:妇科
2.100872 北京,中国人民大学健康科学研究所
3.400014 重庆,重庆医科大学附属儿童医院,儿科研究所
4.400016 重庆,重庆医科大学附属第一医院:护理部
Received:12 December 2019,
Revised:2020-01-13,
Published:15 May 2020
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Weichu LIU, Pan WANG, Yetao LUO, et al. Self-management behaviors of patients with coronary atherosclerotic heart disease based on health belief model: model building and empirical study[J]. Journal of Third Military Medical University, 2020, 42(9): 953-963.
Weichu LIU, Pan WANG, Yetao LUO, et al. Self-management behaviors of patients with coronary atherosclerotic heart disease based on health belief model: model building and empirical study[J]. Journal of Third Military Medical University, 2020, 42(9): 953-963. DOI: 10.16016/j.1000-5404.201912132.
目的
2
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
2
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
2
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
2
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
2
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
2
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
2
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 beha
viors 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
2
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.
胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告2018》概要[J].中国循环杂志, 2019, 34(3): 209-220. DOI: 10.3969/j.issn.1000-3614.2019.03.001.
HU S T, GAO R L, LIU L S. Summary of the 2018 Report on Cardiovascular Diseases in China [J ] . Chin Circ J, 2019, 34(3): 209-220. DOI:10.3969/j.issn.1000-3614.2019.03.001.
DAWKES S, SMITH G D, ELLIOTT L, et al . Self-management of coronary heart disease in older patients after elective percutaneous transluminal coronary angioplasty[J ] . J Geriatr Cardiol, 2016, 13(5): 393-400. DOI:10.11909/j.issn.1671-5411.2016.05.010.
RIEGEL B, MOSER D K, BUCK H G, et al . Self-care for the prevention and management ofcardiovascular disease and stroke: a scientific statement for healthcare professionals from the American heart association[J ] . J Am Heart Assoc, 2017, 6(9): e006997. DOI:10.1161/JAHA.117.006997.
LU M M, XIA H O, MA J Y, et al . Relationship between adherence to secondary prevention and health literacy, self-efficacy and disease knowledge among patients with coronary artery disease in China[J ] . Eur J Cardiovasc Nurs, 2019: 1474515119880059. DOI:10.1177/1474515119880059.
SMALLHEER B A, DIETRICH M S. Social support, self-efficacy, and helplessness following myocardial infarctions[J]. Crit Care Nurs Q, 2019, 42(3): 246-255. DOI:10.1097/CNQ.0000000000000265.
徐卫刚, 彭德荣, 陈晨, 等.社区冠心病患者自我管理现状及影响因素研究[J].中国全科医学, 2019, 22(28): 3516-3522. DOI: 10.12114/j.issn.1007-9572.2019.00.353.
XU W G, PENG D R, CHEN C, et al . Current st atus of self-management among patients with coronary heart disease and its influencing factors in a community[J ] . Chin Gen Pract, 2019, 22(28): 3516-3522. DOI: 10.12114/j.issn.1007-9572.2019.00.353.
包家明.护理健康教育与健康促进[M]. 2版.杭州:浙江大学出版社, 2018: 31-33.
BAO J M. Health promotion and health education in nursing[M]. 2nd ed. Hangzhou: Zhejiang University Press, 2018: 31-33.
MOHAMMADI S, KARIM N A, TALIB R A, et al . The impact of self-efficacy education based on the health belief model in Iranian patients with type 2 diabetes: a randomised controlled intervention study[J ] . Asia Pac J Clin Nutr, 2018, 27(3): 546-555. DOI:10.6133/apjcn.072017.07.
MA C H. An investigation of factorsinfluencing self-care behaviors in young and middle-aged adults with hypertension based on a health belief model[J]. Heart Lung, 2018, 47(2): 136-141. DOI:10.1016/j.hrtlng.2017.12.001.
中华医学会.临床诊疗指南—心血管分册[M].北京:人民卫生出版社, 2009: 65-75.
Chinese Medical Association. Guidelines for clinical diagnosis and treatment—cardiovascular fascicles[M]. Beijing: People's Medical Publishing House, 2009: 65-75.
FINKELSTEIN D M. A beginner's guide to structural equation modeling[J]. Technometrics, 2005, 47(4): 522. DOI:10.1198/tech.2005.s328.
[肖水源. 《社会支持评定量表》的理论基础与研究应用[J ] .临床精神医学杂志, 1994, 4(2):98-100. DOI: CNKI:SUN:LCJS.0.1994-02-019 http://dx.doi.org/CNKI:SUN:LCJS.0.1994-02-019 .
[XIAO S Y. The theoretical basis research and application of Social Support Rating Scale [J ] . J Clin Psychol Med, 1994, 4(2):98-100. DOI: CNKI:SUN:LCJS.0.1994-02-019 http://dx.doi.org/CNKI:SUN:LCJS.0.1994-02-019 ..
刘柳, 谢素丽, 郭瑞, 等.中老年住院患者冠心病健康素养与健康服务利用的关系研究[J].护士进修杂志,2016, 31(2): 116-120. DOI:10.16821/j.cnki.hsjx.2016.02.007.
LIU L, XIE S L, GUO R, et al . Study for the relationship between health literacy of coronary heart disease and health service utilization among the middle-aged and elderly hospitalized patients[J ] . J Nurses Train, 2016, 31(2): 116-120. DOI:10.16821/j.cnki.hsjx.2016.02.007.
LORIG K R, SOBEL D S, RITTER P L, et al . Effect of a self-management program on patients with chronic disease[J ] . Eff Clin Pract, 2001, 4(6): 256-262.
任洪艳, 唐萍, 赵庆华.冠心病自我管理量表的开发和评价[J].第三军医大学学报, 2009, 31(11): 1087-1090.DOI: 10.3321/j.issn:1000-5404.2009.11.026.
REN H Y, TANG P, ZHAO Q H. Development and evaluation of coronary artery disease self-management scale[J]. J Third Mil Med Univ, 2009, 31(11): 1087-1090. DOI: 10.3321/j.issn:1000-5404.2009.11.026.
史静琤, 莫显昆, 孙振球.量表编制中内容效度指数的应用[J].中南大学学报(医学版), 2012, 37(2): 152-155. DOI: 10.3969/j.issn.1672-7347.2012.02.007.
SHI J J, MO X K, SUN Z Q. Content validity index in scale development[J]. J Cent South Univ (Med Sci), 2012, 37(2): 152-155. DOI: 10.3969/j.issn.1672-7347.2012.02.007.
谭伯瑛, 李天虹.社区老年冠心病患者社会支持与生存质量的相关性[J].中国老年学杂志, 2017, 37(4): 1003-1004. DOI:10.3969/j.issn.1005-9202.2017.04.098.
TAN B Y, LI T H. Correlation between social support and quality of life for elderly patients with coronary heart disease in community[J]. Chin J Gerontol, 2017, 37(4): 1003-1004. DOI:10.3969/j.issn.1005-9202.2017.04.098.
张倩, 朱亮, 汪凤兰, 等.疾病不确定感、焦虑水平对中青年冠心病患者自我效能的影响[J].中国卫生事业管理, 2018, 35(6): 455-458.
ZHANG Q, ZHU L, WANG F L, et al . The influence of uncertainty and anxiety level on the self-efficacy of young and middle aged patients with coronary heart disease[J ] . Chin Health Serv Manag , 2018, 35(6): 455-458.
赵月元, 张爱华.冠心病介入治疗患者自我管理行为与焦虑抑郁及生存质量的相关性[J].护理学杂志, 2016, 31(5): 8-11. DOI:10.3870/j.issn.1001-4152.2016.05.008.
ZHAO Y Y, ZHANG A H. Relations of self-management behavior, anxiety, depression and quality of life after percutaneous coronary intervention[J]. J Nurs Sci, 2016, 31(5): 8-11. DOI:10.3870/j.issn.1001-4152.2016.05.008.
高倩, 李晓敏, 孙王乐贤, 等.自我调节疲劳对冠心病患者自我管理行为的影响[J].中国慢性病预防与控制, 2019, 27(1): 38-42. DOI:10.16386/j.cjpccd.issn.1004-6194.2019.01.010.
GAO Q, LI X M, SUN W L X, et al . Effect of self-regulated fatigue on self-management behavior in patients with coronary heart disease[J ] . Chin J Prev Contr Chron Dis, 2019, 27(1): 38-42. DOI:10.16386/j.cjpccd.issn.1004-6194.2019.01.010.
CHIOU A F, HSU S P, HUNG H F. Predictors of health-promoting behaviors in Taiwanese patients with coronary artery disease[J]. Appl Nurs Res, 2016, 30: 1-6. DOI:10.1016/j.apnr.2015.08.008.
郭蕾, 郭秀君.冠心病病人自我管理行为的影响因素及干预方法研究进展[J].全科护理, 2016, 14(23): 2390-2393. DOI:10.3969/j.issn.1674-4748.2016.23.005.
GUO L, GUO X J. Research progress on the influencing factors and intervention methods of self management behavior in patients with coronary heart disease[J]. Chin Gen Pract Nurs, 2016, 14(23): 2390-2393. DOI:10.3969/j.issn.1674-4748.2016.23.005.
SU S F, CHANG M Y, HE C P. Social support, unstable angina, and stroke as predictors of depression in patients with coronary heart disease[J]. J Cardiovasc Nurs, 2018, 33(2): 179-186. DOI:10.1097/JCN.0000000000000419.
VASSILEV I, ROGERS A, KENNEDY A, et al . Social network type and long-term condition management support: a cross-sectional study in six European countries[J ] . PLoS ONE, 2016, 11(8): e0161027. DOI:10.1371/journal.pone.0161027.
CHAIR S Y, WONG K B, TANG J Y, et al . Social support as a predictor of diet and exercise self-efficacy in patients with coronary artery disease[J ] . Contemp Nurse, 2015, 51(2/3): 188-199. DOI:10.1080/10376178.2016.1171726.
IRANI E, MOORE S E, HICKMAN R L, et al . The contribution of living arrangements, social support, and self-efficacy to self-management behaviors among individuals with heart failure: a path analysis[J ] . J Cardiovasc Nurs, 2019, 34(4): 319-326. DOI:10.1097/JCN.0000000000000581.
FIVECOAT H C, SAYERS S L, RIEGEL B. Social support predicts self-care confidence in patients with heart failure[J]. Eur J Cardiovasc Nurs, 2018, 17(7): 598-604. DOI:10.1177/1474515118762800.
[World Health Organization Regional Office for Europe. Health literacy: the solid facts[R/OL ] . (2013-07-08)[2019-11-22 ] . http://www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf http://dx.doi.org/http://www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf .
LEE Y J, SHIN S J, WANG R H, et al . Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus[J ] . Patient Educ Couns, 2016, 99(2): 287-294. DOI:10.1016/j.pec.2015.08.021.
MACKEY L M, DOODY C, WERNER E L, et al . Self-management skills in chronic disease management: what role does health literacy have?[J ] . Med Decis Making, 2016, 36(6): 741-759. DOI:10.1177/0272989X16638330.
KIM Y S, TAE Y S, JUNG K I. The development and evaluation of a health literacy-adapted self-management intervention for elderly cancer patients undergoing chemotherapy[J]. J Korean Acad Nurs, 2019, 49(4): 472-485. DOI:10.4040/jkan.2019.49.4.472.
郭兵妹, 赵琳, 高元鹏, 等.自我效能理论在疾病自我管理中应用的研究进展[J].中国实用护理杂志, 2016, 32(22): 1749-1752. DOI:10.3760/cma.j.issn.1672-7088.2016.22.019.
GUO B M, ZHAO L, GAO Y P, et al . Research progress of the application of self-efficacy theory on disease self-management[J ] . Chin J Prac Nursing, 2016, 32(22): 1749-1752. DOI:10.3760/cma.j.issn.1672-7088.2016.22.019.
PRINCE S A, REED J L, MARTINELLO N, et al . Why are adult women physically active? A systematic review of prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants[J ] . Obes Rev, 2016, 17(10): 919-944.DOI:10.1111/obr.12432.
FRASER S N, RODGERS W M. The influence of general and exercise specific social support on self-efficacy for overcoming barriers to cardiac Rehabilitation1[J]. J Appl Soc Psychol, 2012, 42(8): 1811-1829. DOI:10.1111/j.1559-1816.2012.00919.x.
TAN N C. Self-efficacy assessment: a step towards personalized management of chronic diseases[J]. Proc Singap Healthc, 2016, 25(2): 71. DOI:10.1177/201010581 6643738.
高启雯, 庄蕙婉, 陈亭余.健康应用程式在慢性疾病自我管理的应用[J].护理杂志, 2017, 64(4): 19-25. DOI: 10.6224/JN.000050.
GAO Q W, ZHUANG H W, CHEN T Y. The utilization of health-related applications in chronic disease self-management[J]. J Nursing, 2017, 64(4): 19-25. DOI: 10.6224/JN.000050.
[中华人民共和国国家卫生健康委员会.健康中国行动(2019-2030)[EB/OL ] . (2019-07-15)[2019-11-22 ] . http://www.nhc.gov.cn/wsxf/zcfg/201907/2a771d89e00e4b228028335d4fcf1a7d.shtml http://www.nhc.gov.cn/wsxf/zcfg/201907/2a771d89e00e4b228028335d4fcf1a7d.shtml .
[National Health Commission of the People's Republic of China. Healthy China action plan (2019-2030)[EB/OL ] . (2019-07-15)[2019-11-22 ] . http://www.nhc.gov.cn/wsxf/zcfg/201907/2a771d89e00e4b228028335d4fcf1a7d.shtml http://www.nhc.gov.cn/wsxf/zcfg/201907/2a771d89e00e4b228028335d4fcf1a7d.shtml .
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