摘要
目的基于COM-B模型,探索MHD患者自我管理行为的潜在影响路径,为自我管理行为的干预提供依据。方法采用判断抽样选取350例在广州市某区大型医院透析的MHD患者开展问卷调查,利用SmartPLS软件构建偏最小二乘法结构方程模型并进行路径分析。结果MHD患者自我管理行为得分为(57.06±13.28),单因素分析结果显示年龄、文化程度、就业状态、职业分类、家庭人均月收入、合并症数量可直接影响MHD患者自我管理行为(P<0.05)。PLS-SEM模型结果显示,自我效能(β=0.246)、家庭关怀度(β=0.124)、社会支持(β=0.140)正向影响患者自我管理行为,疾病感知负向影响自我管理行为(β=-0.097);自我效能可以中介影响疾病感知和社会支持对MHD患者自我管理行为的影响路径(P<0.05)。结论MHD患者自我管理行为处于偏低水平,在对维持性血液透析患者设计干预方案时需关注疾病知识宣教、疾病感知重建、机会赋予和动机激励的协同效应,注重提升患者自我效能感,从而提高患者整体的自我管理水平。
Objective To explore the potential impact pathways of self⁃management behavior based on COM⁃B model,in maintenance hemodialysis(MHD)patients,and provide reference for the intervention of self⁃manage⁃ment behavior.Methods Judgment sampling was used to select 350 MHD patients undergoing dialysis at the hospital in a certain district of Guangzhou,and a questionnaire survey was conducted among them.Smart PLS software was used to construct a partial least squares structural equation model and perform path analysis.Results Self⁃manage⁃ment behavior score of MHD patients was(57.06±13.28).Univariate analysis showed that age,education back⁃ground,employment status,occupational classification,per capita monthly income of families,and the number of comorbidities could directly affect self⁃management behavior of MHD patients(P<0.05).PLS⁃SEM model showed that self⁃efficacy(β=0.246),family care level(β=0.124)and social support(β=0.140)positively impacted patients'self⁃management behavior,while disease perception negatively affected self⁃management behavior(β=-0.097).Self⁃efficacy can mediate the impact of disease perception and social support on self⁃management behavior of MHD patients(P<0.05).Conclusions Self⁃management behavior of MHD patients is currently at a low level.Therefore,when devising intervention plans for these patients,it is crucial to consider the combined effects of disease knowledge education,disease perception reconstruction,opportunity provision,and motivation.The primary focus should be on enhancing patients'self⁃efficacy,which will ultimately elevate their overall level of self⁃management.
作者
徐智君
周清平
梁振宁
钱怡
XU Zhijun;ZHOU Qingping;LIANG Zhenning;QIAN Yi(School of Health Management,Southern Medical University,Guangzhou 510515,China)
出处
《实用医学杂志》
CAS
北大核心
2023年第23期3120-3126,共7页
The Journal of Practical Medicine
基金
广东省高校哲学社会科学重点实验室-公共卫生政策研究与评价重点实验室项目(编号:2015WSY0010)。
