本文關(guān)鍵詞：基于COM-B模型的慢性心衰患者自護(hù)行為阻礙與促進(jìn)因素研究　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 慢性心力衰竭 自護(hù)行為 能力 機(jī)會(huì) 動(dòng)機(jī)—行為模型 功能狀態(tài) 心衰疾病知識(shí) 健康素養(yǎng) 社會(huì)支持 社會(huì)經(jīng)濟(jì)地位 自護(hù)信心

【摘要】：目的:依據(jù)能力、機(jī)會(huì)、動(dòng)機(jī)—行為(COM-B)模型,探討慢性心衰患者自護(hù)行為(包括自護(hù)維持和自護(hù)管理)的水平及其阻礙與促進(jìn)因素,為制定干預(yù)策略,改善其自護(hù)行為提供借鑒。方法:本研究采用橫斷面研究設(shè)計(jì)。2015年11月至2016年4月,從某三級(jí)甲等醫(yī)院心內(nèi)科病房抽取321例慢性心衰患者開(kāi)展問(wèn)卷調(diào)查。數(shù)據(jù)收集采用心力衰竭自護(hù)指數(shù)、杜克活動(dòng)狀態(tài)指數(shù)、心衰疾病知識(shí)測(cè)試、慢性病患者健康素養(yǎng)量表、多維度感知社會(huì)支持量表、主觀社會(huì)經(jīng)濟(jì)地位量表和自行設(shè)計(jì)的一般資料問(wèn)卷。數(shù)據(jù)整理后,采用IBM SPSS 20.0軟件包與Mplus7.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1.慢性心衰患者自護(hù)維持得分范圍為10.00～93.32分,平均為(48.42±15.86)分,低于70分者298例(92.8%);自護(hù)管理得分范圍為10.00～95.00分,平均為(54.35±19.32)分,低于 70 分者 243 例(75.7%)。2.慢性心衰患者的社會(huì)人口學(xué)和臨床資料特征與自護(hù)行為有關(guān)。年齡、左室射血分?jǐn)?shù)(LVEF)與自護(hù)維持得分正相關(guān),教育水平較低、從事體力勞動(dòng)、人均月收入較低、居住于農(nóng)村、心衰病程6個(gè)月、心衰住院次數(shù)3次、合并疾病數(shù)量3個(gè)的患者自護(hù)維持得分低于教育水平較高、從事腦力勞動(dòng)或退休/自由職業(yè)、人均月收入較高、居住于城鎮(zhèn)、心衰病程≥6個(gè)月、心衰住院次數(shù)≥3次、合并疾病數(shù)量≥3個(gè)的患者(P0.05或P0.01)。LVEF與自護(hù)管理得分負(fù)相關(guān),從事體力勞動(dòng)、居住于農(nóng)村、心衰病程6個(gè)月、心衰住院次數(shù)3次、NYHA心功能Ⅱ級(jí)的患者自護(hù)管理得分低于從事腦力勞動(dòng)或退休/自由職業(yè)、居住于城鎮(zhèn)、心衰病程≥6個(gè)月、心衰住院次數(shù)≥3次、NYHA心功能Ⅲ級(jí)和Ⅳ級(jí)的患者(P0.05或P0.01)。3.慢性心衰患者功能狀態(tài)平均得分為(18.27±1.90),與自護(hù)管理得分正相關(guān)(r=0.163,P0.01)。心衰疾病知識(shí)平均得分為(4.02±2.05),與自護(hù)維持和自護(hù)管理得分均正相關(guān)(r=0.218,0.453,均P0.01)。健康素養(yǎng)平均得分為(99.53±12.51),與自護(hù)維持和自護(hù)管理得分均正相關(guān)(r=0.407,0.161,均P0.01)。社會(huì)支持平均得分為(64.71±7.41),與自護(hù)維持得分正相關(guān)(r=0.223,P0.01)。社會(huì)經(jīng)濟(jì)地位平均得分為(9.84±2.95),與自護(hù)維持得分正相關(guān)(r=0.189,P0.01)。自護(hù)信心平均得分為(57.09±13.42),與自護(hù)維持和自護(hù)管理得分均正相關(guān)(r=0.260,0.400,均P0.01)。4.路徑分析結(jié)果顯示,健康素養(yǎng)、社會(huì)支持、自護(hù)信心和年齡對(duì)自護(hù)維持有直接影響,直接效應(yīng)值依次為0.265、0.159、0.128和0.139;功能狀態(tài)、心衰疾病知識(shí)、自護(hù)信心和LVEF對(duì)自護(hù)管理有直接影響,直接效應(yīng)值依次為0.115、0.303、0.324和-0.133。心衰疾病知識(shí)、健康素養(yǎng)和社會(huì)支持還可以通過(guò)自護(hù)信心間接影響自護(hù)維持和自護(hù)管理。該模型可以解釋自護(hù)維持27.2%的變異量和自護(hù)管理 34.9%的變異量(R2=0.272,0.349)。5.拔靴法中介效應(yīng)檢驗(yàn)結(jié)果表明,自護(hù)信心在心衰疾病知識(shí)、健康素養(yǎng)、社會(huì)支持與自護(hù)維持關(guān)系中的中介效應(yīng)值分別為0.032、0.023和0.025;在心衰疾病知識(shí)、健康素養(yǎng)、社會(huì)支持與自護(hù)管理關(guān)系中的中介效應(yīng)值分別為0.075、0.054和0.058。以上中介效應(yīng)均呈顯著性。結(jié)論:1.慢性心衰患者的自護(hù)維持和自護(hù)管理水平較低,大多數(shù)患者的自護(hù)行為不足。2.慢性心衰患者的功能狀態(tài)較差,心衰疾病知識(shí)較缺乏,健康素養(yǎng)和社會(huì)支持處于中等水平,自護(hù)信心水平較低,多數(shù)患者缺乏自護(hù)信心。3.慢性心衰患者的健康素養(yǎng)、社會(huì)支持、自護(hù)信心和年齡直接影響自護(hù)維持水平;患者的功能狀態(tài)、心衰疾病知識(shí)、自護(hù)信心和LVEF直接影響自護(hù)管理水平。此外,心衰疾病知識(shí)、健康素養(yǎng)和社會(huì)支持間接影響(通過(guò)自護(hù)信心的中介作用)自護(hù)維持和自護(hù)管理水平。4.心衰疾病知識(shí)不足和自護(hù)信心缺乏是自護(hù)維持的阻礙因素;功能狀態(tài)受損、心衰疾病知識(shí)不足和自護(hù)信心缺乏是自護(hù)管理的阻礙因素。高水平的健康素養(yǎng)和社會(huì)支持是自護(hù)維持和自護(hù)管理的促進(jìn)因素。5.醫(yī)護(hù)人員可采用COM-B模型為理論框架,將以上因素作為切入點(diǎn),采取針對(duì)性的干預(yù)措施,提高慢性心衰患者的自護(hù)維持和自護(hù)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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.54

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