应对适应能力和社会支持介导主观压力感知对代谢综合征患者健康促进行为的影响

目的：基于慢性病适应中域理论探讨主观压力感知与健康促进行为之间的作用关系。方法：2021年1月—5月，采用便利抽样法选取在浙江大学医学院附属邵逸夫医院健康体检住院中心进行体检的230名中青年代谢综合征患者作为调查对象，应用健康促进生活方式量表Ⅱ、压力知觉量表、应对适应过程量表和多维度感知社会支持量表进行横断面调查。采用Mplus软件构建的链式中介效应程序及Bootstrap抽样检验法检验应对适应能力和社会支持在主观压力感知和健康促进行为之间的中介作用。结果：受调查对象健康促进行为平均（100.0±14.6）分，主观压力感知平均（22.0±6.9）分，应对适应能力平均（47.0±6.1）分，社会支持平均（63.8±10.8）分。主观压力感知与健康促进行为存在负相关关系（r=–0.309，P<0.05），两者之间的关系受到应对适应能力（效应值=–0.112，95%CI:–0.199~–0.038）和社会支持（效应值=–0.032，95%CI:–0.083~–0.004）的中介作用以及应对适应能力和社会支持的链式中介作用（效应值=–0.045，95%CI:–0.093~–0.020）。结论：应对适应能力和社会支持水平在中青年代谢综合征患者压力感知和健康行为之间起到中介作用，健康管理工作者可通过构建基于应对适应能力和社会支持的干预策略来引导患者形成适应外部环境变化的健康行为模式。

Influence of perceived stress on health-promoting behaviors in patients with metabolic syndrome: the multiple mediating roles of adaptability and social support

Objective: To explore the potential associations between perceived stress and health-promoting behaviors based on the theoretical schema of the middle-range theory of adaptation to chronic illness. Methods: From January to May 2021, a convenience sampling method was used to recruit 230 young and middle-aged patients with metabolic syndrome who underwent physical examination in the inpatient center of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The Health-Promoting Health Profile-Ⅱ, Chinese Perceived Stress Scale, Coping and Adaptation Processing Scale-Short Form, and Multi-dimensional Scale of Perceived Social Support were used in the cross-sectional study. The chain mediation effect procedure and bootstrap sampling test were used to examine the mediating role of adaptability and social support between perceived stress and health-promoting behaviors. Results: The mean score of health-promoting behaviors was 100.0±14.6, the mean score of perceived stress was 22.0± 6.9, the mean score of adaptability was 47.0±6.1, and the mean score of social support was 63.8±10.8. Perceived stress had a negative impact on patients’ health-promoting behaviors (r=–0.309, P<0.05). The adaptability (effect size= –0.112, 95%CI:–0.199~–0.038) and social support (effect size= –0.032, 95%CI:–0.083~–0.004) played a mediating role and a chain mediating role in the process of perceived stress influencing patients’ health-promoting behaviors (effect size= –0.045, 95%CI:–0.093~–0.020). Conclusions: Adaptability and social support play an intermediary role between perceived stress and health-promoting behaviors in young and middle-aged patients with metabolic syndrome. Healthcare professionals can motivate patients to develop healthy behaviors by developing intervention strategies on adaptability and social support.