基于结构方程模型的冠心病患者生活质量影响因素分析

目的探讨冠心病患者健康素养、自我效能、自我管理、社会支持对生活质量的影响,为其健康管理提供参考。方法采用便利抽样法,对280例冠心病住院患者采用一般情况调查表、冠心病健康素养调查问卷、冠心病自我管理量表、慢性病自我效能量表、社会支持评定量表、欧洲五维度量表进行调查,采用结构方程模型分析各影响因素之间的关系。结果影响冠心病患者生活质量的因素依次为自我管理、健康素养、自我效能、社会支持、文化程度、年龄、个人月收入、合并症种数。自我管理和社会支持对生活质量的直接效应系数分别为0.644和0.355。健康素养通过自我效能、自我管理、社会支持对生活质量产生间接影响,总效应系数为0.479;自我效能通过自我管理间接作用生活质量,总效应系数为0.414;文化程度、年龄、个人月收入、合并症种数对生活质量的总效应系数分别为0.167、-0.126、0.091、-0.058。结论冠心病患者的生活质量影响因素多而复杂,应加强针对性干预,以提高患者健康素养水平,增强自我效能感,从而提高自我管理能力,改善生活质量。

Use of structural equation modeling to identify factors of quality of life in coronary heart disease patients

Objective To determine the impact of health literacy, selfefficacy, selfmanagement and social support on quality of life (QOL) in coronary heart disease (CHD) patients. Methods A total of 280 CHD patients were recruited using convenience sampling method and were investigated using the sociodemographic data questionnaire, CHD Health Literacy Questionnaire, Coronary Artery Disease Self-management Scale (CSMS), Chronic Disease Selfefficacy Scale (CDSS), Social Support Rating Scale (SSRS) and European Quality of Life 5Dimensions Scale(EQ5D). Structural equation modeling (SEM) was used to analyze the relationships among the variables. Results Factors influencing QOL were selfmanagement, health literacy, selfefficacy, social support, education, age, average monthly income and number of comorbidities. Selfmanagement and social support had a direct effect on QOL, with the coefficient for direct effect being 0.644 and 0.355 respectively. Health literacy indirectly affected QOL through selfefficacy, selfmanagement and social support, with the coefficient for total effect of 0.479. Selfefficacy also had an indirect effect on QOL through selfmanagement, with the coefficient for total effect being 0.414. Education level, age, average monthly income and number of comorbidities were also affected QOL, with the coefficients for total effect being 0.167, -0.126, 0.091 and -0.058, respectively. Conclusion QOL of CHD patients was affected by several factors, so targeted interventions should be taken to enhance their health literacy, selfefficacy and selfmanagement, thus to improve QOL.