基于结构方程模型的老年慢性心力衰竭患者自我管理行为研究

目的调查老年慢性心力衰竭(chronic heart failure,CHF)患者自我管理的现状,探索建立CHF患者自我管理行为影响因素的结构方程模型(structural equation modeling,SEM),为构建我国特色的老年CHF患者自我管理教育方案提供依据。方法2015年1月—2017年6月,采用随机整群抽样方法,选取我国华东、华西、华南、华北、华中5个区域的16个省、市、自治区的102所医院的6124例老年CHF患者为研究对象。采用心力衰竭自我管理量表、心力衰竭知识问卷、慢性病自我效能量表、自我概念量表、医学应对方式问卷对其进行调查。运用AMOS22.0软件进行老年CHF患者自我管理行为影响因素模型的构建。结果6124例老年CHF患者自我管理总分为49.00(43.00,54.00)]分,得分率为61.25%。老年CHF患者自我管理影响因素结构方程模型拟合较好,人均收入、工作情况、自理程度、民族、宗教信仰、文化程度、心力衰竭知识、自我概念、自我效能、应对方式均可直接和(或)间接影响自我管理。结论老年CHF患者自我管理处于中等偏下水平,并受不同人口学、不同文化背景、心力衰竭知识等因素影响,医务人员应根据患者不同人口学情况、不同文化背景特点,结合其心力衰竭知识、自我概念、自我效能等情况,制订系统化、个性化的老年CHF患者自我管理教育方案,以提高患者自我管理水平。

Self-management behavior based on structural equation model in elderly chronic heart failure patients

Objective To investigate the self-management of elderly chronic heart failure(CHF)patients and to explore the structural equation modeling(SEM)on the influencing factors of self-management behavior among CHF patients so as to provide a basis for constructing the self-management education plan for elderly CHF patients suitable for the characteristics of our country.Methods From January 2015 to June 2017,The study selected 6124 elderly patients in 102 hospitals of 16 provinces,cities and autonomous region from 5 areas,east China,west China,south China,north China and central China by random cluster sampling as subjects.All of patients were investigated with the self-management scale of heart failure patients,heart failure knowledge questionnaire,chronic disease self-efficacy scale,self-concept scale and the medica coping modes questionnaire.AMOS 22.0 was used to construct the model on the influencing factors of self-management behavior among CHF patients.Results The total score self-management of 6124 elderly CHF patients was49.00(43.00,54.00)]with 61.25%for the scoring rate.The SEM on the direct or indirect influencing factors of self-management among elderly CHF patients fitted well.The influencing factors of self-management included the per-capita incomes,works,self-care,nations,religious belief,education levels,heart failure knowledge,self-concept,self-efficacy,coping styles.Conclusions Self-management of elderly CHF patients are in the below average level influenced by different demographers,cultural background and heart failure knowledge.Medical staff should formulate a systematic and individual self-management education plan for elderly CHF patients based on patients'demographic characteristics,cultural background,heart failure knowledge,selfconcept and self-efficacy to improve their self-management.