广州市老城区慢性病患者健康促进生活方式及影响因素研究

背景　慢性病是全世界尤其是发展中国家面临的重要健康风险，而不健康的生活方式是慢性病的主要诱因之一。国内外研究证明，提高健康促进生活方式水平有利于拓展慢性病患者健康潜能，改善病情及延缓并发症发生，提高其生活质量。目的　了解广州市老城区慢性病患者健康促进生活方式现状，以及社会经济特征和社区卫生服务利用情况对慢性病患者健康促进生活方式的影响，为社区卫生服务机构开展健康教育和慢性病管理提供依据。方法　2017年11月-2018年1月采用多阶段随机抽样法选取广州市4区共12家社区卫生服务机构的750例慢性病患者，采用健康促进生活方式量表第2版修订本（HPLP-ⅡR）及自行设计的社区卫生服务利用调查表对慢性病患者进行问卷调查。结果　共发放调查问卷750份，回收有效问卷697份，问卷有效回收率为92.9%。慢性病患者的健康促进生活方式标准化得分为72.02分，营养、人际关系、健康责任、压力管理、体育运动、精神成长6维度的标准化得分分别为81.33、78.40、71.73、71.00、62.63、71.15分。年龄≤65岁慢性病患者健康促进生活方式优于>65岁者（P<0.05）；受教育水平和经济收入是健康促进生活方式的正向影响因素（P<0.05）；年龄≤65岁慢性病患者营养、人际关系、压力管理、体育运动、精神成长5维度得分优于>65岁者（P<0.05）；受教育程度是营养、健康责任、精神成长3维度的正向影响因素（P<0.05）；个人月均收入对压力管理和体育运动2维度有正面影响（P<0.05）；多种慢性病患者健康责任优于1种慢性病患者（P<0.05），但精神成长不如后者（P<0.05）；接受过全科医生健康教育和慢性病随访服务的患者，健康促进生活方式总分和健康责任、体育运动维度得分优于未接受组（P<0.05）。结论　广州市慢性病患者健康促进生活方式处于良好水平。年龄>65岁、受教育程度小学及以下、个人月均收入≤2 000元是健康促进生活方式干预的重点对象；精神成长、压力管理及体育运动是健康促进生活方式的重点干预维度；社区卫生服务机构提供的健康教育和慢性病随访服务是有效的健康促进生活方式干预手段。

Prevalence of Health-promoting Lifestyle and Influencing Factors among Adults with Noncommunicable Disease in Guangzhou Old Urban Areas

Background　Noncommunicable diseases（NCDs） are a great health risk faced by all nations，especially the developing countries. Unhealthy lifestyle is one of the main causes for NCDs. Studies have found that health-promoting lifestyle is effective in exploring health potentials，improving conditions，delaying the development of complications and enhancing the quality of life in such patients. Objective　To investigate the prevalence of health-promoting lifestyle in adults（≥18 years old） with NCDs in Guangzhou old urban areas，and its associated factors concerning socioeconomic and community health service utilization，providing evidence for the development of community-based health education and NCDs management. Methods　From November 2017 to January 2018，we conducted a survey in 750 adults with NCDs from 12 community health institutions in four districts of Guangzhou by multistage random sampling. The survey tools were the revised version of Health Promoting Lifestyle ProfileⅡ（HPLP-ⅡR） and a self-designed questionnaire named Community Health Services Utilization Questionnaire（CHSUQ）. Results　A total of 697 cases returned responsive questionnaires，achieving a response rate of 92.9%. The overall standardized score of the HPLP-ⅡR scale was 72.02. And the standardized scores for domains of nutrition，interpersonal relations，health responsibility，stress management，physical activity，and spiritual growth were 81.33，78.40，71.73，71.00，62.63，and 71.15，respectively. Compared to those aged over 65 years，patients aged 65 years or less had higher score of the HPLP-ⅡR scale （P<0.05）. Increased education level and mean monthly income were positive influencing factors of health-promoting lifestyle （P<0.05）. Moreover，those aged 65 years or less also scored higher in 5 domains（nutrition，interpersonal relations，stress management，physical activity，and spiritual growth）（P<0.05）．Increased education level was a positive influencing factor of nutrition，health responsibility and spiritual growth（P<0.05）．Increased mean monthly income had a positive impact on stress management and physical activity（P<0.05）. The health responsibility of patients with multiple chronic diseases was better than that of those with one chronic disease（P<0.05），but the spiritual growth was not as good as the latter（P<0.05）. Patients who received health education and follow-up services for NCDs from general practitioners had higher scale score of the HPLP-ⅡR scale，and higher domain scores of health responsibility and physical activity than those who did not（P<0.05）. Conclusion　The prevalence of health-promotion lifestyle in adults with NCDs in Guangzhou old urban areas is high. To further improve the health-promotion lifestyle in such patients，priorities should be given to groups of over 65 years old，primary education level and below，and household monthly income per person less than 2 000 yuan，and should be given to the aspects of spiritual growth，stress management，and physical activity. Moreover，community-based health education and NCDs follow-up services are effective interventions can be used.