上海市社区医护人员骨质疏松症社区管理实施影响因素的路径分析

目的评估上海市社区医护人员骨质疏松症社区管理实施现状,采用社会生态学理论探讨社区医护人员骨质疏松症社区管理实施的相关影响因素,通过路径分析探究影响因素间的相互作用路径。方法采用方便抽样的方法在上海市20家社区卫生服务中心各抽取42名医护人员共840人进行问卷调查,了解被调查的医护人员骨质疏松症社区管理实施现状及相关影响因素,采用Logistic回归和路径分析对相关影响因素进行分析。结果多因素的Logistic回归结果显示,骨质疏松症危险因素识别技巧(ORm=1.66,95%CI=1.14～2.42)、自我效能(ORm=8.39,95%CI=5.90～11.92)、骨质疏松症社区管理的社区医院环境支持(ORm=1.65,95%CI=1.19～2.29)均能促进社区医护人员骨质疏松症社区管理工作的实施。路径分析结果表明自我效能通过直接效应作用于社区医护人员骨质疏松症社区管理的实施(因子载荷=0.60,P0.001),而社区环境支持(因子载荷=0.11,P0.001)和危险因素识别技巧(因子载荷=0.08,P0.001)可直接也可通过自我效能的中介效应来作用于社区医护人员骨质疏松症社区管理的实施。结论经路径分析发现,社区医护人员骨质疏松症的社区管理的实施是个人、人际及社区三层面因素相互作用影响的,提示在进行干预时,应结合个人与周围环境多层面进行有针对性的干预。

Path analysis of influencing factors of osteoporosis community management implementation among community health care workers in Shanghai

Objective To evaluate the implementation status of community management of osteoporosis among community health care workers in Shanghai, to explore the related influencing factors by using social ecological theory, and to explore the interaction between influencing factors using path analysis. Methods Using convenient sampling method, 42 health care workers were selected from each of the 20 community health service centers in Shanghai to conduct a questionnaire survey. 840 health care workers were enrolled to evaluate the status of osteoporosis community management implementation and related influencing factors. Logistic regression and path analysis were adopted to analyze the relevant influencing factors. Results Multivariate logistic regression results showed that osteoporosis risk factor identification skills (ORm=1.66, 95%CI=1.14-2.42), self-efficacy (ORm=8.39, 95%CI=5.90-11.92) and community hospitals environmental support (ORm=1.65, 95%CI=1.19-2.29) could promote the implementation of community management of osteoporosis among community health care workers. Path analysis results showed that self-efficacy could directly promote the implementation of osteoporosis community management among community health care workers (factor loading=0.60, P<0.001), while community hospitals environmental support (factor loading=0.11, P<0.001) and risk factor identification skills ( factor loading=0.08, P<0.001) could promote the implementation of community management of osteoporosis among community health care workers as well through the mediating effect of self-efficacy. Conclusion According to the path analysis, the implementation of community management of osteoporosis in community health care workers is influenced by the interaction of individual, interpersonal and community factors. It suggests that we should combine the individual and the surrounding environment to carry out targeted intervention.