健康赋权在养老机构老年人创伤后成长和慢性病自我管理的中介作用

目的 了解养老机构老年人慢性病自我管理现状，探讨健康赋权在养老机构老年人创伤后成长和慢性病自我管理的中介作用。方法 采用随机数字表法和整群抽样法，应用一般资料调查表、慢性病自我管理量表、创伤后成长量表、老年人健康赋权量表对203名养老机构老年人进行问卷调查。采用独立样本t检验、单因素方差分析和Pearson相关分析对养老机构老年人健康赋权、创伤后成长和慢性病自我管理的影响因素进行分析，应用Bootstrap法检验健康赋权在创伤后成长与慢性病自我管理之间的中介作用。结果 老年人慢性病自我管理总分为（27.96±9.24）分，与创伤后成长和健康赋权均呈正相关（r = 0.547、0.540，P＜0.001）。创伤后成长（t = 6.117，P＜0.001）、健康赋权（t = 5.321，P＜0.001）、每天用药次数（t = 2.420，P = 0.016）是自我管理的独立影响因素，可解释总变异的40.4%。健康赋权在创伤后成长与自我管理之间存在部分中介作用，占总效应的28.32%。结论 养老机构老年人慢性病自我管理处于中等偏下水平，机构管理者和照顾者应重视健康赋权对自我管理的中介效应，提升老年人慢性病自我管理水平。

The mediating role of health empowerment in post-traumatic growth and chronic disease self-management among elderly people in nursing institutions

Objective To understand the current situation of chronic disease self-management among elderly people in nursing institutions and to explore the mediating role of health empowerment in post-traumatic growth and chronic disease self-management among elderly people in nursing institutions. Methods Using random number table method and whole group sampling method, a questionnaire survey was conducted on 203 elderly people in nursing institutions by applying general information questionnaire, chronic disease self-management scale, post-traumatic growth scale and health empowerment scale for the elderly. Independent samples t-test, one-way ANOVA and Pearson’s correlation analysis were used to analyze the factors influencing health empowerment, post-traumatic growth, and chronic disease self-management among the elderly in nursing homes, and Bootstrap method was applied to test the mediating role of health empowerment between post-traumatic growth and chronic disease self-management. Results The total chronic disease self-management score of the elderly was (27.96±9.24), which was positively correlated with both post-traumatic growth and health empowerment (r=0.547, 0.540, P<0.001). Post-traumatic growth (t=6.117, P<0.001), health empowerment (t=5.321, P<0.001), and number of medications per day (t=2.420, P=0.016) were independent influencing factors of self-management, explaining 40.4% of the total variance. Health empowerment partially mediated the relationship between post-traumatic growth and self-management, accounting for 28.32% of the total effect. Conclusion Chronic disease self-management among older adults in nursing facilities is at a moderate to low level, and facility managers and caregivers should pay attention to the mediating effect of health empowerment on self-management to improve the level of chronic disease self-management among older adults.