自我效能理论为指导的自我管理在哮喘儿童中的应用及对自我效能、心理韧性和应对方式的影响

Application of self-management guided by self-efficacy theory in children with asthma and its effects on self-efficacy,psychological resilience and coping styles

目的:研究以自我效能理论为指导的自我管理在支气管哮喘(BA)儿童中的应用及对自我效能、心理韧性和应对方式的影响。方法:选取2015年12月至2018年12月我院稳定期BA患儿94例,采用随机数字表均分为观察组和对照组各47例,其中对照组实施常规治疗和管理方案,观察组采用以自我效能理论为指导的自我管理方案进行干预,比较干预6个月时两组患儿哮喘控制效果及患儿自我效能、心理韧性、应对方式和自我管理行为。结果:干预6个月时,两组FEV1%(t=-9.711,-5.970;P<0.05)、PEF%(t=-8.887,-5.143;P<0.05)及C-ACT评分(t=-7.810,-2.181;P<0.05)均明显升高,且观察组FEV1%、PEF%及C-ACT评分高于对照组(t=2.632,2.548,3.829;P<0.05);两组CDSES量表完成自我管理(t=-8.406,-5.197;P<0.05)、一般自我效能(t=-7.400,-4.767;P<0.05)、达成结果(t=-8.065,-4.165;P<0.05)及应对问题(t=-10.981,-6.507;P<0.05)评分均明显升高,且观察组完成自我管理、一般自我效能、达成结果及应对问题评分均高于对照组(t=2.004,2.136,2.157,2.184;P<0.05);两组CICRS量表个性特征(t=-7.849,-4.173;P<0.05)、应对方式(t=-7.447,-3.750;P<0.05)、人际关系评分(t=-6.115,-3.124;P<0.05)及心理韧性平均分(t=-6119,-2.440;P<0.05)均明显升高,且观察组个性特征、应对方式及心理韧性平均分均高于对照组(t=2.350,2.163,2.466;P<0.05));两组CODI量表逃避(t=7.759,-3.831;P<0.05)、远离(t=6.164,3.247;P<0.05)及负性情绪反应(t=6.003,2.938;P<0.05)评分均明显降低,幻想(t=-6.158,-2.535,P<0.05)、自我安慰(t=-8.408,-5.108;P<0.05)及接受(t=-8.786,-6.785;P<0.05)评分均明显升高,且观察组逃避、远离及负性情绪反应评分低于对照组(t=-2.261,-2.652,-2.523;P<0.05),幻想、自我安慰及接受评分高于对照组(t=2.231,2.084,2.063;P<0.05);两组自我管理行为量表日常生活管理(t=-14.555,-7.415;P<0.05)、疾病医学管理(t=-14.450,-9.218;P<0.05)、社会心理管理(t=-25.510,-11.651;P<0.05)评分及总分(t=-21.245,-10.272;P<0.05)均明显升高,且观察组日常生活管理、疾病医学管理、社会心理管理评分及总分均高于对照组(t=5.793,3.961,9.748,7.356;P<0.05)。结论:采用以自我效能理论为指导的自我管理对哮喘儿童进行干预可有效增强患儿自我效能和心理韧性,改善患儿应对方式并提升患儿自我管理水平和哮喘控制效果。

Objective:To study the application of self-management guided by self-efficacy theory in children with bronchial asthma(BA)and its effects on self-efficacy,psychological resilience and coping styles.Methods:A total of 94 children patients with stable BA in our hospital from December 2015 to December 2018 were selected and divided into observation group and control group according to the random number table method,with 47 cases in each group.Control group was given routine treatment and management regimen,and observation group was given self-management regimen guided by self-efficacy theory for intervention.The asthma control effects and self-efficacy,psychological resilience,coping styles and self-management behavior were compared between the two groups at 6 months of intervention.Results:At 6 months of intervention,the FEV1%(t=-9.711,-5.970;P<0.05),PEF%(t=-8.887,-5.143;P<0.05)and C-ACT score(t=-7.810,-2.181;P<0.05)in the two groups were significantly increased,and the FEV1%,PEF%and C-ACT score in observation group were higher than those in control group(t=2.632,2.548,3.829;P<0.05).The scores of self-management completion(t=-8.406,-5.197;P<0.05),general self-efficacy(t=-7.400,-4.776;P<0.05),achievement of results(t=-8.065,-4.165;P<0.05)and coping problems(t=-10.981,-6.507;P<0.05)of CDSES scale in the two groups were significantly increased,and the scores of self-management completion,general self-efficacy,achievement of results and coping problems in observation group were higher than those in control group(t=2.004,2.136,2.157,2.184;P<0.05).The scores of personality characteristics(t=-7.849,-4.173;P<0.05),coping styles(t=-7.447,-3.750;P<0.05),interpersonal relationship(t=-6.115,-3.14;P<0.05)and average psychological resilience(t=-6119,-2.440;P<0.05)of CICRS scale in the two groups were significantly increased,and the scores of personality characteristics,coping styles and average psychological resilience in observation group were higher than those in control group(t=2.350,2.163,2.466;P<0.05).The scores of escape(t=7.759,-3.831;P<0.05),away from(t=6.164,3.247;P<0.05)and negative emotional responses(t=6.003,2.938;P<0.05)of CODI scale were significantly reduced,and the scores of fantasy(t=-6.158,-2.535;P<0.05),self-consolation(t=-8.408,-5.108;P<0.05)and acceptance(t=-8.786,-6.885;P<0.05)were significantly elevated,and the scores of escape,away from and negative emotional responses in observation group were lower than those in control group(t=-2.261,-2.652,-2.523;P<0.05),and the scores of fantasy,self-consolation and acceptance were higher than those in control group(t=2.231,2.084,2.063;P<0.05).The scores of daily life management(t=-14.555,-7.415;P<0.05),medical management of diseases(t=-14.450,-9.218;P<0.05)and psychosocial management(t=-25.510,-11.651;P<0.05)and total score(t=-21.245,-10.272;P<0.05)of self-management behavior scale in the two groups were significantly increased,and the scores of daily life management,medical management of diseases and psychosocial management and total score in observation group were higher than those in control group(t=5.793,3.961,9.748,7.356;P<0.05).Conclusion:Self-administration guided by self-efficacy theory can effectively enhance self-efficacy and psychological resilience,improve coping styles and improve self-management level and asthma control effects in the intervention of children with asthma.