应用健康信念模式探讨超重、肥胖人群运动锻炼行为及其影响因素

Application of health belief model to research determinants of exercise behavior among overweight and obese residents in Beijing

目的探讨超重肥胖者运动锻炼情况及其影响因素，为今后实施健康促进干预和政策制定提供参考。方法以2489名超重肥胖者作为研究对象，男性1182人，女性1307人，平均年龄（45．3±14．2）岁。研究内容包括问卷调查和体格检查（身高、体重和腰围），问卷基于健康信念模式设计，信效度良好。通过单因素分析，比较不同人口统计学特征运动锻炼量的差异，通过相关分析发现运动锻炼信念与运动锻炼量的关系，最后建立结构方程模型，探究超重肥胖群体运动锻炼行为的影响因素和间接效应。结果研究对象每天运动锻炼量的中位数为4．0千步当量，上下四分位数为（0．5，10．0），22．9％的居民从不进行任何形式的运动锻炼，女性、高中及同等学历和家庭月收入在5000～10000元之间的调查对象运动锻炼最多。感知到运动的益处、感知到不运动的危害的严重性、自我效能与运动锻炼量正相关，主观障碍、客观障碍与运动锻炼量负相关。结构方程模型显示主观障碍、客观障碍和自我效能对运动锻炼的影响显著，其标准化的总效应分别为-0．085（P=0．020）、-0．242（P〈0．001）和0．184（P〈0．001）；自我效能越高，运动锻炼量越多；主观障碍和客观障碍越多，运动锻炼量越少。结构方程模型中影响运动锻炼量的路径存在广泛的中介效应，其中自我效能是所有显著的影响因素的中介变量。结论超重肥胖人群的运动锻炼量严重不足，需要进行一些有针对性地干预，重点是提高该类群体的自我效能感，降低运动锻炼的客观障碍。

Objective To study the determinants of exercise behavior among the overweight and obese residents, so as to provide reference for policy-making and health promotion in the future. Methods The study only enrolled overweight and obese residents to conduct a questionnaire survey and physical examination including height, weight and waist circumference. The self-designed questionnaire based on Health Belief Model had acceptable validity and reliability. Structural Equation Modeling was used to analyze the determinants of exercise behavior after univariate analysis and correlation analysis. Result Totally 2 489 overweight and obese residents （1 182 male and 1 307 female） were included in this study. Their average age was 45.3± 14.2 years and their median amount of exercise was 4 thousand-step equivalent with quartile of （0.5, 10.0）; 22.9% of these residents never took any exercise. Males with high school and equivalent level of education and an income of 5 000 to 10 000 yuan, took more exercise than other demographic groups. Amount of exercise had a positive correlation with perceived benefits of exercise, perceived severity of disadvantage of low exercise and self-efficacy, while it had a negative correlation with subjective barriers and objective barriers. Structural Equation Modeling showed that perceived subjective barriers, objective barriers and self-efficacy were determinants of exercise behavior. Their total standardized effects on exercise behavior were - 0.085 （P=0.020）, - 0.242 （P〈0.001） and 0.184 （P〈0.001） respectively.Those with higher self-efficacy and less barriers preferred to do more exercise. Indirect effect widely existed in the SEM and self-efficacy were the most important mediating variables of all the other significant determinants. Conclusion The overweight and obese residents are seriously lack of exercise, which need some targeted intervention, especially by improving their self-efficacy and reducing their objective barriers.