基于结构方程模型的社区糖尿病患者糖尿病认知与自我管理分析

Disease Cognition and Self Management of Diabetics in Community Based on Structural Equation Model

目的探索社区糖尿病患者对糖尿病认知水平与自我管理行为、自我健康认知间的关系,为糖尿病健康管理工作的改善提供依据。方法采用分层整群抽样的方法,2014年7—12月选取天津市内六区和四郊五县以及滨海新区共16个社区卫生服务中心或卫生院的糖尿病健康管理对象共1 310例,调查社会人口学资料、患者自我管理情况(健康饮食、体育锻炼、自我血糖监测频率、遵医嘱服药)、用药及治疗满意度评分、糖尿病知识知晓得分、自我健康评分、症状评分。采用结构方程模型分析糖尿病患者社会经济水平、疾病认知、日常行为、自我健康评价间的关系。结果剔除调查信息不全者,共1 038例纳入分析。结构方程模型分析结果显示,文化程度(β=0.067,P=0.038)、家庭人均月收入(β=0.083,P=0.012)与糖尿病知识知晓得分存在正向关系;糖尿病知识知晓得分与健康饮食(β=0.079,P=0.011)、自我血糖监测频率(β=0.098,P=0.002)存在正向关系;健康饮食与用药及治疗满意度评分(β=0.187,P<0.001)、自我健康评分(β=0.065,P=0.038)存在正向关系,与症状评分(β=-0.099,P=0.001)存在负向关系;自我血糖监测频率与用药及治疗满意度评分(β=-0.144,P<0.001)、自我健康评分(β=-0.067,P=0.032)存在负向关系,与症状评分(β=0.143,P<0.001)存在正向关系;家庭人均月收入与文化程度存在正向关系(β=0.370,P<0.001);症状评分与自我健康评分存在负向关系(β=-0.270,P<0.001);用药及治疗满意度评分与自我健康评分存在正向关系(β=0.187,P<0.001),与症状评分存在负向关系(β=-0.207,P<0.001)。模型拟合优度检验结果提示拟合良好[χ~2=206.419,自由度(df)=38,P<0.001;拟合优度指数(GFI)=0.971,调整拟合优度指数(AGFI)=0.921;近似误差均方根(RMSEA)=0.065,90%CI(0.051,0.074)]。结论社区糖尿病患者对糖尿病的认知程度越高,对健康饮食和自我血糖关注度越高;关注日常自我管理行为有助于提高患者的自我健康认知,减轻糖尿病症状;而关注医疗行为可能使患者提升对糖尿病症状的关注,主观满意度下降。

Objective To explore the relationship among cognitive level,self-management behavior and self-health cognition of diabetics in community,and to provide support for the improvement of health management of diabetes. Methods Using stratified cluster sampling,a total of 1 310 diabetics from 16 community health service centers or hospitals in Tianjin were selected from July to December in 2014 to investigate their demographic data,self-management situation of diabetes（ healthy diet lifestyle, physical exercise, self-monitoring frequency of blood glucose, medication）, medication and treatment satisfaction score,diabetes knowledge score,VAS score and symptom score. The structural equation model was used to analyze the relationship among diabetics＇ financial capacity,cognitive level of diabetes,daily self-management behavior and self-evaluation of health status. Results Excluding diabetics with incomplete investigation information,a total of 1 038 diabetics were included in this study. The results of structural equation model showed that there was a positive relationship between education level（ β = 0. 067, P = 0. 038）, household per capita monthly income（ β = 0. 083, P = 0. 012） and diabetes knowledge score. A positive relationship was found between diabetes knowledge score and healthy diet lifestyle（ β = 0. 079,P= 0. 011） as well as self-monitoring frequency of blood glucose（ β = 0. 098,P = 0. 002）. A positive relationship was found between healthy diet lifestyle and medication and treatment satisfaction score（ β = 0. 187,P〈0. 001） as well as VAS score（ β= 0. 065, P = 0. 038）, while a negative relationship was found between healthy diet lifestyle and symptom scores（ β=-0. 099,P = 0. 001）. Self-monitoring frequency of blood glucose was significantly negatively related to medication and treatment satisfaction score（ β =-0. 144,P〈0. 001） and VAS score（ β =-0. 067,P = 0. 032）,but there was a positive relationship between self-monitoring frequency of blood glucose and symptom score（ β = 0. 143, P〈0. 001）. A positive relationship was found between household per capita monthly income and education level（ β = 0. 370,P〈0. 001）. Symptom score was significantly negatively related to VAS score（ β =-0. 270,P〈0. 001）. A positive relationship was found between medication and treatment satisfaction score and VAS score（ β = 0. 187,P〈0. 001）,while a negative relationship was found between medication and treatment satisfaction score and symptom scores（ β =-0. 207,P〈0. 001）. The result of model test of fit goodness was acceptable [χ~2= 206. 419,df = 38,P〈0. 001; GFI = 0. 971,AGFI = 0. 921; RMSEA = 0. 065,90% CI（ 0. 051,0. 074） ]. Conclusion The higher level of cognitive level of diabetes,the higher attention diabetics pay to healthy diet lifestyle and self-monitoring of blood glucose in community. Paying attention to daily self-management behavior is helpful to improve patients＇ self-health awareness and alleviate the symptoms of diabetes,while excessive medical behavior may enhance patients＇ attention of diabetes symptoms and reduce their subjective satisfaction.