基于结构方程模型的冠心病患者生活质量影响因素分析

Use of structural equation modeling to identify factors of quality of life in coronary heart disease patients

目的探讨冠心病患者健康素养、自我效能、自我管理、社会支持对生活质量的影响,为其健康管理提供参考。方法采用便利抽样法,对280例冠心病住院患者采用一般情况调查表、冠心病健康素养调查问卷、冠心病自我管理量表、慢性病自我效能量表、社会支持评定量表、欧洲五维度量表进行调查,采用结构方程模型分析各影响因素之间的关系。结果影响冠心病患者生活质量的因素依次为自我管理、健康素养、自我效能、社会支持、文化程度、年龄、个人月收入、合并症种数。自我管理和社会支持对生活质量的直接效应系数分别为0.644和0.355。健康素养通过自我效能、自我管理、社会支持对生活质量产生间接影响,总效应系数为0.479;自我效能通过自我管理间接作用生活质量,总效应系数为0.414;文化程度、年龄、个人月收入、合并症种数对生活质量的总效应系数分别为0.167、-0.126、0.091、-0.058。结论冠心病患者的生活质量影响因素多而复杂,应加强针对性干预,以提高患者健康素养水平,增强自我效能感,从而提高自我管理能力,改善生活质量。

Objective To determine the impact of health literacy, self-efficacy, self-management and social support on quality of life (QOL) in coronary heart disease (CHD) patients. Methods A total of 280 CHD patients were recruited using convenience sampling method and were investigated using the socio-demographic data questionnaire, CHD Health Literacy Questionnaire, Coronary Artery Disease Self- management Scale (CSMS), Chronic Disease Self-efficacy Scale (CDSS), Social Support Rating Scale (SSRS) and European Quality of Life 5-Dimensions Scale(EQ-5D). Structural equation modeling (SEM) was used to analyze the relationships among the variables . Results Factors influencing QOL were self-management, health literacy, self-efficacy, social support, education, age, average monthly income and number of comorbidities. Self-management and social support had a direct effect on QOL, with the coefficient for direct effect being 0.644 and 0.355 respectively. Health literacy indirectly affected QOL through self-efficacy, self-management and social support, with the coefficient for total effect of 0.479. Self-efficacy also had an indirect effect on QOL through self-management, with the coefficient for total effect being 0.414. Education level, age, average monthly income and number of comorbidities were also affected QOL, with the coefficients for total effect being 0.167,-0.126, 0.091 and -0.058, respectively. Conclusion QOL of CHD patients was affected by several factors, so targeted interventions should be taken to enhance their health literacy, self-efficacy and self-management, thus to improve QOL.