健康素养在心功能衰竭患者抑郁与自护维持的中介作用

Mediation Effect of Health Literacy between Depression and Self-care Maintenance in Patients with Heart Failure

目的了解心功能衰竭患者自护维持的现状,分析健康素养在心功能衰竭患者抑郁症状与自护维持间的中介作用,为提高心功能衰竭患者自护维持提供依据。方法方便抽取山东省某三级甲等医院321例住院的心功能衰竭患者,使用问卷调查患者的自护维持、抑郁症状、健康素养、一般资料及临床特征。结果心功能衰竭患者健康素养得分为48.4分;Pearson相关分析显示:抑郁症状与自护维持(r=-0.265,P<0.001)、健康素养(r=-0.462,P<0.001)均呈负相关,健康素养与自护维持呈正相关(r=0.407,P<0.001)。在中介检验中,控制协变量同时将抑郁和健康素养纳入回归中,抑郁症状与自护维持的相关系数下降36.3%(β=-0.137,P=0.017)。结论健康素养在心功能衰竭患者抑郁症状与自护维持间起部分中介作用。医护人员在制定干预措施提高存在抑郁症状的心功能衰竭患者的自护维持时,除减轻心功能衰竭患者的抑郁症状外,改善心功能衰竭患者的健康素养也是一个新的干预思路。

Objectives To assess patients’ self-care maintenance and explore the mediation effect of health literacy between depression and self-care maintenance in patients with heart failure(HF). Methods We recruited 321 patients with HF in a hospital in Shandong province and they were surveyed by using self-designed questionnaires to assess patients’ depressive symptoms, health literacy and self-care maintenance. Results The score of health literacy of HF patients was 48.4. Pearson’s correlation analysis showed depressive symptoms were negatively associated with self-care maintenance( r =-0.265, P <0.001) and health literacy(r =-0.462,P<0.001) but health literacy was positively associated with self-care maintenance(r=0.407, P<0.001). Mediation effect analysis showed that when both depression and health literacy entered the regression equation, coefficient of correlation between depressive symptoms and self-care maintenance decreased to 36.3%(β=-0.137,P =0.017). Conclusion Health literacy plays a partly mediating role between depressive symptoms and self-care maintenance. In addition to the improvement of depressive symptoms, health literacy should be taken into consideration when formulating interventions for improving self-care maintenance of patients with HF.