基于聚类分析对肾移植病人疾病感知与自我管理行为的研究

Study on illness perception and self-management behavior of kidney transplant patients based on cluster analysis

[目的]探讨肾移植病人疾病感知的特征及其与自我管理行为的关系。[方法]采用便利抽样法,选用一般资料调查表、疾病感知修订版问卷、肾移植受者自我管理调查量表对129例肾移植病人进行调查,研究肾移植病人疾病感知的特征,并基于聚类分析探讨疾病感知与自我管理的关系。[结果]肾移植病人症状识别得分(3.88±2.52)分,疾病感知其他维度按条目均分从高到低排序分别为治疗控制[(3.73±0.51)分]、个人控制[(3.53±0.56)分]、疾病一致性[(3.38±0.62)分]、病程[(3.23±0.70)分]、疾病影响[(3.11±0.82)分]、情绪[(2.95±0.86)分]、周期性[(2.59±0.71)分],病人自我管理总分为(90.97±8.03)分。根据肾移植病人疾病感知特征,聚类分析将研究对象分为2个类别。整体自我管理水平较高的类别,其个人和治疗控制、疾病一致性得分较高,症状识别、病程、疾病影响、周期性和情绪得分较低。自我管理水平低的类别,其疾病感知各维度得分与另一类别相反。[结论]肾移植病人感知症状越少、疾病越稳定、疾病影响越小,其情绪反应越少;对疾病越了解,其控制疾病信心越强,自我管理水平也越高。医务人员应帮助病人树立正确的疾病认知,及时纠正负性疾病感知,促进其健康行为,从而提高移植物长期存活率。

Objective:To investigate the characteristics of illness perception and the association between illness perception and self-management among kidney transplant patients.Methods:A total of 129 kidney transplant patients were included by convenience sampling.They completed the general information questionnaire,the revised Illness Perception Questionnaire and the Renal Transplant Recipients Self-Management Scale.Cluster analysis was conducted to explore the characteristics of illness perception.Results:Kidney transplant patients′identity scored(3.88±2.52)and the rest dimensions of the IPQ-R arranged according to the mean of items as follow:treatment control(3.73±0.51),personal control(3.53±0.56),disease awareness(3.38±0.62),course of disease(3.23±0.70),disease consequences(3.11±0.82),emotion(2.95±0.86)and course of disease cyclity(2.59±0.71).Total score of self-management was(90.97±8.03).A cluster analysis was performed to identify 2 clusters of patients who share a similar pattern of illness perceptions based on the characteristics of illness perception.In the cluster which had greater self-management level,patients were more positive to personal and treatment control beliefs and understanding of their disease,and perceived less symptoms,and believed that kidney transplant is a more acute disease that is not cyclical,and thought the illness exhibit less impact on their life,and had less negative emotional responses.In the cluster which had poorer self-management,patients scored opposite in each dimension of illness perception.Conclusions:Those who had more positive illness perception represented higher adherence to self-management.In order to promote patients’healthy behaviors and improve long-term graft survival,clinical professors should help patients instruct positive understanding of their disease and redress their negative illness perception timely,so as to promote their health behavior and improve the longterm survial rate.