基于COM-B模型的中青年高血压患者自我护理影响因素分析

Analysis of influencing factors of self-care of young and middle-aged patients with hypertension based on COM-B model

目的基于能力、机会、动机-行为(COM-B)模型探讨影响中青年高血压患者自我护理行为的因素。方法选取2016年7-12月广州市海珠区、黄浦区的2个社区卫生服务中心就诊的中青年高血压患者216例,采用问卷调查法进行调查,采用结构方程模型分析影响自我护理行为的因素。结果自我护理维持、自我护理管理、自我护理信心、高血压知识、体力活动、抑郁程度及家庭功能之间具有一定相关性。模型的χ2自由度比值、近似误差的均方根、拟合优度指数、调整拟合优度指数及规范拟合指数分别为2.010、0.057(0.038~0.072)、0.920、0.950及0.930。模型变量分别解释了自我护理信心、自我护理维持与自我护理管理总变异的39.6%、41.9%、44.3%。模型变量的组合信度与平均变异抽取量均大于0.50。自我护理信心调节了家庭功能、抑郁程度、高血压知识、体力活动与自我护理维持、自我护理管理之间的关系。结论年龄、病程、家庭功能、抑郁程度、高血压知识、体力活动对中青年高血压患者的自我护理行为会产生直接影响,且通过自我护理信心间接对自我护理维持与自我护理管理发挥作用。

Objective To explore the influencing factors of self-care behavior of young and middle-aged patients with hypertension based on the ability,opportunity,motivation-behavior(COM-B)model.Methods From July to December 2016,216 young and middle-aged patients with hypertension were selected from two community health service centers in Haizhu District and Huang pu District of Guangzhou.The questionnaire survey was used.Structural equation model was used to analyze the factors influencing self-care behavior.Results There was a certain correlation among self-care maintenance,self-care management,self-care confidence,hypertension knowledge,physical activity,depression and family function.Theχ2/df,root mean square error of approximation,goodness of fit index,adjust goodness of fit index and normed fit index were 2.010,0.057(0.038-0.072),0.920,0.950 and 0.930,respectively.The model variables explained 39.6%,41.9%and 44.3%of the total variance of self-care confidence,self-care maintenance and self-care management.The combination reliability and average variation extraction of the model variables were greater than 0.50.Self care confidence regulates the relationship among family function,depression,hypertension knowledge,physical activity and self-care maintenance,self-care management.Conclusion Age,course of disease,family function,depression degree,hypertension knowledge and physical activity have a direct impact on the self-care behavior of young and middle-aged patients with hypertension,and indirectly play a role in self-care maintenance and self-care management through self-care confidence.