自我护理能力在血液透析病人健康赋权认知与康复运动接受程度间的中介效应和调节效应

The mediating and moderating effects of self-care ability on health empowerment cognition and rehabilitation exercise acceptance of hemodialysis patients

目的:探究自我护理能力在血液透析病人健康赋权认知水平与康复运动接受程度间的中介效应及调节效应。方法:采用中文版病人感知赋权量表(PPES)、自我护理能力测定量表(ESCA)对2017年1月—2019年1月医院收治的180例规律透析病人进行问卷调查,并按照病人接受康复运动的规律程度将病人分为4个等级。通过采用分层回归法分析研究变量间的中介效应和调节效应。结果:本研究中,PPES量表总分为(41.91±4.96)分,其中信息维度得分为(12.74±2.09)分,决策维度得分为(6.22±1.71)分,个体化维度得分为(11.02±1.88)分,自我管理维度得分为(11.93±1.40)分。ESCA量表总分为(112.80±9.11)分,自我护理技能维度得分为(30.21±5.22)分,自护责任感维度得分为(14.87±4.27)分,自我概念维度得分为(11.68±3.60)分,健康知识水平维度得分为(50.28±8.69)分。康复运动接受程度:<30%共17例,30%~50%共62例,51%~80%共58例,>80%共43例。相关性分析显示,自我护理能力与健康赋权认知水平、康复运动接受程度呈正相关(r=0.758、0.694,P<0.01),健康赋权认知水平与康复运动接受程度呈正相关(r=0.802,P<0.01)。进一步行分层回归分析调节效应显示,“健康赋权认知水平×自我护理能力”的回归系数有统计学意义(β′=0.002,t=5.661,P<0.01),且调节效应显著(ΔR 2=0.008,P<0.01)。结论:自我护理能力在血液透析病人健康赋权认知水平与康复运动接受程度间具有中介效应及调节效应。

Objective:To explore the mediating and moderating effects of self-care ability on health empowerment cognition and rehabilitation exercise acceptance of hemodialysis.Methods:Chinese version of Patient Perception of Empowerment Scale(PPES)and Exercise of Self-Care Agency Scale(ESCA)were performed on 180 regular dialysis patients from January 2017 to January 2019,and the patients were divided into four grades according to the regularity of rehabilitation exercise.Stratified regression method was used to analyze the mediating effect and moderating effect of variables.Results:In this study,the total score of PPES scale of patients was(41.91±4.96),including information dimension(12.74±2.09),decision-making dimension(6.22±1.71),individualization dimension(11.02±1.88),self-management dimension(11.93±1.40).The total score of ESCA scale was(112.80±9.11),self-care skill dimension was(30.21±5.22),self-care responsibility dimension was(14.87±4.27),self-concept dimension was(11.68±3.60),and health knowledge level dimension was(50.28±8.69).The acceptance degree of rehabilitation exercise:17 cases were<30%,62 cases were 30%~50%,58 cases were 50%~80%,and 43 cases were>80%.Pearson correlation analysis showed that the ability of self-care was positively correlated with the cognitive level of health empowerment and the acceptance degree of rehabilitation exercise(r=0.758,0.694,P<0.01),and the cognitive level of health empowerment was positively correlated with the acceptance degree of rehabilitation exercise(r=0.802,P<0.01).Further lines of hierarchical regression analysis to adjust effect,the results of"health empowerment cognitive level×self-care ability"of the regression coefficient was statistically significant(β′=0.002,t=5.661,P<0.01)and the adjusting effect was remarkable(ΔR 2=0.008,P<0.01).Conclusions:The self-care ability had mediating effect and regulating effect between the cognition level of health empowerment and the acceptance degree of rehabilitation exercise in hemodialysis patients.