基于慢性疾病轨迹模式的不同疾病时期卒中患者健康知识及自我管理行为特征比较

Comparison of health knowledge and self-management behavior characteristics of stroke patients in different disease periods based on Chronic Illness Trajectory Framework

目的 探讨急性住院期、早期康复期、持续康复期及半稳定期的首发脑卒中患者自我效能、卒中健康知识、自我管理现状,分析三者间相关性及其影响因素。方法 采用分层便利抽样对四个疾病时期的卒中患者进行问卷调查,研究工具为自行设计的一般资料调查表、慢性病自我效能量表、脑卒中健康知识问卷、中风患者自我管理行为评定量表。结果 362例脑卒中患者自我效能、卒中健康知识、自我管理行为分别处于中等、偏差和中等水平;不同病程组的卒中健康知识与自我管理得分比较差异有统计学意义(P<0.01);自我管理、文化程度、家庭月收入水平是患者自我效能、卒中健康知识的影响因素(P<0.001),自我效能、卒中健康知识、文化程度、职业、共患病情况(有无高血压、高血脂)是患者自我管理行为的影响因素(P<0.001);三个得分指标间存在两两正相关关系(r=0.46、0.43、0.27,P<0.01)。结论 卒中的管理是一个动态变化的过程,针对不同时期幸存者表现优弱势的针对性干预方案是必要的。

Objective To explore the status quo of the self-efficacy, stroke health knowledge, and self-management level of stroke survivors in periods of acute hospitalization, early rehabilitation, continuous rehabilitation and semi-stable stage, and to analyze the correlation among the three and their influencing factors.Methods The stratified convenient sampling method was used to conduct the survey among the stroke survivors at the four different disease stages. The research tools were Self-Designed General Information Questionnaire, Self-efficacy Scale for Chronic Disease Management, Stroke Health Knowledge Questionnaire, and Stroke Patients′Self-management Behavior Rating Scale.Results The self-efficacy, stroke health knowledge, and self-management behavior of 362 stroke patients were at moderate, biased and moderate levels, respectively. There were statistically significant differences in stroke health knowledge and self-management scores in different disease course groups(P<0.01). Self-management, educational level, and family monthly income were the influencing factors of patients′ self-efficacy and stroke health knowledge(P<0.001). Self-efficacy, stroke health knowledge, educational level, occupation, comorbid conditions(with or without hypertension and/or hyperlipidemia) were the influencing factors of patients′ self-management behavior(P<0.001). There is a pairwise positive correlation between the three indicators(r = 0.46, 0.43 and 0.27;P<0.01).Conclusion Stroke management is a dynamic process. Targeted intervention programs for the strengths and weaknesses of survivors at different stages are necessary.