自我效能感在肝硬化患者症状体验和生命质量间的中介作用

The mediating effects of self-efficacy between symptom experience and quality of life in patients with cirrhosis

目的评价肝硬化患者的症状体验,探讨自我效能感在症状体验和生命质量间的中介作用。方法采用方便抽样法,抽取2020年6月至2021年2月入住上海交通大学医学院附属瑞金医院感染科的197例肝硬化患者,使用记忆症状评估量表、慢性肝病问卷和慢性疾病自我效能感量表评价患者的症状体验、生命质量和自我效能感。分析三者间的相关性,构建结构方程模型评价自我效能感在症状体验与生命质量间的中介效应。结果肝硬化患者的记忆症状评估、生命质量和自我效能感总分分别为(0.79±0.34)、(32.51±5.96)、(5.10±1.33)分,症状体验与自我效能感、生命质量呈负相关(r=-0.343、-0.763,均P<0.01);自我效能感与生命质量呈正相关(r=0.347,P<0.01);症状体验可通过自我效能感负向影响生命质量(β=-0.036,P=0.045),症状体验对生命质量的总效应由直接效应(β=-0.727,P<0.001)和间接效应(β=-0.036,P=0.045)两部分组成。结论自我效能感在肝硬化患者的症状体验和生命质量间存在中介效应,可通过提升自我效能感改善症状体验,降低症状对生命质量的负面影响。

Objective To describe the symptom experience of patients with cirrhosis,and explore the mediating effect of self-efficacy between symptom experience and quality of life.Methods A total of 197 inpatients with liver cirrhosis from June 2020 to February 2021 in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were recruited in this study by convenient sampling method.Symptom experience,quality of life and self-efficacy were assessed by Memorial Symptom Assessment Scale,Chronic Liver Disease Questionnaire and Self-efficacy for Managing Chronic Disease.The correlation among the three was analyzed and a structural equation model was constructed to evaluate the mediating effect of self-efficacy on symptom experience and quality of life.Results The total score of symptom experience,quality of life and self-efficacy were(0.79±0.34),(32.51±5.96),(5.10±1.33).Symptom experience was significantly negatively correlated with self-efficacy and quality of life(r=-0.343,-0.763,both P<0.01).Self-efficacy was significantly positively correlated with quality of life(r=0.347,P<0.01).Symptom experience significantly negatively affected quality of life through self-efficacy(β=-0.036,P=0.045).The total effect of symptom experience on quality of life was composed of direct effect(β=-0.727,P<0.001)and indirect effect(β=-0.036,P=0.045).Conclusions Self-efficacy has a mediating effect between symptom experience and quality of life in patients with liver cirrhosis,which can improve symptom experience and reduce the negative impact of symptoms on quality of life by improving self-efficacy.