初治肺结核患者自我管理困境的质性研究

A qualitative study on self-management dilemma of newly treated patients with pulmonary tuberculosis

目的探讨初治肺结核患者在自我管理过程中的困境体验。方法应用现象学研究方法,采取目的抽样法选取2022年7—9月住院的初治肺结核患者为研究对象,进行半结构式访谈,并采用Colaizzi 7步分析法提炼主题。结果以计划行为理论为基础,对主题进行归纳,包括3个维度、9个主题。(1)行为态度,包括深陷负性情绪困扰、忽略自我管理的重要性;(2)主观规范,包括家庭支持不足、社交隔离、“烟酒文化”桎梏;(3)知觉行为控制,包括难以改变的不良习惯、缺乏疾病知识的延迟就医、疾病风险认知不足引起的遵医行为差、多药联合导致的不良反应严重。结论初治肺结核患者的自我管理行为的维持受多重因素影响,医护人员应从改变患者主观行为认知、重视外界支持以及提供专业指导和个性化健康教育这3个方面促进患者行为意图的改善,以提高患者的自我管理能力。

Objective To explore the dilemma experience in self-management process in newly treated patients with pulmonary tuberculosis.Methods The phenomenology research method and the purposive sampling method were used to select the newly treated hospitalized patients with pulmonary tuberculosis from July to September 2022 as research objects,the semi-structured interviews were performed,and the themes were extracted by the Colaizzi 7-step analysis method.Results Based on the theory of planned behavior,the themes were summarized,including 3 dimensions and 9 themes.①behavioral attitudes,including being deeply troubled by negative emotions and neglecting the importance of self-management;②subjective norms,including insufficient family support,social isolation and the shackles of"tobacco and alcohol culture";③perceptual behavior control,including bad habits hard to change,delayed medical treatment due to lack of disease knowledge,poor compliance behavior caused by insufficient disease risk awareness,and severe adverse reactions caused by multi-drug combinations.Conclusion The maintenance of self-management behavior in newly treated patients with pulmonary tuberculosis is influenced by multiple factors,and medical staffs should promote the improvement of patients′behavioral intentions from three aspects including changing patients′subjective behavior cognition,valuing external support and providing professional guidance and personalized health education,in order to improve patients′self-management ability.