基于健康信念理论对老年2型糖尿病患者自我管理影响因素间的路径分析

Pathway analysis of influencing factors of self-management in elderly patients with type 2 diabetes mellitus based on health belief model

目的探讨基于健康信念理论对老年2型糖尿病患者自我管理影响因素间的路径。方法本研究为横断面研究,选取2021年1月至2022年3月就诊于上海市第十人民医院的老年2型糖尿病患者210例为研究对象。分别对患者进行一般资料问卷、社会支持评定量表、糖尿病自我管理量表、慢性病患者健康素养调查量表、糖尿病患者自我效能量表的问卷。采用t检验和Spearman相关性分析检验变量间的相关性。结果社会支持、健康素养、自我效能与自我管理得分均呈正相关(r=0.380、0.392、0.274,均P<0.001)。单因素分析显示,不同年龄、文化程度、体育锻炼情况、医疗支付方式、家族史、睡眠质量患者自我管理差异均有统计学意义(均P<0.05)。路径分析显示,社会支持在健康素养和自我效能关系里的中介效应具有显著性(95%CI:0.014~0.117),社会支持、自我效能和健康素养直接作用于自我管理(β=0.25、0.27、0.35,均P<0.01)。自我效能和健康素养也可以通过社会支持的多重中介正向影响自我管理(β=0.16、0.27,均P<0.01)。结论社会支持、自我效能、健康素养在老年2型糖尿病合并慢性并发症患者的自我管理中起中介作用且相互影响。

Objective To explore the pathway of influencing factors of self-management in elderly patients with type 2 diabetes mellitus(T2DM)based on health belief theory.Methods It was a cross-sectional study.A total of 210 elderly patients with T2DM admitted to Shanghai 10th People′s Hospital from January 2021 to March 2022 were selected as research subjects.The surveys of general data questionnaire,social support rating scale,the diabetes self-management scale,the health literacy survey scale for patients with chronic diseases,and the self-efficacy scale for patients with diabetes were conducted in all the subjects.The t test and Spearman correlation analysis were used to test the correlation among variables.Results Social support,health literacy and self-efficacy were positively correlated with self-management scores in these patients(r=0.380,0.392,0.274,all P<0.001).Univariate analysis showed that there were statistically significant differences in self-management among patients with different age,education level,physical exercise,medical payment method,family history and sleep quality(all P<0.05).Path analysis showed that the mediating effect of social support in the relationship between health literacy and self-efficacy was significant(95%CI:0.014-0.117),social support,self-efficacy and health literacy directly affected self-management(β=0.25,0.27,0.35,all P<0.01).Self-efficacy and health literacy also positively affected self-management through multiple mediators of social support(β=0.16,0.27,both P<0.01).Conclusion Social support,self-efficacy and health literacy mediate in the self-management of elderly patients with T2DM complicated with chronic complications and interact with each other.