基于健康信念模型的徐州市老年人健康指导依从性影响因素分析

Analysis on Influencing Factors of Health Guidance Adherence Among Older Adults in Xuzhou Based on Health Belief Model

目的:探索徐州市老年人健康指导依从性的影响因素,为改善老年人健康管理的服务效果提供参考。方法:采用多阶段分层整群随机抽样法,对徐州市510名65岁及以上老年人进行问卷调查。基于健康信念模型设计量表并建立初始模型。经过模型的拟合修正,获得该模型中各维度与老年人健康指导依从性的关系模型。结果:健康信念模型维度中的严重性、提示因素和障碍性对老年人健康指导依从性有显著的影响(P<0.01),总效应分别为0.242、-0.235和0.248。效益性(P=0.806)、易感性(P=0.486)对健康指导依从性没有直接显著性影响,但效益性(P<0.01)、易感性(P<0.01)分别通过提示因素(P<0.01)、障碍性(P<0.01)对健康指导依从性有显著性影响,总效应分别为0.135、0.125。结论:疾病的严重性、亲友的提示因素、采取行动的障碍性对老年人健康指导依从性有影响,采取行动的效益性、疾病的易感性对其没有直接显著性影响;提升依从性可以从增加老年人的健康知识储备、强调亲友的影响力、提升健康指导中的沟通效果和提高电子健康档案查询结果的灵活性等方面着手。

Objective:To explore the influencing factors of health guidance adherence among the older adults in Xuzhou,so as to provide references for improving the effectiveness of health management services for older adults.Methods:A questionnaire survey was conducted by multi-stage stratified cluster random sampling among 510 older adults aged 65 years and above in Xuzhou.A scale was designed and an initial model was established based on the health belief model.After the model fitting correction,a model of the relationship between the dimensions in this model and the adherence to health guidance among the elderly was obtained.Results:Severity,cueing factors and barriers in the health belief model dimensions had significant effects(P<0.01)on health guidance adherence in older adults,with total effects of 0.242,-0.235 and 0.248,respectively.Benefit(P=0.806)and susceptibility(P=0.486)did not have direct significant effects on health guidance adherence,but benefit(P<0.01)and susceptibility(P<0.01)had significant effects on health instruction adherence through cueing factors(P<0.01)and barriers(P<0.01)respectively,with total effects of 0.135 and 0.125 respectively.Conclusion:Severity of illness,cueing factors of family and friends and barriers of behavior have an effect on health guidance adherence in older adults,and effectiveness of behavior and susceptibility of illness have no direct significant effect on it.Improving adherence can be done as follows:increasing the health knowledge base of older people,emphasizing the influence of family and friends,improving communication in health guidance and increasing the query flexibility of electronic health records results.