基于社会生态系统理论的2型糖尿病患者健康结局影响因素分析

Analysis on influencing factors of health outcomes of type 2 diabetes patients based on social ecological system theory

目的以上海市部分地区的2型糖尿病患者为样本,基于社会生态系统理论,对2型糖尿病患者健康结局的影响因素进行分析。方法采用回顾性研究,样本选取2019年6月至12月上海浦东新区和杨浦区4家社区卫生服务中心的987例2型糖尿病患者作为研究对象,男431例(43.67%),女556例(56.33%),年龄(68.8±7.1)岁。利用糖尿病自我管理行为问卷、中文版糖尿病管理自我效能量表及社会支持量表,运用结构方程模型探讨2型糖尿病患者健康结局的影响因素。结果将社会支持、自我效能和自我管理作为潜变量,知识掌握和病程作为协变量纳入模型。修正后,结构方程模型各拟合指数均达到模型拟合标准,绝对拟合度指标GFI=0.990,RMSEA=0.011,增值拟合度指标CFI=0.998,精简拟合度指标PNFI=0.644,拟合结果较好;各潜变量和测量指标的非标准化因素负荷差异均有统计学意义(均P<0.05)。回归分析和中介效应分析显示,自我效能和自我管理在社会支持与健康结果(糖化血红蛋白)关系间的中介作用显著,总中介效应为-0.038(P<0.05)。结论社会支持通过自我效能和自我管理对糖尿病健康结局有积极影响,可将社会生态系统理论作为我国糖尿病患者健康管理实施的理论基础,该模型可以为糖尿病的相关健康管理和健康促进项目提供支持。

Objective To analyzes the influencing factors of health outcomes of type 2 diabetes patients based on the social ecological system theory in Shanghai.Methods A retrospective study was conducted to select 987 patients with type 2 diabetes from 4 community health service centers in Pudong New Area and Yangpu District of Shanghai from June to December 2019 as the study subjects,including 431 males(43.67%)and 556 females(56.33%),aged(68.8±7.1)years.Using the Diabetes Self-management Behavior Questionnaire,Chinese version of Diabetes Management Self-Efficacy Scale(C-DMSES),and Social Support Scale,the influencing factors of health outcomes of type 2 diabetes patients were explored by the structural equation model.Results Social support,self-efficacy,and self-management were included in the model as latent variables,and knowledge mastery and disease course as covariables.After verification,the values of GFI(0.990),RMSEA(0.011),CFI(0.998),and PNFI(0.644)of the final model indicated that the goodness-of-fit of the model was excellent.The non-standardized factor loads of each latent variable and measurement index were statistically significant(all P<0.05).Regression analysis and mesomeric effect analysis showed that self-efficacy and self-management played significant mediating roles in the relationship between social support and health outcomes(glycated hemoglobin),and the total mesomeric effect was-0.038(P<0.05).Conclusions Social support has a positive impact on the health outcomes of diabetes through self-efficacy and self-management.The social ecological system theory can be used as the theoretical basis for the implementation of health management for diabetes patients in China.This model can provide support for related health management and health promotion projects of diabetes.