影响老年糖尿病患者健康认知评价机制的路径分析

Analysis of pathways affecting the evaluation mechanisms of health cognitive evaluation in elderly patients with diabetes mellitus

目的 运用并行过程模型(EPPM)探讨影响老年糖尿病患者健康认知评价的作用机制。方法 2021年8月~2022年3月面对面访谈法调查314例老年糖尿病患者,运用结构方程模型探讨社会支持、糖尿病痛苦、心理韧性对健康认知评价的影响途径。结果 调查对象的平均健康认知评价得分为48.25分。其中有害/失去维度得分最高,为17.32分。社会支持对糖尿病痛苦、心理韧性的效应分别为-0.169(P=0.012)、0.386(P<0.001)。糖尿病痛苦、心理韧性对健康认知评价的直接效应分别为0.149(P=0.011)、0.833(P<0.001)。心理韧性对健康认知评价的中介效应为-0.169(95%CI:-0.311~-0.001),其中糖尿病痛苦的中介贡献率为16.9%。结论 调查对象的健康认知评价处中等水平,多为负性评价。心理韧性可通过糖尿病痛苦间接影响健康认知评价,社会支持可影响糖尿病痛苦及心理韧性,应鼓励提高患者亲属及医务工作者的支持,加强积极应对方式的教育,同时强化对消极情绪危害的认识,从而有效改善老年糖尿病患者心理健康水平。

Objective To explore the mechanisms of action affecting the evaluation of health cognitive of elderly diabetic patients using parallel process modeling(EPPM).Methods From August 2021 to March 2022,314 elderly patients with diabetes were interviewed face to face.The structural equation model was used to explore the impact of social support,diabetes pain,and psychological resilience on health cognitive assessment.Results The average health cognitive assessment score of the survey respondents was 48.25.The highest score was 17.32 for the harmful/loss dimension.The effects of social support on diabetes pain,and mental toughness were respectively-0.169(P=0.012),0.386(P<0.001).The direct effect of diabetes pain,and mental toughness on health cognitive evaluation was 0.149,respectively(P=0.011),and 0.833(P<0.001).The mediating effect of mental toughness on health cognitive evaluation was-0.169(95%[WTBX]CI:-0.311 to-0.001),with a mediating contribution of 16.9%for diabetes pain.Conclusion The health cognition evaluation of the survey respondents is at a medium level,with mostly negative evaluations.Psychological resilience can indirectly affect health cognition and evaluation through diabetes pain,and social support can affect diabetes pain and psychological resilience.We should encourage and improve the support of patients'relatives and medical workers,strengthen the education of positive coping styles,and strengthen the awareness of negative emotional hazards,so as to effectively improve the mental health of elderly diabetes patients.