膝骨性关节炎患者积极度在健康素养与自我管理行为间的中介效应研究

Mediating effect of patient motivation between health literacy and self-management behaviour in patients with knee osteoarthritis

目的探讨膝骨性关节炎患者积极度在健康素养与自我管理行为间的中介效应。调查膝骨性关节炎(knee osteoarthritis,KOA)患者的健康素养、积极度和自我管理行为现状,为改善KOA患者自我管理行为提供依据。方法采取便利抽样法,选取2021年9月至12月咸阳市某3所三级甲等综合医院就诊的169例膝骨性关节炎患者为研究对象,采用一般状况调查表、慢性病健康素养量表、积极度量表以及慢性病自我管理行为量表进行现场调查。使用Pearson相关分析KOA患者的健康素养,积极度及自我管理行为的相关性。采用Process 4.0插件检验KOA患者积极度在健康素养与自我管理行为的中介效应。结果KOA患者的健康素养、积极度及自我管理行为总分分别为(79.66±11.91)分、(54.97±9.95)分和(23.75±8.89)分。KOA患者的健康素养、积极度均与其自我管理行为呈正相关(r=0.872、r=0.822,均P<0.01),健康素养和积极度呈正相关(r=0.877,P<0.01)。健康素养可直接预测自我管理行为(β=0.708,95%CI:0.539~0.876),也可通过积极度的中介作用预测自我管理行为(β=0.228,95%CI:0.676~0.787),中介效应占总效应的24.36%。结论KOA患者的健康素养、积极度和自我管理行为水平均不佳,有待进一步提升,且积极度是健康素养和自我管理行为的中介变量,提示医护工作者可在提升膝骨性关节炎患者健康素养的基础上激发积极度,进而提高其自我管理行为水平。

Objective To investigate the status quo of health literacy,motivation and self-management behaviours of patients with knee osteoarthritis(KOA),to explore the influence of health literacy and motivation on self-management behaviours to the patients with KOA,and to clarify the relationships among the three factors.Methods Convenience sampling method was used to select 169 KOA patients who were treated in 3 tertiary hospitals in Xianyang between September and December 2021.General status table,chronic disease health literacy scale,patient motivation scale and chronic disease self-management behaviour scale were employed in the onthe-spot survey.Pearson correlation was used to analyze the correlation of health literacy,motivation and self-management behaviour of patients with KOA.Results Total scores of health literacy,motivation and self-management behaviour of the patients with KOA were 79.66±11.91,54.97±9.95 and 23.75±8.89,respectively.It was found that health literacy and motivation of the patients were positively correlated with their self-management behaviour(r=0.872,r=0.822,both P<0.01).Health literacy of the patients was positively correlated with motivation of patients(r=0.877,P<0.01).Health literacy of the patients could be used to directly predict selfmanagement behaviour of patients(β=0.708,95%CI:0.539-0.876),as well as to predict self-management behaviour of the patients through the mediating effect of patient motivation(β=0.228,95%CI:0.676-0.787).The mediating effect accounted for 24.36%of the total effect.Conclusions The health literacy,motivation and self-management behaviours of patients with KOA are all poor and they should be further improved.Patient motivation is the mediating variable in health literacy and self-management behaviour of the patients.It is suggested that nursing staff could encourage the motivation of patients hence to improve the self-management behaviour in the patients with KOA based on an improvement of health literacy.