健康自我倾注在原发性高血压患者健康管理知信行建立过程中的作用初探

Correlation of health self-focused attention with knowledge,attitude and practice in health management of patients with essential hypertension

目的探讨健康自我倾注在原发性高血压患者健康管理知信行建立过程中的作用。方法该研究为横断面研究。于2021年10至12月在上海市黄浦区打浦桥街道社区卫生服务中心的4个卫生服务站点,采用随机数字表法抽取原发性高血压患者。通过调查问卷收集入选患者的一般信息,高血压对生活、工作及家庭的影响程度,高血压相关知识与认知,高血压自我管理行为,健康自我倾注的情况,并对后4者进行评分。调查结束后测量患者血压,以此判断患者血压控制是否达标。采用Spearman秩相关分析及Pearson相关分析分析高血压对生活、工作及家庭的影响程度,高血压相关知识与认知,高血压自我管理行为,健康自我倾注,以及血压达标的两两相关性。采用AMOS 24.0软件构建“健康自我倾注-高血压相关知识与认知-高血压自我管理行为及高血压对生活、工作及家庭的影响程度”的结构方程模型,分析健康自我倾注对高血压相关知识与认知及自我管理行为的作用。结果纳入患者190例,年龄(71.2±8.5)岁,男性82例(43.2%),达标组119例、未达标组71例。调查问卷有效回收率100%(190/190)。达标组患者高血压自我管理行为总分和健康自我倾注总分均高于未达标组(均P<0.05)。高血压对生活、工作及家庭的影响程度与高血压相关知识与认知、高血压自我管理行为均呈负相关(r值分别为-0.39和-0.28,均P<0.01);高血压相关知识与认知与高血压自我管理行为、健康自我倾注均呈正相关(r值分别为0.29和0.27,均P<0.01);高血压自我管理行为与健康自我倾注呈正相关(r=0.28,P<0.01),与血压达标呈正相关(r=0.48,P<0.01);健康自我倾注与血压达标呈正相关(r=0.21,P<0.01)。结构方程模型分析结果显示健康自我倾注在原发性高血压患者认知和行为中具有驱动作用,其影响患者对高血压相关知识的掌握程度和正确认知的形成(路径系数为0.28),进而促进患者采取自我健康管理行为(路径系数为0.20)。此外,高血压对患者生活、工作和家庭的影响对患者接受并认同高血压相关知识及形成正确的认知、采取自我管理行为均具有负向调节作用,调节系数分别为-0.48、-0.22。结论健康自我倾注在原发性高血压患者健康管理知信行建立过程中可能具有驱动作用。

Objective To explore the impact of health self-focused attention on knowledge,attitude and practice of health management in patients with essential hypertension.Methods This was a cross-sectional study.A total of 190 patients with essential hypertension were randomly selected from Shanghai Dapuqiao Community Health Service Center to participate in a questionnaire survey from October to December,2021.The contents of the questionnaire included the general information of the patients,the degree of influence of hypertension on individuals,and the patients′knowledge and personal cognition of hypertension,self-management behaviors,health self-focused attention,and blood pressure control.SPSS 25.0 and AMOS 24.0 were used to develop a structural equation model for analysis.Results The recovery rate of questionnaires was 100.0%(190/190).Of the 190 patients,there were 82 males and 108 females with a mean age of(71.2±8.5)years.According to blood pressure,190 hypertensive patients were divided into blood pressure controlled group(n=119)and blood pressure non-controlled group(n=71).There were significant differences in the total scores of hypertension self-management behavior and health self-focused attention between the two groups(P<0.05).Correlation analysis showed that the degree of influence of hypertension on individuals was negatively correlated with the disease knowledge and personal cognition,and the performance of hypertension self-management behavior(r=-0.39 and-0.28,P<0.01),while the disease knowledge and personal cognition were positively correlated with the performance of hypertension self-management behavior and health self-focused attention(r=0.29 and 0.27,P<0.01).Hypertension self-management behavior was positively correlated with health self-focused attention and blood pressure control(r=0.28 and 0.48,P<0.01),and health self-focused attention was positively correlated with blood pressure control(r=0.21,P<0.01).The equation model analysis showed that health self-focused attention had a driving effect on patients′disease knowledge and cognition and self-management behavior.Health self-focused attention significantly affected patients′mastery of disease knowledge and formation of correct cognition(path coefficient=0.28).In addition,hypertension patients′disease knowledge storage and internal recognition of prevention and treatment strategies determined their self-management behavior(path coefficient=0.20).On the other hand,the impact of hypertension on patients life,work and economic burden played a negative role in their acceptance of disease management knowledge,formation of correct concepts,and adoption of self-management behaviors with adjustment coefficients of-0.48 and-0.22,respectively.Conclusion Health self-focused attention may play an initial role in the process of changing the knowledge,attitude and behavior of hypertension patients.