基于能力、机会、动机-行为模型的孕晚期孕妇自我管理行为影响因素分析

Influencing factors of COM-B model-based self-management behaviors of pregnant women in the third trimester

目的基于能力、机会、动机-行为(COM-B)模型分析各因素对孕晚期孕妇自我管理行为的影响机制,为制定相关的健康干预措施提供理论参考。方法采用便利抽样法,选取延吉市某三级甲等综合医院、某妇幼保健医院及某社区卫生服务中心产科门诊常规产前检查的320名孕晚期孕妇为研究对象。采用一般资料调查表、母婴健康素养量表、中文版分娩恐惧问卷、领悟社会支持量表(PSSS)和孕妇自我保健管理评定问卷对孕妇进行调查。结果320名孕妇的孕妇自我保健管理评定问卷得分为(73.81±10.43)分。相关分析结果显示,研究对象自我管理行为分别与母婴健康素养(r=0.498,P<0.01)、领悟社会支持(r=0.527,P<0.01)呈中度正相关,与分娩恐惧呈中度负相关(r=-0.542,P<0.01)。多元线性回归分析结果显示,年龄、文化程度、家庭人均月收入、孕周、孕次、母婴健康素养、分娩恐惧、领悟社会支持是自我管理行为的影响因素(P<0.001),共解释总体变异的57.0%。结构方程模型显示,各项拟合指数均达到适配标准;母婴健康素养、领悟社会支持既可以直接影响自我管理行为,也可以通过分娩恐惧的中介作用间接影响自我管理行为。结论孕晚期孕妇的自我管理行为处于中等水平,整体水平有待进一步提高。医护人员应积极动员社会各界力量,提供系统化、规范化的妇幼保健知识教育,提高孕妇的母婴健康素养水平及领悟社会支持水平,缓解分娩恐惧情绪,增强孕妇孕期进行自我管理的信心和动力,以促进孕妇形成良好的自我管理行为,保障母婴健康。

Objective This paper aims to analyze the influence factors of self-management behaviors of pregnant women in the third trimester based on the capability,opportunity,and motivation-behavior(COM-B)model to provide a theoretical reference for formulating relevant health interventions.Methods A total of 320 pregnant women in the third trimester of pregnancy who underwent routine prenatal care in a grade A tertiary general hospital,a maternal and child health hospital,and an obstetrical clinic of a community health service center in Yanji city were selected using a convenience sampling method.They were investigated by the general data questionnaire,the maternal and child health literacy scale,the Chinese version of fear of delivery questionnaire,the perceived social support scale(PSSS),and the maternal self-care management assessment questionnaire.Results The score of the self-care management questionnaire of 320 pregnant women was 73.81±10.43.The results of correlation analysis showed that the self-management behaviors of the participants were moderately positively correlated with maternal and child health literacy(r=0.498,P<0.01),perceived social support(r=0.527,P<0.01),and moderately negatively correlated with fear of delivery(r=-0.542,P<0.01),respectively.The results of multiple linear regression analysis indicated that age,education level,per capita monthly household income,gestational age,gravidity,maternal and child health literacy,fear of childbirth,and perceived social support were the influencing factors of selfmanagement behaviors(P<0.001),accounting for overall 57.0%of the overall variation.A structural equation model demonstrated that all fitting indices met the fitting criteria.Maternal and child health literacy and perceived social support could not only directly affect self-management behavior,but also indirectly affect self-management behavior through the mediating effect of childbirth fear.Conclusion The self-management behavior of pregnant women in the third trimester of pregnancy is at a moderate level,and the overall level needs to be further promoted.Medical staff should actively mobilize all sectors of society,provide systematic and standardized maternal and child health knowledge education,potentiate the maternal and child health literacy level and perceived social support level of pregnant women,alleviate the fear of delivery,and strengthen the confidence and impetus of pregnant women in self-management during pregnancy to promote them to form good self-management behaviors and ensure maternal and child health.