维持性血液透析患者治疗依从性影响因素结构方程模型构建与验证

Construction and validation of structural equation modeling of factors influencing treatment adherence in maintenance hemodialysis patients

目的基于信息-动机-行为技巧模型构建维持性血液透析患者治疗依从性影响因素的结构方程,验证其内部路径并为优化模型指导下的干预性研究提供科学依据。方法2022年7月—11月,采用便利抽样法,选取河南省郑州市某2所三级甲等医院血液净化中心收治的283例维持性血液透析患者为调查对象,采用血液透析患者知识水平问卷、社会支持评定量表、慢性病自我效能量表、维持性血液透析患者自我管理量表、终末期肾病维持性血液透析患者治疗依从性量表对其进行调查。使用SPSS 25.0软件对患者治疗依从性得分进行统计描述,对各量表得分进行相关性分析,采用AMOS 24.0软件建立结构方程模型。结果回收有效问卷267份,有效问卷回收率为94.3%;结构方程模型显示:疾病知识对自我管理、疾病知识对治疗依从性无影响(P>0.05),自我效能对治疗依从性具有正向影响关系(总效应0.382,直接效应0.183,间接效应0.199,P<0.05),社会支持对治疗依从性具有正向影响关系(总效应0.699,直接效应0.300,间接效应0.399,P<0.05),自我管理对治疗依从性具有正向影响关系(总效应0.183,直接效应0.183,P<0.05)。结论在信息-动机-行为技巧模型指导下制订干预策略时,应侧重动机和行为技巧因素对治疗依从性的促进作用,特别是社会动机在模型中重要路径作用,以提高患者整体的治疗依从性水平和生活质量。

Objective To construct the structural equation of the influencing factors of the treatment compliance of maintenance hemodialysis patients based on the information-motivation-behavioral skill model,verify its internal pathway,and provide scientific bases for the intervention study under the guidance of the optimized model.Methods From July to November 2022,283 patients with maintenance hemodialysis were selected by convenience sampling method from 2 tertiary A hospitals in Henan Province.The hemodialysis patients’knowledge level questionnaire,social support rating scale,chronic disease self-efficacy scale,maintenance hemodialysis patients’self-management scale,dialysis treatment compliance scale of end-stage renal disease patients were investigated.SPSS25.0 was used to statistically describe the scores of patients’treatment compliance;correlation analysis of each scale was carried out;structural equation model was established by AMOS 24.0 software.Results 267 valid questionnaires were collected,and the effective recovery rate was 94.3%.Structural equation model showed that disease knowledge had no effect on self-management and treatment compliance(P>0.05);self-efficacy had a positive effect on treatment compliance(total effect 0.382,direct effect 0.183,indirect effect 0.199,P<0.05);social support had a positive effect on treatment compliance(total effect 0.699,direct effect 0.300,indirect effect 0.399,P<0.05);self-management had a positive effect on treatment compliance(total effect 0.183,direct effect 0.183,P<0.05).Conclusion When developing intervention strategies under the guidance of information-motivation-behavioral skill model,the emphasis should be placed on the promoting effect of motivation and behavioral skill factors on treatment compliance,especially the important pathway role of social motivation in the model,so as to improve the overall level of treatment compliance and quality of life of patients.