慢性病共病老年患者健康素养潜剖面分析及对健康促进生活方式的影响

Analysis of the latent profiles of health literacy and its effect on health promoting lifestyle in elderly patients with multiple chronic conditions

目的探究慢性病共病(MCCs)老年患者健康素养的潜在剖面特征,以及不同潜剖面类型对患者健康促进生活方式的影响,为制订干预策略提供参考。方法采用横断面调查方法,便利选取2022年7月至2023年5月南方医科大学南方医院住院的MCCs老年患者作为调查对象。采用一般资料调查表、全面健康素养测量量表、健康促进生活方式量表-Ⅱ对其进行调查。以全面健康素养测量量表的11个条目作为外显指标进行潜剖面分析,比较不同潜剖面患者一般资料的差异,采用回归混合模型分析不同健康素养潜剖面对患者健康促进生活方式的影响。结果回收有效问卷198份,有效回收率94.3%。其中男127例,女71例,年龄60~80(64.57±4.60)岁。MCCs老年患者健康素养分为3个潜剖面,依次为"高素养-健康信息应用高效型"51例(25.8%)、"中素养-健康信息应用中效型"87例(43.9%)、"低素养-健康信息应用低效型"60例(30.3%)。文化程度[高中或中专OR(95%CI)为0.134(0.034~0.531)、大专及以上OR(95%CI)为0.056(0.005~0.670)]、家庭人均月收入[3000~5000元OR(95%CI)=0.176(0.052~0.593)、>5000元OR(95%CI)为0.095(0.024~0.370)]、患病年限[>5年OR(95%CI)为0.204(0.053~0.787)]、共患疾病数[4~5种OR(95%CI)为3.500(1.324~4.252)]是"高素养-健康信息应用高效型"的影响因素(均P<0.05)。家庭人均月收入[3000~5000元OR(95%CI)为0.336(0.150~0.753)]、患病年限[1~5年OR(95%CI)为0.266(0.098~0.721)]是"中素养-健康信息应用中效型"的影响因素(均P<0.05)。3个潜剖面的MCCs老年患者在健康促进生活方式总分和各维度得分比较差异均有统计学意义(F值为32.12~81.04,均P<0.05)。结论MCCs老年患者的健康素养有明显异质性,不同潜剖面患者健康促进生活方式存在差异。医护人员应根据MCCs老年患者健康素养的分类特点,制订针对性干预策略,以提升其健康促进生活方式。

Objective To explore the characteristics of latent profiles of health literacy in elderly patients with multiple chronic conditions(MCCs),and to analyze the impacts of the profiles on patients′health promoting lifestyle,and to provide reference for developing intervention strategies.Methods From July 2022 to May 2023,elderly patients with multiple chronic conditions in Nanfang Hospital,Southern Medical University were selected as the survey subjects by cross-sectional survey method.The General Information Questionnaire,All Aspects of Health Literacy Scale and Health Promoting Lifestyle Profile-Ⅱwere used for investigation.The latent profile analysis was conducted with the 11 entries of health literacy in elderly patients with MCCs as the explicit indicators.The difference of clinical data in potential profiles of health literacy were compared,and regression mixture model was implemented to analyze the impacts of different profiles on health promoting lifestyle of patients.Results Totally 198 valid questionnaires[127 males and 71 females with 60-80(64.57±4.60)years old]were collected,with the effective recovery rate of 94.3%.The latent profiles of health literacy in elderly patients with MCCs was divided into 3 profiles,high literacy and high efficiency in health information application group 51 cases(25.8%),moderate literacy and moderate efficiency in health information application group 87 cases(43.9%),low literacy and low efficiency in health information application group 60 cases(30.3%).Education level[high school or technical secondary school:OR(95%CI)=0.134(0.034-0.531),college degree or above:OR(95%CI)=0.056(0.005-0.670)],per capita monthly income of families[3000-5000yuan:OR(95%CI)=0.176(0.052-0.593),>5000 yuan:OR(95%CI)=0.095(0.024-0.370)],years of illness[>5years:OR(95%CI)=0.204(0.053-0.787)],and number of co-occurring diseases[4-5kinds:OR(95%CI)=3.500(1.324-4.252)]were the influencing factors of high literacy and high efficiency in health information application group(all P<0.05).Per capita monthly income of families[3000-5000yuan:OR(95%CI)=0.336(0.150-0.752)]and years of illness[1-5years:OR(95%CI)=0.266(0.098-0.721)]were the influencing factors of moderate literacy and moderate efficiency in health information application group(all P<0.05).There were statistically significant difference in the total score of Health Promoting Lifestyle Profile-Ⅱand the scores of each dimension among elderly patients with MCCs between 3 latent profiles(F=32.12-81.04,all P<0.05).Conclusions The health literacy of elderly patients with MCCs is significantly heterogeneous,and there are significant differences in health promoting lifestyle among the profiles.Medical staff should formulate personalized intervention strategies based on the classification characteristics of health literacy of MCCs elderly patients to improve their health promoting lifestyle.