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医院健康素养环境对患者术后疼痛自我管理行为的影响

Impact of hospital health literacy environment on patients′postoperative pain self-management behaviors
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摘要 目的探讨医院健康素养环境对患者术后疼痛自我管理行为的影响,旨在为医院落实《疼痛综合管理试点工作方案》,以及为促进其他疾病或症状的患者自我健康管理提供启示。方法2023年11—12月,便利选取浙江省3所三级甲等综合医院的术后患者,采用现场问卷调查法,以中文版健康素养简要筛查问卷(BHLS)、健康素养环境评价简表(SF-HLES)与术后镇痛自我管理行为问卷(PPSMB)为调查工具分别调查患者的健康素养水平、医院的健康素养环境和患者的术后疼痛管理行为。采用双因素方差分析比较医院健康素养环境不同维度对不同健康素养水平患者术后疼痛管理行为的影响。采用多重线性回归分析医院健康素养环境、个体健康素养和术后患者疼痛自我管理行为之间的关系,并探讨在不同健康素养环境下,个体健康素养对术后患者疼痛自我管理行为的影响。结果回收有效问卷341份,医院SF-HLES平均得分为(73.62±19.54)分,患者BHLS平均得分为(9.65±2.88)分,患者PPSMB平均得分为(25.99±6.35)分。双因素方差分析结果显示,个体健康素养与医院健康素养环境临床维度(F=5.463,P=0.020)和结构维度(F=6.470,P=0.011)的交互作用对患者术后疼痛自我管理行为的影响具有统计学意义,而与人际维度(F=0,P=0.984)的交互作用对患者疼痛管理行为的影响无统计学意义;简单效应分析表明,仅在临床维度和结构维度的高健康素养环境下,健康素养良好与健康素养有限的患者在疼痛自我管理行为上的差异具有统计学意义(P<0.001)。多重线性回归分析结果显示,患者的BHLS得分每增加1分,其PPSMB得分提高3.74分(β1=0.832,P<0.001);医院的SF-HLES得分每提高1分,患者PPSMB得分可提高0.198分(β2=0.610,P<0.001)。在低健康素养环境中,个体健康素养对疼痛管理行为不造成影响(P>0.05);而在高健康素养环境中,患者的BHLS得分每增加1分,其PPSMB得分相应提高4.037分(β4=0.317,P<0.001)。结论个体健康素养对其疼痛自我管理的积极影响依赖于优质的医院健康素养环境,提示优化医院健康素养环境是落实《疼痛综合管理试点工作方案》相关内容的必要前提,可为疼痛以及其他疾病和症状的患者自我健康管理促进提供参考。 ObjectiveTo explore the impact of the hospital health literacy environment on patients′postoperative pain self-management behaviors,aiming to provide insights for hospitals to implement the Comprehensive Pain Management Pilot Work Program in hospitals and to promote self-health management among patients with other diseases or symptoms.MethodsFrom November to December 2023,a convenience sampling method was used to select postoperative patients from three grade A tertiary general hospitals in Zhejiang Province for an on-site questionnaire survey.The Chinese version of brief health literacy screen(BHLS),short-form health literacy environment scale(SF-HLES)and postoperative pain self-management behavior questionnaire(PPSMB)were used as survey tools to investigate the health literacy level of patients,the health literacy environment of the hospital,and the postoperative pain management behaviors of patients.Two-way ANOVA was used to compare the impact of different dimensions of the hospital health literacy environment on postoperative pain management behaviors among patients with different levels of health literacy.Multiple linear regression analysis was used to explore the relationship between the hospital health literacy environment,individual health literacy,and patients′postoperative pain self-management behaviors,and to discuss the impact of individual health literacy on patients′postoperative pain self-management behaviors under different hospital health literacy environments.Results341 valid questionnaires were collected.The average score of the hospitals′SF-HLES was(73.62±19.54)points.The average score of the patients′BHLS was(9.65±2.88)points.The average score of the patients′PPSMB was(25.99±6.35)points.Two-way ANOVA results showed that the interaction between individual health literacy and the clinical dimension(F=5.463,P=0.020)and structural dimension(F=6.470,P=0.011)of the hospital health literacy environment had a statistically significant impact on patients′postoperative pain self-management behaviors,while the interaction with the interpersonal dimension(F=0,P=0.984)had no statistically significant impact on pain self-management behaviors.Simple effect analysis indicated that only in the high health literacy environment of the clinical and structural dimensions did the difference in pain self-management behaviors between patients with good health literacy and those with limited health literacy had statistical significance(P<0.001).Multiple linear regression analysis results showed that for each 1-point increase in the patients′BHLS score,their PPSMB score increased by 3.74 points(β1=0.832,P<0.001);for each 1-point increase in the hospital′s SF-HLES score,the patients′PPSMB score could increase by 0.198 points(β2=0.610,P<0.001).In a low health literacy environment,individual health literacy did not affect pain self-management behaviors(P>0.05);however,in a high health literacy environment,for each 1-point increase in the patients′BHLS score,their PPSMB score correspondingly increased by 4.037 points(β4=0.317,P<0.001).ConclusionsThe positive impact of individual health literacy on pain self-management is contingent upon a high-quality hospital health literacy environment.This suggests that optimizing the hospital health literacy environment is a necessary precondition for implementing the relevant content of the Comprehensive Pain Management Pilot Work Program and can provide a reference for promote self-health management among patients with pain and other diseases or symptoms.
作者 潘祥 童莺歌 倪珂 薛子豪 冯静 娄瑛巧 金旦飞 尉烨玲 王苗玲 Pan Xiang;Tong Yingge;Ni Ke;Xue Zihao;Feng Jing;Lou Yingqiao;Jin Danfei;Wei Yeling;Wang Miaoling(School of Nursing,Hangzhou Normal University,Hangzhou 310021,China;Post-Anesthesia Care Unit,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Nursing,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China;Department of Cardiothoracic Surgery,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China;Department of Cardiothoracic Surgery,Enze Hospital of Taizhou City,Zhejiang Province,Taizhou 318050,China;Nursing Department,Xixi Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310023,China)
出处 《中华医院管理杂志》 CSCD 北大核心 2024年第9期701-707,共7页 Chinese Journal of Hospital Administration
基金 浙江省教育厅高校"十四五"教学改革项目(jg20220481)。
关键词 健康素养 健康素养环境 术后疼痛 疾病管理 自我管理 Health literacy Health literacy environment Postoperative pain Disease management Self-management
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