计划行为理论视角下脑卒中后吞咽障碍患者居家自我管理障碍的质性研究

A Qualitative Study of Home Self-Management Barriers in Patients with Post-Stroke Swallowing Disorders from a Theory of Planned Behavior Perspective

目的:探讨脑卒中后吞咽障碍患者居家自我管理的障碍因素,为今后医护人员制定针对性的干预方案,提升脑卒中后吞咽障碍患者的自我管理水平提供依据。方法:于2023年5月~7月,采用目的抽样法选取贵阳市3个社区的脑卒中后吞咽障碍患者,对其进行半结构式访谈,采用Colaizzi 7步分析法进行资料分析并提炼主题。结果:应用计划行为理论对主题进行归纳,共提炼出3个类别9个主题。行为态度(疾病治疗无望感、疾病认知偏差、负面情绪的干扰)、主观规范(社会环境的影响、家庭支持不足、他人行为)、知觉行为控制(经济负担过重、信息支持不足、缺乏长期自我管理行为监督)。结论:脑卒中后吞咽障碍患者居家自我管理存在诸多障碍因素,医护人员应根据障碍因素制定针对性自我管理干预措施,促进患者健康行为改变,以提高患者自我管理水平。

Objective: To explore the barriers to home self-management of post-stroke dysphagia patients, and to provide a basis for future healthcare professionals to develop targeted intervention programs to enhance the self-management of post-stroke dysphagia patients. Methods: From May to July 2023, patients with post-stroke dysphagia in three communities in Guiyang City were selected using purposive sampling, semi-structured interviews were conducted, and the Colaizzi 7-step analysis method was used to analyze the data and refine the themes. Results: The Theory of Planned Behavior was applied to summarize the themes, and a total of 9 themes in 3 categories were extracted. Behavioral attitudes (sense of hopelessness in disease treatment, disease cognitive bias, interference from negative emotions), subjective norms (influence of social environment, insufficient family support, behavior of others), and perceived behavioral control (excessive financial burden, insufficient information support, and lack of long-term self-management behavioral supervision). Conclusion: There are many barriers to home self-management in patients with swallowing disorders after stroke, and healthcare professionals should develop targeted self-management interventions based on the barriers to promote health behavior change in order to improve patient self-management.