影响孕妇孕期体力活动的环境因素及路径分析

doi:10.3761/j.issn.0254-1769.2023.17.010

摘要/Abstract

摘要：

目的探究影响孕妇孕期体力活动的环境因素及作用路径，为制订针对性的运动干预策略提供参考。方法采用便利抽样法，于2021年5月—12月使用一般资料调查表、孕期身体活动问卷、国际跌倒效能量表、居家跌倒风险筛查量表、社会支持评定量表对浙江省某三级甲等妇产科医院产科门诊常规产前检查的1 200名孕妇进行问卷调查。进行单因素分析、Spearman相关分析，并使用Mplus 7.4软件构建并检验链式中介模型。结果最终共纳入1 118名孕妇，202名（18.07%）孕妇孕期体力活动达标。跌倒恐惧、居住环境、社会支持对孕妇孕期体力活动的直接效应成立，效应值分别为-0.168、0.326、0.381；居住环境通过跌倒恐惧的中介作用间接影响孕期体力活动，效应值为0.074，占总效应的18.50%；社会支持通过居住环境、跌倒恐惧的单独中介作用及居住环境-跌倒恐惧的链式中介作用间接影响孕妇孕期体力活动，效应值为0.198，占总效应的34.20%。结论孕妇孕期体力活动达标率较低，临床医护人员应重视跌倒恐惧、居住环境、社会支持对孕妇孕期体力活动的影响，实施科学、精准的运动管理，以提高孕妇孕期体力活动水平。

关键词: 孕妇, 体力活动, 跌倒恐惧, 居住环境, 社会支持, 路径分析, 围产期护理

Abstract:

Objective To investigate the environmental factors of physical activity among pregnant women，so as to provide a basis for the formulation of targeted intervention programs. Methods Using convenient sampling method，from May to December 2021，we investigated 1200 pregnant women who were received routine prenatal examination in obstetric clinic of a tertiary hospital in Zhejiang province with the general information questionnaire，Pregnancy Physical Activity Questionnaire，Falls Efficacy Scale International，Home Falls and Accidents Screening Tool，and Social Support Rate Scale. Univariate analysis，Spearman correlation were used to analysis the data，and the structural equation model was established. Results A total of 1118 pregnant women were enrolled，and only 202（18.70%） of whom met the criteria of physical activity. Pathway analysis showed that fear of falling，residential environment and social support had a direct impact on the physical activity during pregnancy with an effect of -0.168，0.326 and 0.381，respectively. Residential environment also affected physical activity through the independent mediating effect of fear of falling with an effect of 0.074，accounting for 18.50% of the total effects. Social support also affected physical activity through the independent mediating effect of residential environment and fear of falling，and the chain mediating effect of residential environment and fear of falling，accounting for 34.20% of the total effects. Conclusion The rate of pregnant women met the criteria of physical activity is low. Medical staff should pay attention to the impact of fear of falling，residential environment and social support on physical activity during pregnancy，and take targeted measures to increase the level of activity，so as to improve the level of physical activity during pregnancy.

Key words: Pregnant Women, Physical Activity, Fear of Falling, Residential Environment, Social Support, Pathway Analysis, Perinatal Care

王玉鹏, 徐萍, 冯素文. 影响孕妇孕期体力活动的环境因素及路径分析[J]. 中华护理杂志, 2023, 58(17): 2119-2125.

WANG Yupeng, XU Ping, FENG Suwen. Analysis of environmental factors and impact path of physical activity in pregnant women[J]. Chinese Journal of Nursing, 2023, 58(17): 2119-2125.

图/表 4

表1 调查对象的一般资料及孕期体力活动的单因素分析[名（百分比，%）]

Table 1 The general data of subjects and the results of univariate analysis of predictors for physical activity during pregnancy

表2 国际跌倒效能量表、居家跌倒风险筛查量表及社会支持评定量表得分（n=1 118，分，$\bar{x}±s$）

Table 2 Scores of Falls Efficacy Scale International， Home Falls and Accidents Screening Tool and Social Support Rate Scale（n=1 118，score，$\bar{x}±s$）

图1 影响孕妇孕期体力活动环境因素的结构方程模型

Figure 1 Structural equation model diagram of environmental factors affecting physical activity during pregnancy

表3 各变量对孕妇孕期体力活动达标的效应值

Table 3 The effect values of each variable on physical activity of pregnant women during pregnancy

参考文献 28

[1]	Bauer C, Graf C, Platschek AM, et al. Reasons,motivational factors,and perceived personal barriers to engagement in physical activity during pregnancy vary within the BMI classes:the prenatal prevention project Germany[J]. J Phys Act Health, 2018, 15(3):204-211. DOI URL
[2]	卢友敏, 李金芝. 孕妇体力活动现状及影响因素研究进展[J]. 护理学杂志, 2021, 36(9):110-113.
	Lu YM, Li JZ. Research progress on physical activity of pregnant women and its influencing factors[J]. J Nurs Sci, 2021, 36(9):110-113.
[3]	杨红梅, 邓永芳, 高玲玲. 孕妇运动水平与运动自我效能、运动知识的相关性研究[J]. 中国实用护理杂志, 2017, 33(23):1785-1788.
	Yang HM, Deng YF, Gao LL. Correlation of exercise,self-efficacy and knowledge among pregnant women[J]. Chin J Pract Nurs, 2017, 33(23):1785-1788.
[4]	龚晶晶, 邢丽莉. 孕妇孕期运动知识、态度及自我运动效能的调查研究[J]. 中华护理教育, 2019, 16(12):942-945.
	Gong JJ, Xing LL. A survey of attitude,knowledge and exercise self-efficacy of pregnant women[J]. Chin J Nurs Educ, 2019, 16(12):942-945.
[5]	陈欣. 基于健康信念模式孕妇身体活动影响因素的研究[D]. 长春: 吉林大学, 2020.
	Chen X. Determinants of physical activity among pregnant women using the health belief model[D]. Changchun: Jilin Uni-versity, 2020.
[6]	王文娜, 张振香, 林蓓蕾, 等. 环境因素对居家脑卒中患者影响质性研究的Meta整合[J]. 中华护理杂志, 2020, 55(2):281-287. DOI
	Wang WN, Zhang ZX, Lin BL, et al. The impact of environmental factors on stroke patients at home:a qualitative meta-synthesis[J]. Chin J Nurs, 2020, 55(2):281-287.
[7]	朱小烽, 马云, 陆跃. 孕期体力活动与健康促进:过去、现在与未来[J]. 体育科学, 2017, 37(8):69-80.
	Zhu XF, Ma Y, Lu Y. Physical activity and health promotion during pregnancy:the past,present and future[J]. China Sport Sci, 2017, 37(8):69-80.
[8]	王玉鹏, 冯素文, 胡小黎. 孕妇孕期活动量与跌倒恐惧的相关性及影响因素分析[J]. 护理学杂志, 2022, 37(8):72-75.
	Wang YP, Feng SW, Hu XL. Relationship between activity during pregnancy and fear of falling:the influencing factors[J]. J Nurs Sci, 2022, 37(8):72-75.
[9]	van Loon J, Frank L. Urban form relationships with youth phy-sical activity[J]. J Plan Lit, 2011, 26(3):280-308. DOI URL
[10]	Berkman LF, Glass T, Brissette I, et al. From social integration to health:Durkheim in the new millennium[J]. Soc Sci Med, 2000, 51(6):843-857. DOI PMID
[11]	Mottola MF, Davenport MH, Ruchat SM, et al. No. 367-2019 Canadian guideline for physical activity throughout pregnancy[J]. J D’obstetrique Gynecol Du Can, 2018, 40(11):1528-1537.
[12]	Chasan-Taber L, Schmidt MD, Roberts DE, et al. Development and validation of a Pregnancy Physical Activity Questionnaire[J]. Med Sci Sports Exerc, 2004, 36(10):1750-1760. DOI URL
[13]	张燕, 赵岳, 董胜雯, 等. 中文版孕期身体活动问卷信效度评定[J]. 中华护理杂志, 2013, 48(9):825-827.
	Zhang Y, Zhao Y, Dong SW, et al. Reliability and validity of the Chinese version of the Pregnancy Physical Activity Questionnaire(PPAQ)[J]. Chin J Nurs, 2013, 48(9):825-827.
[14]	Yardley L, Beyer N, Hauer K, et al. Development and initial validation of the Falls Efficacy Scale-International(FES-I)[J]. Age Ageing, 2005, 34(6):614-619. DOI PMID
[15]	郭启云, 郭沐洁, 张林, 等. 国际版跌倒效能量表汉化后信效度评价[J]. 中国全科医学, 2015, 18(35):4273-4276. DOI
	Guo QY, Guo MJ, Zhang L, et al. Evaluation of the reliability and validity of Chinese version of Falls Efficacy Scale[J]. Chin Gen Pract, 2015, 18(35):4273-4276.
[16]	MacKenzie L, Byles J, Higginbotham N. Designing the Home Falls and Accidents Screening Tool(HOME FAST):selecting the items[J]. Br J Occup Ther, 2000, 63(6):260-269. DOI URL
[17]	郭启云, 郭沐洁, 张林, 等. 居家跌倒风险筛查量表在中国社区老年人中的应用[J]. 中华护理杂志, 2015, 50(9):1128-1132.
	Guo QY, Guo MJ, Zhang L, et al. Application of the Chinese version of Home Falls and Accidents Screening Tool in aged dwelling in community in China[J]. Chin J Nurs, 2015, 50(9):1128-1132.
[18]	肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994, 4(2):98-100.
	Xiao SY. Theoretical basis and research application of Social Support Rating Scale[J]. J Clin Psychol Med, 1994, 4(2):98-100.
[19]	孙振球, 徐勇勇. 医学统计学[M]. 4版. 北京: 人民卫生出版社, 2014.
	Sun ZQ,Xu YY. Medical statistics[M]. 4th ed. Beijing: People’s Medical Publishing House, 2014.
[20]	Zhang Y, Dong SW, Zuo JH, et al. Physical activity level of urban pregnant women in Tianjin,China:a cross-sectional study[J]. PLoS One, 2014, 9(10):e109624. DOI URL
[21]	Aljehani MA, Alghamdi LF, Almehwari OB, et al. Exercise among pregnant females in maternity and children hospital in Jeddah,Saudi Arabia,2019:prevalence and barriers[J]. J Family Med Prim Care, 2021, 10(6):2394-2399. DOI PMID
[22]	Lethem J, Slade PD, Troup JD, et al. Outline of a Fear-Avoid-ance Model of exaggerated pain perception:I[J]. Behav Res Ther, 1983, 21(4):401-408. DOI PMID
[23]	王玉鹏, 胡小黎, 吴陆萍, 等. 孕妇跌倒恐惧现状及影响因素分析[J]. 中华护理教育, 2022, 19(10):950-955.
	Wang YP, Hu XL, Wu LP, et al. The status and influencing factors of fall fear in pregnant women[J]. Chin J Nurs Educ, 2022, 19(10):950-955.
[24]	王文花. 孕妇不同孕期跌倒发生现状及危险因素的调查研究[D]. 银川: 宁夏医科大学, 2019.
	Wang WH. Investigation and study on the current situation and risk factors of falls in pregnant women in different pregnancy periods[D]. Yinchuan: Ningxia Medical University, 2019.
[25]	朱小烽, 陈为玮, 陈强, 等. 城市女性孕期闲暇性体力活动与建成环境感知效应研究[J]. 浙江体育科学, 2018, 40(2):73-80.
	Zhu XF, Chen WW, Chen Q, et al. A study on urban women’s leisure-time physical activity and built environmental perception effects[J]. Zhejiang Sport Sci, 2018, 40(2):73-80.
[26]	李诗琪. 居住环境对人心理健康的影响研究:基于临床数据的实证分析[D]. 武汉: 华中科技大学, 2019.
	Li SQ. Study on the influence of living environment on peo-ple’s mental health-an empirical analysis based on clinical data[D]. Wuhan: Huazhong University of Science and Techno-logy, 2019.
[27]	Okafor UB, Goon DT. Applying the Ecological Model to understand pregnant women’s perspectives on the modifiable constraints to physical activity during pregnancy:a qualitative research study[J]. Medicine(Baltimore), 2020, 99(49):e23431.
[28]	向芝萱, 韩蓉蓉, 赵倩, 等. 锻炼社会支持量表的修订及其在孕妇人群中的信度效度检验[J]. 中国护理管理, 2022, 22(7):998-1002.
	Xiang ZX, Han RR, Zhao Q, et al. Adaptation and psychometric evaluation of the Social Support Scale for Exercise among pregnant women[J]. Chin Nurs Manag, 2022, 22(7):998-1002.