炎症性肠病患者自我管理行为的影响因素分析

doi:10.3761/j.issn.0254-1769.2021.04.012

摘要/Abstract

摘要：

目的探讨炎症性肠病患者心理韧性、疾病接受度及社会支持对其自我管理行为的影响。方法采用便利抽样法选取2019年12月—2020年8月于南京市某三级甲等医院就诊的200例炎症性肠病患者,采用一般资料调查表、炎症性肠病自我管理行为量表、炎症性肠病心理韧性量表、疾病接受度量表、社会支持量表进行问卷调查,应用AMOS 26.0软件建立结构方程模型。结果炎症性肠病患者自我管理行为得分为（139.00±21.13）分。患者心理韧性、疾病接受度对自我管理行为有直接正向效应,效应值分别为0.294、0.453（P<0.05）,心理韧性对自我管理行为有间接效应,效应值为0.371（P<0.001）;社会支持通过心理韧性和（或）疾病接受度间接作用于自我管理行为,总效应值为0.158（P<0.05）。心理韧性、疾病接受度和社会支持可解释自我管理行为总变异的50.1%。结论炎症性肠病患者自我管理行为处于中等水平。心理韧性、疾病接受度和社会支持对炎症性肠病患者自我管理行为具有积极影响,护理人员可通过积极心理干预、帮助患者设定阶段性成就目标及获取其家属和同事的积极支持等方法改善患者自我管理行为。

关键词: 炎症性肠病, 自我管理, 疾病接受度, 心理韧性, 社会支持, 结构方程模型, 护理

Abstract:

Objective To explore the effects of resilience,acceptance of illness and social support on self-management behavior among patients with inflammatory bowel disease（IBD）. Methods By using the convenient sampling method,200 patients with IBD were selected from December 2019 to August 2020 in a tertiary hospital in Nanjing. General information questionnaire,social support rating scale,acceptance of illness scale,resilience scale for IBD,self-management behavior scale for IBD were used to conduct the investigation. We established the structural equation model by AMOS 26.0 software. Results The score of self-management behavior of patients with IBD was（139.00±21.13）. Patients’ resilience and acceptance of illness had direct positive effects on self-management behavior,and the effect values were 0.294 and 0.453 respectively（all P<0.05）. Patients’ resilience has indirect positive effects on self-management behavior,with effect values of 0.371（P<0.001）. Social support could affect self-management behavior indirectly through resilience and（or） acceptance of illness,and the total effect value was 0.158（P<0.05）. Resilience,acceptance of illness and social support can explain 50.1% of the total variation of self-management behavior. Conclusion The self-management behavior of patients with IBD was at a moderate level. Resilience,acceptance of illness and social support of patients with IBD had positive impacts on their self-management behavior. Nurses can promote patients’ self-management behavior by positive psychological interventions,helping patients set phased goals,and obtaining positive support from their families and colleagues.

Key words: Inflammatory Bowel Disease, Self-Management, Acceptance of Illness, Resilience, Social Support, Structural Equation Model, Nursing Care

周美景,罗丹,林征,张红杰,卞秋桂,刘梅红,任树荣,顾子君,孙彩云,王咪. 炎症性肠病患者自我管理行为的影响因素分析[J]. 中华护理杂志, 2021, 56(4): 550-555.

ZHOU Meijing,LUO Dan,LIN Zheng,ZHANG Hongjie,BIAN Qiugui,LIU Meihong,REN Shurong,GU Zijun,SUN Caiyun,WANG Mi. Analysis of influencing factors of self-management behavior in patients with inflammatory bowel disease[J]. Chinese Journal of Nursing, 2021, 56(4): 550-555.

图/表 4

表1 研究对象一般资料（n=200）

Table 1 General information of participants（n=200）

表2 炎症性肠病患者自我管理行为量表各维度得分情况（n=200）

Table 2 The scores of each dimension of self-management behavior of patients with inflammatory bowel disease（n=200）

表3 炎症性肠病患者社会支持、心理韧性、疾病接受度及自我管理行为的相关性分析（r值）

Table 3 Correlation analysis of resilience,acceptance of illness,social support and self-management behavior in patients with inflammatory bowel disease（r value）

表4 炎症性肠病患者心理韧性、疾病接受度及社会支持对自我管理行为影响的路径分析

Table 4 Analysis of the standard path of resilience, acceptance of illness and social support on self-management behavior

参考文献 22

[1]	吴开春, 梁洁, 冉志华, 等. 炎症性肠病诊断与治疗的共识意见(2018年,北京)[J]. 中华消化杂志, 2018,38(5):292-311.
	Wu KC, Liang J, Ran ZH, et al. Chinese consensus on diagnosis and treatment of inflammatory bowel disease(Beijing,2018)[J]. Chin J Dig, 2018,38(5):292-311.
[2]	Kaplan GG. The global burden of IBD:from 2015 to 2025[J]. Nat Rev Gastroenterol Hepatol, 2015,12(12):720-727.
[3]	Juan LS, Correa G, Fuxman C, et al. Treatment adherence in inflammatory bowel disease patients from Argentina:a multicenter study[J]. Gastroenterol Res Pract, 2020,2020:4060648.
[4]	Tew GA, Jones K, Mikocka-Walus A. Physical activity habits,limitations,and predictors in people with inflammatory bowel disease:a large cross-sectional online survey[J]. Inflamm Bowel Dis, 2016,22(12):2933-2942. URL PMID
[5]	罗丹, 林征, 卞秋桂, 等. 炎症性肠病患者自我管理体验质性研究的系统评价[J]. 中华护理杂志, 2018,53(1):41-47.
	Luo D, Lin Z, Bian QG, et al. Self-management experience of patients with inflammatory bowel disease:a systematic review of qualitative studies[J]. Chin J Nurs, 2018,53(1):41-47.
[6]	夏婷婷. 永久性结肠造口患者造口压力对自我管理影响的路径分析[D]. 青岛:青岛大学, 2019.
	Xia TT. The path of stoma pressure on self-management in permanent colostomy patients[D]. Qingdao:Qingdao University, 2019.
[7]	Qiu C, Zhang XN, Zang XY, et al. Acceptance of illness mediate the effects of health literacy on self-management behaviour[J]. Eur J Cardiovasc Nurs, 2020,19(5):411-420.
[8]	邱皓政, 林碧芳. 结构方程模型的原理与应用[M]. 北京: 中国轻工业出版社, 2009.
	Qiu HZ, Lin BF. The principle and application of structural equation model[M]. Beijing: China Light Industry Press, 2009.
[9]	尚星辰, 林征, 卞秋桂, 等. 炎症性肠病病人自我管理行为量表的编制及信效度检验[J]. 护理研究, 2019,33(14):2374-2380.
	Shang XC, Lin Z, Bian QG, et al. Development and reliability and validity test of Self-Management Behavior Scale for Patients with Inflammatory Bowel Disease[J]. Chin Nurs Res, 2019,33(14):2374-2380.
[10]	穆欣, 李娟, 刘瑞荣, 等. 首发脑卒中患者自我管理行为及影响因素的研究[J]. 中华护理杂志, 2016,51(3):289-293.
	Mu X, Li J, Liu RR, et al. The current status and influencing factors of self-management behaviors in patients with first stroke[J]. Chin J Nurs, 2016,51(3):289-293.
[11]	罗丹. 炎症性肠病心理韧性量表的编制及信效度检验[D]. 南京:南京医科大学, 2018.
	Luo D. The development and psychometric assessment of the Strength and Resilience Scale for Inflammatory Bowel Disease[D]. Nanjing:Nanjing Medical University, 2018.
[12]	Felton BJ, Revenson TA, Hinrichsen GA. Stress and coping in the explanation of psychological adjustment among chronically ill adults[J]. Soc Sci Med, 1984,18(10):889-898.
[13]	赵雯雯. 中文版疾病接受度量表的信效度评价[J]. 中华现代护理杂志, 2018,24(22):2652-2655.
	Zhao WW. Evaluation of reliability and validity of the Chinese version of Acceptance Illness Scale[J]. Chin J Mod Nurs, 2018,24(22):2652-2655.
[14]	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. The theoretical basis and research application of Social Support Rating Scale[J]. J Clin Psychol Med, 1994,4(2):98-100.
[15]	Podsakoff PM, MacKenzie SB, Lee JY, et al. Common method biases in behavioral research:a critical review of the literature and recommended remedies[J]. J Appl Psychol, 2003,88(5):879-903. DOI URL PMID
[16]	罗丹, 林征, 卞秋桂, 等. 炎症性肠病患者感知病耻感现状及其对生活质量、服药依从性和心理状态的影响[J]. 中华护理杂志, 2018,53(9):1078-1083.
	Luo D, Lin Z, Bian QG, et al. Perceived stigma in patients with inflammatory bowel disease and its effect on psychology,medication compliance and quality of life[J]. Chin J Nurs, 2018,53(9):1078-1083.
[17]	曾星, 叶向红, 孙琳, 等. 克罗恩病患者出院后体力活动状况、限制、需求及影响因素[J]. 解放军护理杂志, 2019,36(10):1-4.
	Zeng X, Ye XH, Sun L, et al. Influencing factors of physical activity,restrictions,demands in patients with Crohn’s disease[J]. Nurs J Chin PLA, 2019,36(10):1-4.
[18]	Pasek M, Dębska G, Wojtyna E. Perceived social support and the sense of coherence in patient-caregiver dyad versus accep-tance of illness in cancer patients [J]. J Clin Nurs, 2017,26(23/24):4985-4993.
[19]	Keany KC, Glueckauf RL. Disability and value change:an over-view and reanalysis of acceptance of loss theory[J]. Rehabil Psychol, 1993,38(3):199-210.
[20]	刘玮楚, 王攀, 罗业涛, 等. 基于健康信念模式的冠心病患者自我管理行为模型构建及实证研究[J]. 第三军医大学学报, 2020,42(9):953-963.
	Liu WC, Wang P, Luo YT, et al. Self-management behaviors of patients with coronary atherosclerotic heart disease based on health belief model:model building and empirical study[J]. J Third Mil Med Univ, 2020,42(9):953-963.
[21]	Lee HY, Oh J, Kawachi I, et al. Positive and negative social support and depressive symptoms according to economic status among adults in Korea:cross-sectional results from the Health Examinees-Gem Study[J]. BMJ Open, 2019,9(4):e023036. URL PMID
[22]	Kumpfer KL, Glantz MD, Johnson JL. Resilience and development:positive life adaptations[M]. New York:Kluwer Academic, 1999.