缺血性脑卒中患者健康行为决策现状及其影响因素分析

doi:10.3761/j.issn.0254-1769.2024.18.006

摘要/Abstract

摘要：

目的调查缺血性脑卒中患者健康行为决策现况并分析其影响因素。方法 2023年2月—5月，选取郑州市和安阳市某2所医院250例缺血性脑卒中患者作为调查对象。采用一般资料调查表、脑卒中患者行为决策评估量表、脑卒中患者复发风险感知评估量表、脑卒中康复自我效能量表进行问卷调查，采用多元线性回归分析缺血性脑卒中患者健康行为决策的影响因素。结果 229例缺血性脑卒中患者行为决策评估量表得分为（117.83±7.15）分。多元线性回归分析结果表明，职业状况、血糖达标、主要照顾者、目前症状数、康复自我效能及复发风险感知是缺血性脑卒中患者健康行为决策的影响因素（P<0.05）。结论缺血性脑卒中患者健康行为决策处于中等偏上水平，可针对不同特征患者进行个体化干预，促进患者健康行为决策水平的提升和健康行为的形成。

关键词: 缺血性脑卒中, 健康行为, 决策, 风险感知, 护理

Abstract:

Objective To investigate the current status of health behavioral decision-making in ischemic stroke patients and analyze its influencing factors. Methods Totally 250 ischemic stroke patients were selected from 2 hospitals in Zhengzhou and Anyang from February to May 2023. A general information questionnaire，Behavioral Decision-Making Scale for Stroke Patients，Recurrence Risk Perception Scale for Patients with Stroke，and Stroke Self-Efficacy Questionnaire were used to conduct the questionnaire survey. Results The Behavioral Decision-Making Scale for Stroke Patients score of 229 ischemic stroke patients was （117.83±7.15） scores. The results of multiple linear regression analysis showed that occupational status，glycemic compliance，primary caregiver，current symptoms，stroke self-efficacy，and recurrence risk perception were the influencing factors of health behavioral decision making in ischemic stroke patients（P<0.05）. Conclusion The health behavioral decision making of ischemic stroke patients is at an upper-middle level. Individualized interventions can be carried out for patients with different characteristics to promote the patients’ ability to behavior decision making and the formation of preventive behaviors.

Key words: Ischemic Stroke, Health Behavior, Decision Making, Risk Perception, Nursing Care

何福培, 林蓓蕾, 刘雪婷, 张振香, 王佳佳. 缺血性脑卒中患者健康行为决策现状及其影响因素分析[J]. 中华护理杂志, 2024, 59(18): 2222-2228.

HE Fupei, LIN Beilei, LIU Xueting, ZHANG Zhenxiang, WANG Jiajia. Current situation of the health behavioral decision making in ischemic stroke patients and its influencing factors analysis[J]. Chinese Journal of Nursing, 2024, 59(18): 2222-2228.

图/表 4

表1 缺血性脑卒中患者的一般资料及健康行为决策影响因素的单因素分析结果（n=229）

Table 1 The general demographic data and the univariate analysis of health behavioral decision-making in ischemic stroke patients（n=229）

表2 缺血性脑卒中患者健康行为决策与复发风险感知、康复自我效能的相关性分析（r值，n=229）

Table 2 Correlation between the BDMS for RRPS and SSEQ ischemic stroke patients（r value，n=229）

表3 分类变量赋值方式

Table 3 Assignment of categorical variables

表4 缺血性脑卒中患者健康行为决策的多元线性回归分析（n=229）

Table 4 Multiple regression analysis of predictors of health behavioral decision-making in ischemic stroke patients（n=229）

参考文献 28

[1]	GBD Stroke Collaborators. Global,regional,and national burden of stroke and its risk factors,1990-2019:a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10):795-820.
[2]	王陇德. 《中国脑卒中防治报告2021》概要[J]. 中国脑血管病杂志, 2023, 20(11):783-793.
	Wang LD. Brief report on stroke prevention and treatment in China,2021[J]. Chin J Cerebrovasc Dis, 2023, 20(11):783-793.
[3]	Yusuf S, Joseph P, Rangarajan S, et al. Modifiable risk factors,cardiovascular disease,and mortality in 155 722 individuals from 21 high-income,middle-income,and low-income countries (PURE):a prospective cohort study[J]. Lancet, 2020, 395(10226):795-808.
[4]	Bam K, Olaiya MT, Cadilhac DA, et al. Enhancing primary stroke prevention:a combination approach[J]. Lancet Public Health, 2022, 7(8):e721-e724.
[5]	林蓓蕾, 张振香, 郭云飞, 等. 脑卒中患者复发风险感知评估量表的编制及信效度检验[J]. 中华护理杂志, 2021, 56(11):1666-1671. DOI
	Lin BL, Zhang ZX, Guo YF, et al. Development and psychometric test of Recurrence Risk Perception Scale for Patients with Stroke[J]. Chin J Nurs, 2021, 56(11):1666-1671. DOI
[6]	Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors[J]. Am Psychol, 1992, 47(9):1102-1114. DOI PMID
[7]	王崇梁, 曹锦丹, 王珅, 等. 信息框架对健康风险认知和行为改变决策的影响[J]. 图书情报工作, 2020, 64(4):68-77. DOI
	Wang CL, Cao JD, Wang S, et al. Research on the influence of message frame on health risk perception and decision-making of health behavior change[J]. Libr Inf Serv, 2020, 64(4):68-77.
[8]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9):666-682.
	Cerebrovascular Disease Group of the Neurological Branch of the Chinese Medical Association, Chinese Medical Association, Neurological Branch of the Chinese Medical Association. Interpretation of “Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018”[J]. Chin J Contemp Neurol Neurosurg, 2018, 51(9):666-682.
[9]	王彤, 姚应水. 医学统计学[M]. 北京: 人民卫生出版社, 2020.
	Wang T, Yao YS. Medical statistics[M]. Beijing: People’s Medical Publishing House, 2020.
[10]	林蓓蕾. 脑卒中患者复发风险感知与行为决策模型构建及应用研究[D]. 郑州: 郑州大学, 2022.
	Lin BL. Study on the construction and application of recurrence risk perception and behavior decision model for stroke patients[D]. Zhengzhou: Zhengzhou University, 2022.
[11]	林蓓蕾, 张振香, 梅永霞. 脑卒中患者行为决策评估量表的编制及信效度检验[J]. 中华护理杂志, 2022, 57(13):1605-1610. DOI
	Lin BL, Zhang ZX, Mei YX, et al. Development and psychometric test of the Behavioral Decision-making Scale for Stroke Patients[J]. Chin J Nurs, 2022, 57(13):1605-1610. DOI
[12]	Jones F, Partridge C, Reid F. The Stroke Self-Efficacy Questionnaire:measuring individual confidence in functional performance after stroke[J]. J Clin Nurs, 2008, 17(7B):244-252.
[13]	李鸿艳, 方亮, 毕瑞雪, 等. 中文版脑卒中康复自我效能量表的信效度研究[J]. 中华护理杂志, 2015, 50(7):790-794.
	Li HY, Fang L, Bi RX, et al. The reliability and validity of the Chinese version of Stroke Self-Efficacy Questionnaire[J]. Chin J Nurs, 2015, 50(7):790-794.
[14]	李月, 薛云珍. 恐惧诉求在健康传播中的应用与展望[J]. 中国健康教育, 2019, 35(11):1033-1035.
	Li Y, Xue YZ. The application and prospect of fear appeal in health communication[J]. Chin J Health Educ, 2019, 35(11):1033-1035.
[15]	吴巧娣, 周静, 王硕. 康复自我效能在老年脑卒中康复期患者卒中后抑郁与卒中后疲劳间的中介效应[J]. 护理学报, 2021, 28(17):64-69.
	Wu QD, Zhou J, Wang S. Mediating effect of rehabilitation self-efficacy on post-stroke depression and post-stroke fatigue of elderly stroke patients in rehabilitation period[J]. J Nurs(China), 2021, 28(17):64-69.
[16]	江莲, 甘秀妮, 熊桂清, 等. 2型糖尿病患者饮食决策平衡与大五人格特征的相关性研究[J]. 解放军护理杂志, 2021, 38(1):17-20,36.
	Jiang L, Gan XN, Xiong GQ, et al. Research on the correlation between diet decision-making balance and big five personality traits among patients with Type 2 diabetes mellitus[J]. Nurs J Chin PLA, 2021, 38(1):17-20,36.
[17]	邹红, 栾炳江, 彭争呈, 等. 退休是否会改变城镇老年人的健康行为?基于烟酒消费的断点回归经验证据[J]. 南开经济研究, 2018(6):112-128.
	Zou H, Luan BJ, Peng ZC, et al. Does retirement change the health behavior of urban older adults evidence based on regression discontinuity design of alcohol and tobacco consumption[J]. Nankai Econ Stud, 2018(6):112-128.
[18]	李骁天, 吴金昊. 退休对我国居民体育锻炼参与的影响:基于断点回归的实证研究[J]. 北京体育大学学报, 2022, 45(8):72-84.
	Li XT, Wu JH. The effect of retirement on Chinese residents’ participation in physical activities:an empirical study based on regression discontinuity design[J]. J Beijing Sport Univ, 2022, 45(8):72-84.
[19]	Feng J, Li Q, Smith JP. Retirement effect on health status and health behaviors in urban China[J]. World Dev, 2020,126:104702.
[20]	Huang NC, Kuo PH, Hsu WC, et al. Retirement planning and types of healthy lifestyle after retirement:a nationwide survey in Taiwan[J]. Health Promot Int, 2023, 38(3):daad044.
[21]	Polsook R, Aungsuroch Y, Thontham A. The effect of self-management intervention among type 2 diabetes:a systematic review and meta-analysis[J]. Worldviews Evid Based Nurs, 2023, 21(1):59-67.
[22]	Jing J, Pan YS, Zhao XQ, et al. Insulin resistance and prognosis of nondiabetic patients with ischemic stroke:the ACROSS-China study(abnormal glucose regulation in patients with acute stroke across China)[J]. Stroke, 2017, 48(4):887-893. DOI PMID
[23]	Pearce G, Pinnock H, Epiphaniou E, et al. Experiences of self-management support following a stroke:a meta-review of qualitative systematic reviews[J]. PLoS One, 2015, 10(12):e0141803.
[24]	唐宝丽, 吕玉华, 王线妮, 等. 首发缺血性脑卒中患者感知复发风险现况及影响因素研究[J]. 中华护理杂志, 2023, 58(3):289-295. DOI
	Tang BL, Lü YH, Wang XN, et al. Analysis of status and influencing factors of recurrence risk perception in first-episode ischemic stroke patients[J]. Chin J Nurs, 2023, 58(3):289-295. DOI
[25]	Sheeran P, Maki A, Montanaro E, et al. The impact of changing attitudes,norms,and self-efficacy on health-related intentions and behavior:a meta-analysis[J]. Health Psychol, 2016, 35(11):1178-1188.
[26]	Bandura A. Self-efficacy:toward a unifying theory of behavioral change[J]. Psychol Rev, 1977, 84(2):191-215. DOI PMID
[27]	Riedinger C, Campbell J, Klein WMP, et al. Analysis of the components of cancer risk perception and links with intention and behaviour:a UK-based study[J]. PLoS One, 2022, 17(1):e0262197.
[28]	郭园丽, 杨彩侠, 郭丽娜, 等. 急性缺血性脑卒中溶栓代理决策者的决策困境及影响因素[J]. 中华护理杂志, 2023, 58(1):23-30. DOI
	Guo YL, Yang CX, Guo LN, et al. The decisional conflict and influence factors of proxies of patients with acute ischemic stroke in thrombolysis decision-making[J]. Chin J Nurs, 2023, 58(1):23-30. DOI