住院老年慢性共病患者健康积极指数现状及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.14.009

摘要/Abstract

摘要：

目的探讨并分析住院老年慢性共病患者健康积极指数现状及其影响因素，为临床制订干预措施提供参考。方法采用便利抽样法，选取2024年7月—12月合肥市某三级甲等医院住院的332例老年慢性共病患者为调查对象，采用一般资料调查表、公众健康积极指数量表、慢性病病人健康素养量表、老年人自我忽视量表以及领悟社会支持量表进行调查，采用单因素分析及多元线性回归分析住院老年慢性共病患者健康积极指数的影响因素。结果共发放332份问卷，回收有效问卷325例。住院老年慢性共病患者健康积极指数量表得分为（61.68±15.12）分。多元线性回归结果显示，受教育程度、家庭人均月收入、患慢性病数量、服药频率、自理能力、健康素养、领悟社会支持以及自我忽视是住院老年慢性共病患者健康积极指数的影响因素（P<0.05），可以解释59.9%的变异度。结论住院老年慢性共病患者健康积极指数处于偏低水平，未来可结合相关影响因素制订精准、系统的积极度干预措施，以推动患者由被动健康转变为主动健康，进而促进积极老龄化。

关键词: 老年人, 慢性共病, 公众健康积极指数, 问卷调查, 护理

Abstract:

Objective To explore and analyze the current situation of consumer health activation index and its influencing factors in hospitalized elderly patients with multiple chronic conditions，and to provide reference basis for clinical intervention. Methods Convenience sampling method was used to select 332 hospitalized elderly patients with multiple chronic conditions from a tertiary hospital in Hefei City from July to December 2024 as the study subjects，and general information questionnaire，Consumer Health Activation Index，Health Literacy Management Scale，Scale of the Elderly Self-neglcet（Rural），and Perceived Social Support Scale were used to investigate the current situation of consumer health activation index of hospitalized elderly patients with multiple chronic conditions. Univariate analysis and multiple linear regression analysis were employed to explore the influencing factors of consumer health activation index in patients with multiple chronic conditions. Results A total of 332 questionnaires were distributed，and 325 valid questionnaires were retrieved. The score of the consumer health activation index of hospitalized elderly patients with multiple chronic conditions was（61.68±15.12）. The results of multiple linear regression showed that literacy，average monthly household income，number of chronic diseases，medication frequency，self-care ability，health literacy management，perceived social support and self-neglect were the influencing factors for the positivity of hospitalized elderly patients with multiple chronic conditions（P<0.05），which could explain 59.9% of the variance of the consumer health activation index of hospitalized elderly patients with multiple chronic conditions. Conclusion The consumer health activation index of hospitalized elderly patients with multiple chronic conditions is at a low level. In the future，precise and systematic intervention measures for enhancing positive health status can be formulated by taking into account relevant influencing factors，in order to promote the transformation of patients from passive health to active health，and thereby facilitating positive aging.

Key words: Aged, Multiple Chronic Conditions, Consumer Health Activation Index, Questionnaire, Nursing Care

赵云凤, 刘芮, 吴敏, 许采颉, 章文敏, 王悦, 潘爱红. 住院老年慢性共病患者健康积极指数现状及影响因素研究[J]. 中华护理杂志, 2025, 60(14): 1716-1722.

ZHAO Yunfeng, LIU Rui, WU Min, XU Caijie, ZHANG Wenmin, WANG Yue, PAN Aihong. Research on the current status and influencing factors of consumer health activation index in hospitalized elderly patients with multiple chronic conditions[J]. Chinese Journal of Nursing, 2025, 60(14): 1716-1722.

图/表 2

表1 住院老年慢性共病患者一般资料及健康积极指数得分的单因素分析[n=325，分（$\bar{x} \pm s$）]

Table 1 Univariate analysis of factors affecting the consumer health activation index of hospitalized elderly patients with multiple chronic conditions[n=325，score（$\bar{x} \pm s$）]

表2 住院老年慢性共病患者健康积极指数的多元线性回归分析（n=325）

Table 2 Multiple linear regression analysis of the consumer health activation index of hospitalized elderly patients with multiple chronic conditions（n=325）

参考文献 24

[1]	王萍萍. 人口总量降幅收窄人口素质持续提升[N]. 中国信息报,2025-01-22.
	Wang PP. The total population has decreased,and high-quality development of the population has achieved effect[N]. China Information News,2025-01-22.
[2]	孙柳, 王莹, 梁嘉贵, 等. 老年人应对慢性病共病体验的Meta整合[J]. 中华护理杂志, 2022, 57(6):748-755. DOI
	Sun L, Wang Y, Liang JG, et al. Experience of the elderly coping with multiple chronic conditions:a qualitative meta-synthesis[J]. Chin J Nurs, 2022, 57(6):748-755.
[3]	Zhong Y, Qin G, Xi H, et al. Prevalence, patterns of multimorbidity and associations with health care utilization among middle-aged and older people in China[J]. BMC Public Health, 2023, 23(1):537. DOI PMID
[4]	Dugravot A, Fayosse A, Dumurgier J, et al. Social inequalities in multimorbidity,frailty,disability, and transitions to mortality:a 24-year follow-up of the Whitehall Ⅱ cohort study[J]. Lancet Public Health, 2020, 5(1):e42-e50.
[5]	Frank P, David Batty G, Pentti J, et al. Association between depression and physical conditions requiring hospitalization[J]. JAMA Psychiatry, 2023, 80(7):690-699. DOI PMID
[6]	Wolf MS, Smith SG, Pandit AU, et al. Development and validation of the consumer health activation index[J]. Med Decis Making, 2018, 38(3):334-343. DOI PMID
[7]	Haering C, Heyne S, Mehnert-Theuerkauf A, et al. The role of patient activation in mediating the effects of health literacy level on quality of life among patients with gastrointestinal cancers[J]. Sci Rep, 2025, 15(1):7295.
[8]	张妍欣, 杨丽, 李家燕, 等. 鼻咽癌患者同步放化疗后自我管理积极度现状及影响因素分析[J]. 中华护理杂志, 2022, 57(15):1853-1859. DOI
	Zhang YX, Yang L, Li JY, et al. Analysis on the current situation and influencing factors of the self-management positivity of patients in the recovery period after simultaneous radiotherapy for nasopharyngeal carcinoma[J]. Chin J Nurs, 2022, 57(15):1853-1859. DOI
[9]	吴蕾, 张力, 彭夏培, 等. 首发脑卒中患者积极度现状及影响因素[J]. 护理学杂志, 2020, 35(15):15-17,68.
	Wu L, Zhang L, Peng XP, et al. Activation and its influencing factors among patients with first stroke[J]. J Nurs Sci, 2020, 35(15):15-17,68.
[10]	Charlson M, Szatrowski TP, Peterson J, et al. Validation of a Combined Comorbidity Index[J]. J Clin Epidemiol, 1994, 47(11):1245-1251 DOI PMID
[11]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[12]	查慧贤, 严红云, 刘扣英, 等. 公众健康积极指数量表汉化及在慢性病患者中的信效度研究[J]. 护理学杂志, 2023, 38(2):104-107.
	Zha HX, Yan HY, Liu KY, et al. Translation and validation of the Consumer Health Activation Index in patients with chronic diseases[J]. J Nurs Sci, 2023, 38(2):104-107.
[13]	Jordan JE, Buchbinder R, Osborne RH. Conceptualising health literacy from the patient perspective[J]. Patient Educ Couns, 2010, 79(1):36-42. DOI PMID
[14]	孙浩林. 慢性病病人健康素养量表的研究及其初步应用[D]. 上海: 复旦大学, 2012.
	Sun HL. Research and preliminary application of Health Literacy Scale for Patients with Chronic Diseases[D]. Shanghai: Fudan University, 2012.
[15]	赵媛媛. 农村老年人自我忽视的评定、影响因素及其对生活质量影响的研究[D]. 合肥: 安徽医科大学, 2017.
	Zhao YY. A study on the evaluation,influencing factors and its influence on the quality of life of the elderly in rural areas[D]. Hefei: Anhui Medical University, 2017.
[16]	Zimet GD, Powell SS, Farley GK, et al. Psychometric characteristics of the multidimensional scale of Perceived Social Support[J]. J Pers Assess, 1990, 55(3/4):610-617.
[17]	姜乾金. 领悟社会支持量表[J]. 中国行为医学科学, 2001, 10(10):41-43.
	Jiang QJ. Perceived Social Support Scale[J]. Chin J Behav Med Sci, 2001, 10(10):41-43.
[18]	杨侠, 于卫华, 任影, 等. 社区老年慢性病病人积极度与心理困扰的相关性[J]. 护理研究, 2024, 38(24):4365-4370.
	Yang X, Yu WH, Ren Y, et al. Correlation between positive degree and psychological distress of elderly chronic disease patients in communities[J]. Chin Nurs Res, 2024, 38(24):4365-4370.
[19]	Yadav UN, Lloyd J, Hosseinzadeh H, et al. Levels and determinants of health literacy and patient activation among multi-morbid COPD people in rural Nepal:findings from a cross-sectional study[J]. PLoS One, 2020, 15(5):e0233488.
[20]	Lunardi LE, Le Leu RK, Matricciani LA, et al. Patient activation in advanced chronic kidney disease:a cross-sectional study[J]. J Nephrol, 2024, 37(2):343-352. DOI PMID
[21]	Lee JW, Li JX, Szanton SL, et al. Higher patient activation is associated with lower odds of functional limitation in older adults with chronic diseases[J]. Geriatr Nurs, 2025,61:157-161.
[22]	骆雅萍, 于淑娟, 朱苗苗, 等. 社区老年糖尿病患者自我忽视的诠释性现象学研究[J]. 中华护理杂志, 2024, 59(2):203-209. DOI
	Luo YP, Yu SJ, Zhu MM, et al. Self-neglect in elderly diabetic patients in the community:an interpretive phenomenological study[J]. Chin J Nurs, 2024, 59(2):203-209.
[23]	周小莉, 钱嘉璐, 吴孟玮, 等. 基于认知行为疗法的护理干预在胎儿异常引产产妇中的应用研究[J]. 中华护理杂志, 2023, 58(14):1676-1682. DOI
	Zhou XL, Qian JL, Wu MW, et al. Effect of Internet-based Cognitive Behavior Therapy in women with abnormal fetal termination[J]. Chin J Nurs, 2023, 58(14):1676-1682. DOI
[24]	Geerlings AD, Kapelle WM, Sederel CJ, et al. Caregiver burden in Parkinson’s disease:a mixed-methods study[J]. BMC Med, 2023, 21(1):247. DOI PMID