乳腺癌患者一级亲属健康行为改变模型构建的研究

doi:10.3761/j.issn.0254-1769.2023.16.002

摘要/Abstract

摘要：

目的探索乳腺癌患者一级亲属健康行为改变，为该人群的健康促进和疾病预防提供参考。方法采用个案研究法，于2020年1月—2021年7月选择21名在行为改变上存在较大差异的乳腺癌患者一级亲属为个案，基于访谈、文件和观察法收集资料，通过个案研究分析策略和主题分析法分析资料。结果乳腺癌患者一级亲属的健康行为改变包括“得心应手型”、“潜移默化型”、“有心无力型”、“依然故我型”4种类型，影响行为改变的因素包括个人限制、暴露因素、不利环境、应对能力、社会支持、关键事件6类。根据上述结果提出6个相关命题假设，构建了乳腺癌患者一级亲属健康行为改变模型。结论乳腺癌患者一级亲属的健康行为受较多因素影响，其健康行为改变模型提示医护人员为乳腺癌患者一级亲属提供支持时可从影响行为改变的因素着手，增强有利因素，减少不利因素，促进健康行为往“得心应手”和“潜移默化”方向改变，以降低乳腺癌患病风险。

关键词: 乳腺肿瘤, 家族史, 一级亲属, 健康行为, 个案研究, 护理

Abstract:

Objective To explore the health behavior changes in first-degree relatives（FDRs） of breast cancer（BC） survivors. Methods A multiple embedded case study was adopted，and a total of 21 FDRs of BC survivors were recruited by purpose sampling between January 2020 and July 2021. Data were collected through individual interviews，original documents，and observation. Then，thematic analysis was performed based on case study analysis strategies. Results Health behavior change types included “with intention and condition”，“no intention，with condition”，“with intention，no condition”，and “no intention and condition”. Meanwhile，there were 6 influencing factors，including personal restrictions，exposure，adverse circumstances，coping ability，endorsement from social network，and special events. Based on behavior change types and influence factors，6 hypotheses were drawn and a model of FDRs’ behavior changes for coping with BC risk was developed. Conclusion Healthcare professionals should design targeted interventions based on FDRs’ individual circumstances and help them tilt the model scale to the right by increasing facilitators，reducing barriers，strengthening special events，and improving coping ability，which will ultimately lead to the occurrence of protective behaviors and a reduced risk of BC.

Key words: Breast Neoplasms, Family History, First-Degree Relative, Health Behavior, Case Study, Nursing Care

陈少华, 刘均娥, 郭冬梅, 苏娅丽, 刘宇. 乳腺癌患者一级亲属健康行为改变模型构建的研究[J]. 中华护理杂志, 2023, 58(16): 1932-1939.

CHEN Shaohua, LIU Jun’e, GUO Dongmei, SU Yali, LIU Yu. Study on the theoretical framework of health behavior changes in first-degree relatives of breast cancer survivors[J]. Chinese Journal of Nursing, 2023, 58(16): 1932-1939.

图/表 6

图1 开放式研究框架

Figure 1 The open research framework

表1 访谈提纲

Table 1 Semi-structured question guide for the interview

表2 乳腺癌患者及一级亲属的基本信息

Table 2 Characteristics of breast cancer survivors and first-degree relatives

图2 乳腺癌患者一级亲属行为改变影响因素的聚类分析

Figure 2 Cluster analysis of influencing factors of behavior change of health behavior changes in first-degree relatives of breast cancer survivors

表3 乳腺癌患者一级亲属行为改变的命题、关键变量以及变量间关系

Table 3 Propositions, key variables, and relationships between variables of health behavior changes in first-degree relatives of breast cancer survivors

图3 乳腺癌患者一级亲属健康行为改变模型

Figure 3 The model about health-related behavior changes among first-degree relatives of breast cancer survivors

参考文献 32

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
[2]	Global Burden of Disease Cancer Collaboration. Global,regional,and national cancer incidence,mortality,years of life lost,years lived with disability,and disability-adjusted life-years for 29 cancer groups,1990 to 2017:a systematic analysis for the global burden of disease study[J]. JAMA Oncol, 2019, 5(12):1749-1768. DOI URL
[3]	Rudolph A, Chang-Claude J, Schmidt MK. Gene-environment interaction and risk of breast cancer[J]. Br J Cancer, 2016, 114(2):125-133. DOI
[4]	Albright FS, Kohlmann W, Neumayer L, et al. Population-based relative risks for specific family history constellations of breast cancer[J]. Cancer Cause Control, 2019, 30(6):581-590. DOI PMID
[5]	Brewer HR, Jones ME, Schoemaker MJ, et al. Family history and risk of breast cancer:an analysis accounting for family structure[J]. Breast Cancer Res Tr, 2017, 165(1):193-200. DOI URL
[6]	Bevers TB, Ward JH, Arun BK, et al. Breast cancer risk reduction[J]. J Natl Compr Canc Netw, 2015, 13(7):880-915. DOI URL
[7]	Lofterød T, Frydenberg H, Flote V, et al. Exploring the effects of lifestyle on breast cancer risk,age at diagnosis,and survival:the EBBA-Life study[J]. Breast Cancer Res Tr, 2020, 182(1):215-227. DOI PMID
[8]	Bertoni N, de Souza MC, Crocamo S, et al. Is a family history of the breast cancer related to women's cancer prevention behaviors?[J]. Int J Behav Med, 2019, 26(1):85-90. DOI PMID
[9]	Erdoğan E, Tuzcu A. Comparison of mammography behaviors,health beliefs,and fear levels of women with and without familial breast cancer history[J]. Women Health, 2020, 60(7):776-791. DOI PMID
[10]	Yin RK. Case study research:design and methods[M]. 5th ed. Thousand Oak, CA: Sage Publications, 2014.
[11]	Eisenhardt K. Building theories from case study research[J]. Acad Manage Rev, 1989, 14(4):532-550. DOI URL
[12]	王宁. 个案研究的代表性问题与抽样逻辑[J]. 甘肃社会科学, 2007(5):1-4.
	Wang N. Representative problem and sampling logic of case study[J]. Gansu Soc Sci, 2007(5):1-4.
[13]	Bandura A. Social foundations of thought and action:a social cognitive theory[J]. J Appl Psychol, 1986, 12(1):169. DOI URL
[14]	Ajzen I. The theory of planned behavior[J]. Organ Behav Hum Decis Process, 1991, 50:179-211. DOI URL
[15]	Cummings KM, Jette AM, Rosenstock IM. Construct validation of the health belief model[J]. Health Educ Monogr, 1978, 6:394-405. DOI PMID
[16]	Steven PD, Rogers RW. Protection motivation theory and preventive health:beyond the health belief model[J]. Health Educ Res, 1986, 3:153-161. DOI URL
[17]	Prochaska JO, Velicer WF. The transtheoretical model of health behavior change[J]. Am J Health Promot, 1997, 12:38-48. DOI PMID
[18]	陈向明, 朱晓阳, 赵旭东. 社会科学研究:方法评论[M]. 重庆: 重庆大学出版社, 2006:169-172.
	Chen XM, Zhu XY, Zhao XD. Social science research:methodo-logical review[M]. Chongqing: Chongqing University Press, 2006: 169-172.
[19]	Baun V, Clarke V. Using thematic analysis in psychology[J]. Qual Res Psychol, 2006,3,77-101.
[20]	陈晓萍, 徐淑英, 樊景立. 组织与管理研究的实证方法[M]. 北京: 北京大学出版社, 2008.
	Chen XP, Xu SY, Fan JL. Empirical methods in organization and management research[M]. Beijing: Peking University Press, 2008.
[21]	Paalosalo-Harris K, Skirton H. Mixed method systematic review:the relationship between breast cancer risk perception and health-protective behaviour in women with family history of breast cancer[J]. J Adv Nurs, 2017, 73(4):760-774. DOI PMID
[22]	Fattahi AM, Salehi-Abargouei A, Sotoudeh A, et al. Do subjec-tive norms predict the screening of cancer patients’ first-de-gree relatives?A systematic review and meta-analysis[J]. Asian Pac J Cancer Prev, 2020, 21(6):1521-1530. DOI URL
[23]	Kırca N, Tuzcu A, Gözüm S. Breast cancer screening behaviors of first degree relatives of women receiving breast cancer treatment and the affecting factors[J]. Eur J Breast Health, 2018, 14(1):23-28. DOI PMID
[24]	黄娜, 周英凤, 李丽, 等. 妊娠期糖尿病孕妇血糖管理行为改变动机的质性研究[J]. 中华护理杂志, 2022, 57(4):389-394. DOI
	Huang N, Zhou YF, Li L, et al. A qualitative study on the motivation of blood glucose management behavior changes in pregnant women with gestational diabetes mellitus[J]. Chin J Nurs, 2022, 57(4):389-394. DOI
[25]	Rabin C, Pinto B. Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives[J]. Psycho-Oncology, 2006, 15:701-712. DOI PMID
[26]	Mackenzie CR. ‘It is hard for mums to put themselves first’:how mothers diagnosed with breast cancer manage the sociological boundaries between paid work,family and caring for the self[J]. Soc Sci Med, 2014, 117:96-106. DOI URL
[27]	Tahergorabi Z, Mohammadifard M, Salmani F, et al. Breast cancer screening behavior and its associated factors in female employees in South Khorasan[J]. J Educ Health Promot, 2021, 10:102. DOI PMID
[28]	Damghanian M, Mahmoodzadeh H, Khakbazan Z, et al. Self-care behaviors in high-risk women for breast cancer:a randomized clinical trial using health belief model education[J]. J Educ Health Promot, 2020, 9:265. DOI PMID
[29]	Fisher CL, Kastrinos A, Piemonte N, et al. Coping with breast cancer together:challenging topics for mothers and their adolescent-young adult(AYA) daughters[J]. J Psychosoc Oncol, 2021, 40(6),756-769. DOI URL
[30]	Khorsandi B, Khakbazan Z, Mahmoodzadeh HA, et al. Self-efficacy of the first-degree relatives of patients with breast cancer in the prevention of cancer:using the health belief model[J]. J Cancer Educ, 2020, 35(5):977-982. DOI PMID
[31]	宋鹏娟, 刘均娥, 陈少华, 等. 回归家庭干预对乳腺癌术后患者康复效果的影响[J]. 中华护理杂志, 2022, 57(2):133-139. DOI
	Song PJ, Liu JE, Chen SH, et al. Effect of return-to-family intervention on rehabilitation efficacy of breast cancer patients[J]. Chin J Nurs, 2022, 57(2):133-139. DOI
[32]	张薇, 金颖, 徐萍, 等. 多理论模型在健康管理领域应用的研究进展[J]. 中华护理杂志, 2022, 57(15):1893-1898. DOI
	Zhang W, Jin Y, Xu P, et al. Research progress on the application of Multi-Theory Model for health behavior change in health management[J]. Chin J Nurs, 2022, 57(15):1893-1898. DOI