糖尿病高危足患者足部护理知信行的分型预测及护理启示

doi:10.3761/j.issn.0254-1769.2024.19.003

摘要/Abstract

摘要：

目的分析糖尿病高危足患者足部护理知识、态度、行为（以下简称知信行）的潜在剖面，分析不同潜在剖面分型预测的决策和影响因素，为临床护理提供参考。方法采用便利抽样法，选取2023年7月—10月在广州市某三级甲等医院就诊的200例糖尿病高危足患者作为调查对象，采用一般资料调查表、糖尿病患者足部护理知识、态度和行为评价量表进行调查。通过潜在剖面分析确定糖尿病高危足患者足部护理知信行的潜在类别，采用机器学习中迭代二叉树3代算法对患者足部护理知信行不同潜在剖面进行分型预测，采用多因素Logistic回归分析其影响因素。结果糖尿病高危足患者足部护理知信行存在3个潜在剖面：高知识-中态度-中行为型（29.00%）、低知识-低态度-低行为型（56.00%）和中知识-高态度-高行为型（15.00%）。决策树模型显示，居住地、文化程度、是否接受过糖尿病足相关健康教育以及糖尿病高危足分期是足部护理知信行不同潜在剖面的决策因素。多因素分析结果显示，文化程度、家庭人均月收入、是否接受过糖尿病相关随访是足部护理知信行不同潜在剖面的影响因素。结论糖尿病高危足患者的足部护理知信行水平有待提升，且存在群体异质性。医护人员应根据不同潜在剖面及影响因素对糖尿病高危足患者进行干预，以提高其知信行水平。

关键词: 糖尿病足, 护理, 知识, 态度, 行为, 潜在剖面分析, 决策树分析

Abstract:

Objective To analyze the potential categories of foot care knowledge-attitude-practice（KAP） of diabetic high-risk foot patients，and analyze the influencing factors of different potential categories classification prediction，so as to provide references for clinical nursing. Methods By convenience sampling，a questionnaire survey was conducted from July to December 2023，employing a general information questionnaire and a diabetes foot care KAP evaluation scale on patients at high risk of diabetic foot in a tertiary hospital in Guangzhou. Latent profile analysis was used to identify the potential classifications of foot care KAP status among these patients. The iterative dichotomiser 3 algorithm of decision tree in machine learning was used to make classification prediction of foot nursing KAP status of patients，using multivariate logistic regression to analyse its influencing factors. Results There are 3 potential profiles of foot care KAP in high-risk diabetic foot patients，including “high knowledge-medium attitude-medium behavior” type（29.00%），“low knowledge-low attitude-low behavior” type（56.00%） and “medium knowledge-high attitude-high practice” type（15.00%）. Decision tree model showed that residence，education level，receiving education about diabetic foot and stage of diabetic high-risk foot were decision-making factors for different potential categories of foot care KAP. The results of the Logistic analysis showed that literacy level, per capita monthly household income, and whether received diabetes-related follow-up were influential factors in different potential profiles of foot care KAP. Conclusion The level of foot care KAP of patients at high risk of diabetic foot needs to be improved，and shows population heterogeneity. Medical staff should intervene and support diabetic foot patients at high risk according to different potential profile and influencing factors to improve their KAP level.

Key words: Diabetic Foot, Nursing Care, Knowledge, Attitude, Practice, Latent Profile Analysis, Decision Tree Analysis

黄欣婷, 汪艳, 杨青. 糖尿病高危足患者足部护理知信行的分型预测及护理启示[J]. 中华护理杂志, 2024, 59(19): 2326-2332.

HUANG Xinting, WANG Yan, YANG Qing. Prediction of foot care knowledge-attitude-practice about foot care in patients with diabetic high-risk feet and nursing insights[J]. Chinese Journal of Nursing, 2024, 59(19): 2326-2332.

图/表 5

表1 调查对象一般资料及足部护理知信行潜在剖面的单因素分析[例（百分比，%）]

Table 1 Univariate analysis of general information and potential profiles of foot care KAP[case（percentage，%）]

表2 糖尿病足高危患者足部护理知信行潜在剖面模型拟合指标(n=200)

Table 2 Summary of potential profile model fitting information for patients’ foot care KAP(n=200)

图1 患者足部护理知信行潜在剖面分析结果

Figure 1 Potential profile analysis of patients’ foot care KAP status

图2 糖尿病高危足患者足部护理知信行分型的决策树模型注：类别1为高知识-中态度-中行为型；类别2为低知识-低态度-低行为型；类别3为中知识-高态度-高行为型。

Figure 2 Decision tree model of diabetic high-risk feet patients’ foot care KAP status classification

表3 糖尿病高危足患者足部护理知信行潜在剖面的多因素分析 (n=200)

Table 3 Multifactor analysis of potential profiles of foot care KAP in diabetic foot patients at high risk (n=200)

参考文献 14

[1]	邵腾腾, 陈聪, 陆侃, 等. 糖尿病高危足腻苔患者的舌图像特征参数分析[J]. 中华中医药杂志, 2020, 35(9):4622-4625.
	Shao TT, Chen C, Lu K, et al. Analysis of characteristic parameters of tongue image in greasy fur diabetic patients with high risk for foot ulceration[J]. China J Tradit Chin Med Pharm, 2020, 35(9):4622-4625.
[2]	刘瑾, 袁晓勇, 袁戈恒, 等. 糖尿病患者高危足筛查及分级、干预规范流程的构建[J]. 中华糖尿病杂志, 2017, 9(5):281-285.
	Liu J, Yuan XY, Yuan GH, et al. Construction of the standardized process of at-risk foot screening,stratification and intervention for diabetic patients[J]. Chin J Diabetes Mellit, 2017, 9(5):281-285.
[3]	魏华伟, 刘桂娟, 魏玉玲, 等. 社区分级管理对糖尿病足危险因素的控制效果[J]. 中华护理杂志, 2012, 47(10):923-926.
	Wei HW, Liu GJ, Wei YL, et al. Effect of community grade management on the risk factors of diabetic foot[J]. Chin J Nurs, 2012, 47(10):923-926.
[4]	Bakker K, Schaper NC, International Working Group on Diabetic Foot Editorial Board. The development of global consensus guidelines on the management and prevention of the diabetic foot 2011[J]. Diabetes Metab Res Rev, 2012, 28(Suppl 1):116-118.
[5]	中华医学会糖尿病学分会, 中华医学会感染病学分会, 中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)[J]. 中华糖尿病杂志, 2019, 11(2):92-108.
	Chinese Diabetes Society, Chinese Society of Infectious Diseases, Chinese Society for Tissue Repair and Regeneration. Chinese guideline on prevention and management of diabetic foot(2019 edition)(Ⅰ)[J]. Chin J Diabetes Mellit, 2019, 11(2):92-108.
[6]	赵晨旭, 周慧敏. 《中国糖尿病足诊治指南》解读[J]. 中国临床医生杂志, 2021, 49(12):1405-1408.
	Zhao CX, Zhou HM. Interpretation of “guidelines for diagnosis and treatment of diabetic foot in China”[J]. Chin J Clin, 2021, 49(12):1405-1408.
[7]	孔令慧, 于杰, 张会君, 等. 基于Logistic回归和决策树的老年脑卒中病人肌少症风险预测模型的构建[J]. 护理研究, 2024, 38(10):1703-1710.
	Kong LH, Yu J, Zhang HJ, et al. Construction of risk prediction model of sarcopenia in senile patients with stroke based on Logistic regression and decision tree[J]. Chin Nurs Res, 2024, 38(10):1703-1710.
[8]	许娇, 韩利, 张红, 等. 糖尿病患者足部自我护理的知信行及影响因素研究进展[J]. 中国护理管理, 2020, 20(7):1034-1037.
	Xu J, Han L, Zhang H, et al. The knowledge,belief,and behavior of foot self-care in diabetic patients and the influencing factors:a literature review[J]. Chin Nurs Manag, 2020, 20(7):1034-1037.
[9]	杨柳, 戚以勤, 蒋超南, 等. 糖尿病足高危患者足部自护行为及影响因素研究[J]. 护理学杂志, 2021, 36(19):23-27.
	Yang L, Qi YQ, Jiang CN, et al. Stages of foot self-care behavior among patients at high risk of diabetic foot:the influencing factors[J]. J Nurs Sci, 2021, 36(19):23-27.
[10]	王君. 糖尿病患者足部护理知识、态度和行为评价量表的研制[D]. 北京: 中国疾病预防控制中心, 2018.
	Wang J. Development of evaluation scale of knowledge,attitude and behavior of foot care for diabetic patients[D]. Beijing: Chinese Center for Disease Control and Prevention, 2018.
[11]	肖景芳, 夏锐南, 王瑞, 等. 护士建言行为现状及潜在剖面分析[J]. 中华护理杂志, 2024, 59(1):93-99. DOI URL
	Xiao JF, Xia RN, Wang R, et al. Study on the current situation and latent profile analysis of nurses’ voice behavior[J]. Chin J Nurs, 2024, 59(1):93-99. DOI URL
[12]	唐立健, 钱东福, 王中华. 农村老年高血压患者的上门随访需求及其影响因素[J]. 卫生软科学, 2017, 31(5):60-63. DOI
	Tang LJ, Qian DF, Wang ZH. Analysis on the demand of follow-up and influence factors among rural aged patients with hypertension[J]. Soft Sci Health, 2017, 31(5):60-63.
[13]	丁慧敏, 戴莉敏, 蔡冬青, 等. 糖尿病前期患者自我管理潜在剖面分析及影响因素研究[J]. 中华护理杂志, 2024, 59(9):1057-1064.
	Ding HM, Dai LM, Cai DQ, et al. Potential profile analysis and influencing factors of self-management in prediabetic patients[J]. Chin J Nurs, 2024, 59(9):1057-1064.
[14]	张莹湘, 蔡英华, 周海琴, 等. 肺移植患者居家肺康复自我管理行为决策体验的质性研究[J]. 军事护理, 2024, 41(2):39-42.
	Zhang YX, Cai YH, Zhou HQ, et al. Decision-making experiences of home-based lung rehabilitation behaviors in patients with lung transplant:a qualitative study[J]. Mil Nurs, 2024, 41(2):39-42.

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