类风湿关节炎患者自我效能潜在类别及影响因素分析

doi:10.3761/j.issn.0254-1769.2024.19.008

摘要/Abstract

摘要：

目的探索类风湿关节炎（rheumatoid arthritis，RA）患者自我效能潜在类别，分析其影响因素，为制订个性化护理措施提供参考。方法便利选取2022年3月—2023年3月就诊于常州市某三级甲等综合医院风湿免疫科门诊的RA患者，采用一般资料调查表、中文版类风湿关节炎自我效能感量表，风湿病治疗依从性问卷对RA患者进行调查，采用潜在类别分析对自我效能进行分类，通过多元Logistic回归分析探索自我效能的影响因素。结果共纳入RA患者219例，中文版类风湿关节炎自我效能感量表得分为（100.68±12.64）分，RA患者自我效能分为高效能-低支持组（105.18±10.18）分，中效能-多样需求组（93.21±4.16）分，低效能-高疲劳组（84.07±13.96）分。Logistic回归分析显示，病程（OR=1.062，P=0.024）、学历（OR=5.405，P=0.036；OR=12.347，P=0.021）、红细胞沉降率（OR=1.019，P=0.020；OR=1.019，P=0.027）是RA患者自我效能的影响因素。RA患者自我效能3个潜在类别的治疗依从性得分（F=10.902，P<0.001）、治疗依从性良好率（χ²=16.053，P<0.001）比较，差异具有统计学意义。结论 RA患者自我效能水平具有明显的异质性，不同自我效能类别的患者治疗依从性存在差异。护士应重点关注中效能-多样需求组和低效能-高疲劳组人群，对患者实施认知行为等干预手段，协助其设定明确的目标，并提供具体的规划和指导，以改善其健康结局。

关键词: 关节炎，类风湿, 自我效能, 治疗依从性, 潜在类别分析, 影响因素分析, 护理

Abstract:

Objective To explore the potential categories of self-efficacy in patients with rheumatoid arthritis （RA），analyze their influencing factors，and provide references for the development of personalized care measures. Methods Patients with RA who visited the rheumatology and immunology outpatient department of a tertiary hospital in Changzhou from March 2022 to March 2023 were selected. A general information questionnaire，the Chinese version of the Rheumatoid Arthritis Self-Efficacy Scale（C-RASE），and Compliance Questionnaire Rheumatology（CQR） were used to investigate RA patients. Latent class analysis was used to classify self-efficacy，and logistic regression analysis was conducted to explore the influencing factors of self-efficacy. Results A total of 219 subjects were included in the survey. The score of C-RASE was（100.68±12.64）. The self-efficacy of RA patients was divided into a high efficacy-low support group（105.18±10.18），a moderate efficacy-diverse needs group（93.21±4.16），and a low efficacy-high fatigue group（84.07±13.96）. Logistic regression analysis showed that disease duration（OR=1.062，P=0.024），education（OR=5.405，P=0.036；OR=12.347，P=0.021），and erythrocyte sedimentation rate （OR=1.019，P=0.020；OR=1.019，P=0.027） were factors affecting patients’ self-efficacy. The treatment compliance scores of the 3 latent class categories（F=10.902，P<0.001） and the rate of good treatment compliance（χ²=16.053，P<0.001） were statistically significant. Conclusion RA patients exhibit significant heterogeneity in their self-efficacy levels，and there are variations in treatment adherence among patients in different self-efficacy categories. Nurses should prioritize the attention towards the population groups with moderate efficacy-diverse needs，as well as the groups with low efficacy-high fatigue，implementing cognitive behavioral interventions to assist them in setting clear goals and providing specific plans and guidance to improve their health outcomes.

Key words: Arthritis，Rheumatoid, Self-Efficacy, Therapy Adherence, Latent Class Analysis, Root Cause Analysis, Nursing Care

李芬, 耿亚琴, 张艺, 沈碧玉, 高波, 裔雅萍. 类风湿关节炎患者自我效能潜在类别及影响因素分析[J]. 中华护理杂志, 2024, 59(19): 2362-2368.

LI Fen, GENG Yaqin, ZHANG Yi, SHEN Biyu, GAO Bo, YI Yaping. Analysis of potential categories and influencing factors of self-efficacy among patients with rheumatoid arthritis[J]. Chinese Journal of Nursing, 2024, 59(19): 2362-2368.

图/表 6

表1 类风湿关节炎患者一般资料及自我效能潜在类别的单因素分析(n=219)

Table 1 Demographic characteristics and univariate analysis of latent classes of self-efficacy in rheumatoid arthritis patients(n=219)

表2 类风湿关节炎患者自我效能潜在类别分析模型拟合结果(n=219)

Table 2 Model fitting results of self-efficacy in rheumatoid arthritis patients(n=219)

表3 类风湿关节炎患者自我效能感量表在不同潜在类别间的比较（n=219，分，$\bar{x}±s$）

Table 3 Distribution of potential categories of the scores of RASE in rheumatoid arthritis patients（n=219，scores，$\bar{x}±s$）

图1 类风湿关节炎患者自我效能的3个潜在类别

Figure 1 Potential categories of self-efficacy in RA patients

表4 类风湿关节炎患者自我效能潜在类别的多元Logistic回归分析结果（n=219）

Table 4 Results of multiple Logistic regression of self-efficacy category in rheumatoid arthritis patients（n=219）

表5 不同自我效能潜在类别类风湿关节炎患者风湿治疗依从性比较(n=219)

Table 5 Comparison oftreatment compliance in different classes of self-efficacy of patients with rheumatoid arthritis(n=219)

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