基于家庭功能理论的慢性病患者健康行为改善的路径分析

云青萍; 纪颖; 姜学文; 朱赫; 常春

doi:10.16462/j.cnki.zhjbkz.2019.07.023

基于家庭功能理论的慢性病患者健康行为改善的路径分析

doi: 10.16462/j.cnki.zhjbkz.2019.07.023

100191 北京, 北京大学公共卫生学院

详细信息

通讯作者:
常春, E-mail: changchun@bjmu.edu.cn

中图分类号: R181.22
计量
- 文章访问数: 425
- HTML全文浏览量: 153
- PDF下载量: 31
- 被引次数: 0
出版历程
- 收稿日期: 2019-01-18
- 修回日期: 2019-04-08
- 刊出日期: 2019-07-10

Path analysis of health behavior improvement in chronic disease patients based on family function theory

School of Public Health of Peking University, Beijing 100191, China

More Information

Corresponding author: CHANG Chun, E-mail: changchun@bjmu.edu.cn

摘要

摘要: 目的了解家庭亲密度与适应性以及家庭健康提示对慢性病（以下简称慢病）患者健康行为改善的路径及其效应大小，为家庭慢病健康管理工作提供科学依据。方法从全国抽样调查数据库抽取1 134名慢病患者问卷信息进行分析：家庭亲密度、家庭适应性、家庭提示与健康行为改善情况的组间比较采用t检验；变量间相关性分析采用Pearson分析；通径分析的参数估计方法为极大似然估计法。结果在1 134名慢病患者中，男性占41.4%，女性占58.6%；平均年龄为（53.6±10.0）岁。慢病患者健康行为改善得分为（1.89±1.20）分。通径分析结果显示：家庭亲密度对慢病患者健康行为改善表现为间接正向作用，效应值为0.072；家庭适应性既有直接正向作用，也通过家庭健康提示起到间接正向作用，总效应为0.156；家庭健康提示表现为直接正向作用，效应值为0.357。结论良好的家庭亲密度与适应性可通过促进家庭健康提示来改善慢病患者健康行为。这提示在开展以家庭为中心的慢病患者健康管理服务中，强调家庭成员参与的同时也要注重家庭功能的改善。
- 家庭亲密度 /
- 家庭适应性 /
- 家庭健康提示 /
- 慢性病患者 /
- 健康行为改善
Abstract: Objective To explore the path and effect of family cohesion, family adaptability and health remind on health behavior improvement of chronic disease patients, so as to provide evidences for the family-centered chronic disease management. Methods Data of all 1 134 patients with chronic diseases was selected from the national sample survey database. t-test was used to compare family cohesion, family adaptability, health remind and health behavior improvement between different groups, and Pearson correlation was used to analyze the correlation between variables. In the process of path analysis, parameters were estimated by maximum likelihood. Results Among the 1 134 chronic diseases patients, male accounted for 41.4%, and female accounted for 58.6%. The average age of participants was (53.6±10.0) years old. The score of health behavior improvement was (1.89±1.20). Path analysis showed that family cohesion had indirect effects on behavior improvement (effect size=0.072); family adaptability had both direct and indirect effects on behavior improvement (effect size=0.156); Health remind had direct effect on behavior improvement (effect size=0.357). Conclusions The high-level family cohesion and adaptability can improve patients' health behavior by improving the health remind. It is suggested that family-centered health management services for chronic disease patients should emphasize the participation of family members as well as the improvement of family function.
- Family cohesion /
- Family adaptability /
- Family health remind /
- Chronic disease patients /
- Health behavior improvement

HTML全文

图 1 基于家庭功能理论的慢病患者健康行为改善的路径图

Figure 1. The path way of health behavior improvement in chronic disease patients based on family function theory

下载: 全尺寸图片幻灯片

图 2 慢病患者健康行为改善的路径分析

Figure 2. Path analysis of health behavior improvement in chronic disease patients

下载: 全尺寸图片幻灯片

表 1 调查对象基本情况、家庭各因素得分与健康行为改善情况(x±s)

Table 1. Demographic characteristics, family-level variables and healthy behavior changes of participants(x±s)

	N(%)	家庭亲密度	家庭适应性	家庭提示	健康行为改善
性别
男	469(41.4)	73.61±8.53	53.19±7.38	10.29±3.05	1.71±1.21
女	665(58.6)	74.47±8.73	53.34±7.63	10.64±2.96	2.02±1.18
		P < 0.001	P=0.795	P=0.750	P=0.052
年龄(岁)
18~	415(36.6)	73.22±8.72	52.19±7.53	10.05±2.97	1.78±1.21
51~	407(35.9)	73.69±8.96	54.15±7.47	10.58±2.99	1.87±1.15
≥61	312(27.5)	73.73±8.14	53.58±7.43	10.97±3.00	2.08±1.24
		P=0.003	P=0.653	P=0.001	P < 0.001
受教育程度
小学及以下	275(24.3)	73.34±8.80	52.59±7.09	9.29±3.30	1.56±1.16
初中	405(35.7)	73.10±8.83	52.72±8.09	10.45±2.95	1.84±1.22
高中或中专	343(30.2)	73.87±8.34	54.07±7.30	11.20±2.74	2.08±1.14
大专及以上	111(9.8)	74.50±8.54	54.56±6.83	11.50±2.04	2.32±1.20
		P < 0.001	P=0.376	P=0.009	P < 0.001
职业类型
企事业及技术类	196(17.3)	72.28±9.26	52.47±7.87	10.69±3.06	1.96±1.20
服务业	519(45.8)	73.95±8.04	53.17±7.29	9.83±3.14	1.70±1.18
生产及交通运输	104(9.2)	73.43±10.09	53.03±8.80	10.82±2.62	2.07±1.20
离退休及其他	315(27.8)	73.65±8.68	54.04±7.21	11.36±2.59	2.12±1.19
		P < 0.001	P=0.145	P=0.127	P < 0.001
婚姻状况
已婚或同居	1048(92.4)	73.84±8.43	53.34±7.36	10.57±2.97	1.90±1.20
未婚、离婚或丧偶	86(7.6)	69.72±10.33	52.50±9.35	9.59±3.32	1.79±1.26
		P=0.402	P < 0.001	P=0.320	P=0.004
家庭结构
核心家庭	738(65.1)	73.72±8.88	53.34±7.07	10.70±3.00	1.94±1.19
非核心家庭	396(34.9)	73.18±8.20	53.15±7.19	10.13±2.99	1.80±1.22
		P=0.059	P=0.305	P=0.687	P=0.002
年人均可支配收入(元)
＜5 000	318(28.1)	72.99±8.75	52.20±8.17	9.29±3.31	1.53±1.20
5 000~	250(22.0)	73.20±8.54	52.51±7.15	10.18±3.00	1.76±1.09
10 001~	256(22.6)	73.61±0.55	53.95±7.21	10.94±2.68	2.07±1.18
＞20 000	310(27.3)	74.28±8.53	54.45±7.20	11.62±2.39	2.23±1.19
		P < 0.001	P=0.261	P < 0.001	P < 0.001
注：对家庭亲密度得分、家庭适应性得分、家庭提示得分以及慢病患者健康行为改善得分进行了相关性分析。四个变量间的两两相关系数在0.156~0.756之间(均有P＜0.05)。

下载: 导出CSV

参考文献(18)

[1]	国家卫生和计划生育委员会. 2017中国卫生和计划生育统计年鉴[M]. 北京: 中国协和医科大学出版社, 2017. National Health and Family Planning Commission. 2017 China Health and Family Planning Statistical Yearbook[M]. Beijing: China Union Medical University Press, 2017.
[2]	中华人民共和国国家卫生和计划生育委员会. 中国疾病预防控制工作进展(2015年)[J]. 首都公共卫生, 2015, 9(3): 97-101. DOI: 10.16760/j.cnki.sdggws.2015.03.001. National Health and Family Planning Commission of People's Republic of China. Progress of disease prevention and control in China(2015)[J]. Capit J Public Health, 2015, 9(3): 97-101. DOI: 10.16760/j.cnki.sdggws.2015.03.001.
[3]	修麓璐, 高玉芳, 王会会, 等. 以家庭为中心的慢病管理对COPD患者自我管理及生活质量的影响[J]. 中国医药导报, 2017, 14(11): 151-154. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201711039.htm Xiu LL, Gao YF, Wang HH, et al. Effect of family-oriented chronic disease management on the self-management and quality of life in patients with COPD[J]. China Medical Herald, 2017, 14(11): 151-154. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201711039.htm
[4]	刘胜兰, 娜荷芽, 张欣, 等. 糖尿病患者家庭支持情况及其对运动行为的影响[J]. 中华疾病控制杂志, 2018, 22(8): 781-785. DOI: 10.16462/j.cnki.zhjbkz.2018.08.005. Liu SL, Na HY, Zhang X, et al. Family support of diabetic patients and its impact on physical activity[J]. Chin J Dis Control Prev, 2018, 22(8): 781-785. DOI: 10.16462/j.cnki.zhjbkz.2018.08.005.
[5]	郭来金, 涂长莲. 家庭亲密度和适应性对男性高血压病人家庭健康护理效果的影响[J]. 护理研究, 2014, 28(18): 2189-2190. DOI: 10.3969/j.issn.1009-6493.2014.18.006. Guo LJ, Tu CL. Influence of family cohesion and adaptability on nursing effect of home health for male hypertensive patients[J]. Chinese Nursing Research, 2014, 28(18): 2189-2190. DOI: 10.3969/j.issn.1009-6493.2014.18.006.
[6]	王凤玲, 郑修霞, 梁万宁, 等. 早期乳腺癌患者术后家庭亲密度和适应性与生活质量的关系研究[J]. 中国肿瘤, 2009, 18(10): 809-813. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU200910013.htm Wang FL, Zheng XX, Liang WN, et al. Study on the relationship of family cohesion and adaptability with quality of life in patients with breast cancer early-stage post-operation[J]. China cancer, 2009, 18(10): 809-813. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU200910013.htm
[7]	Olson DH. Circumplex model Ⅶ: validation studies and FACES Ⅲ[J]. Family Process, 1986, 25(3): 337-351. DOI: 10.1111/j.1545-5300.1986.00337.x.
[8]	Yahav, Rivka. External and internal symptoms in children and characteristics of the family system: a comparison of the linear and Circumplex Models[J]. Am J Fam Ther, 2002, 30(1): 39-56. DOI: 10.1080/019261802753455633.
[9]	Franklin C, Streeter CL. Validity of the 3-D circumplex model for family assessment[J]. Res Soc Work Pract, 1993, 3(3): 258-275. DOI: 10.1177/104973159300300302.
[10]	国务院办公厅. 国务院办公厅关于印发中国防治慢性病中长期规(2017-2025年)的通知[EB/OL]. (2017-02-14)[2019-01-18]. General Office of the State Council. Notice of the General Office of the State Council on printing and distributing the medium-and long-term regulations on prevention and treatment of chronic diseases in China (2017-2025)[EB/OL]. (2017-02-14)[2019-01-18]. http://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm
[11]	张赛, 路孝琴, 杜蕾, 等. 家庭功能评价工具家庭亲密度和适应性量表的发展及其应用研究[J]. 中国全科医学, 2010, 13(7): 725-728. DOI: 10.3969/j.issn.1007-9572.2010.07.013. Zhang S, Lu XQ, Du L, et al. Development and application of FACES[J]. Chin Gen Pract, 2010, 13(7): 725-728. DOI: 10.3969/j.issn.1007-9572.2010.07.013.
[12]	周浩, 龙立荣. 共同方法偏差的统计检验与控制方法[J]. 心理科学进展, 2004, 12(6): 942-950. DOI: 10.3969/j.issn.1671-3710.2004.06.018. Zhou H, Long LR. Statistical inspection and control method of common method biases[J]. Advances in Psychological Science, 2004, 12(6): 942-950. DOI: 10.3969/j.issn.1671-3710.2004.06.018.
[13]	李翠花, 窦淑萍, 葛娜, 等. 创伤性脊髓损伤患者家庭亲密度和适应性[J]. 中国健康心理学杂志, 2019, 27(1): 52-56. DOI: 10.13342/j.cnki.cjhp.2019.01.019. Li CH, Dou SP, Ge N, et al. Family cohesion and adaptability in patients with traumatic spinal cord injury[J]. Chin J Health Psychology, 2019, 27(1): 52-56. DOI: 10.13342/j.cnki.cjhp.2019.01.019.
[14]	张瑞红, 谷岩梅, 宋玉芝. 农村维持性血液透析患者家庭亲密度与适应性状况及其与社会支持的相关性[J]. 现代临床护理, 2015, 14(2): 65-68. DOI: 10.3969/j.issn.1671-8283.2015.02.019. Zhang RH, Gu YM., Song YZ. Association of family cohesion and adaptability in patients accepting maintenance hemodialysis with social supports[J]. Modern Clin Nurs, 2015, 14(2): 65-68. DOI: 10.3969/j.issn.1671-8283.2015.02.019.
[15]	刘延迪, 王红艳, 李梅, 等. 陪伴教育对提高青少年1型糖尿病患者生活质量及家庭亲密度和适应性的效果[J]. 解放军护理杂志, 2016, 33(2): 26-28, 34. DOI: 10.3969./j.issn.1008-9993.2016.02.007. Liu YD, Wang HY, Li M, et al. Effect of accompanied education in improving the quality of life in adolescents with type 1 diabetes and their family cohesion and adaptability evaluation[J]. Nurs J Chin PLA, 2016, 33(2): 26-28, 34. DOI: 10.3969./j.issn.1008-9993.2016.02.007.
[16]	雷艳, 汤红玲, 傅碧玲, 等. 家庭亲密度和适应性对维持性腹膜透析患者生活质量的影响[J]. 护理学杂志, 2013, 28(15): 18-19. DOI: 10.3870/hlxzz.2013.15.018. Lei Y, Tang HL, Fu BL, et al. Effects of family cohesion and adaptability on quality of life of patients on continuous ambulatory peritoneal dialysis[J]. J Nurs sci, 2013, 28(15): 18-19. DOI: 10.3870/hlxzz.2013.15.018.
[17]	张丽岩, 宋旭生, 王文博, 等. 自我效能在宫颈癌患者家庭亲密度与适应性和益处发现间中介效应[J]. 中国公共卫生, 2018, 34(1): 111-113. DOI: 10.11847/zgggws1115167. Zhang LY, Song XS, Wang WB, et al. Mediating effect of self-efficacy on correlation between family adaptability cohesion and benefit finding among cervical cancer patients[J]. Chin J Public Health, 2018, 34(1): 111-113. DOI: 10.11847/zgggws1115167.
[18]	吴小婷, 章新琼, 王芹, 等. 化疗前胃癌患者心理弹性与家庭功能、希望的关系: 自我效能感的中介作用[J]. 现代预防医学, 2018, 45(10): 1822-1826. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201810025.htm Wu XT, Zhang XQ, Wang Q, et al. The relationship of resilience and family function, hope of gastric cancer before chemotherapy: self-efficacy as a mediator[J]. Modern Preventive Medicine, 2018, 45(10): 1822-1826. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201810025.htm