45岁以上农村地区成年人健康自我管理能力影响因素

胡筱蕾; 李桂林; 李君; 王皓翔; 周志衡; 王家骥; 陈小瑜

doi:10.16462/j.cnki.zhjbkz.2020.09.013

45岁以上农村地区成年人健康自我管理能力影响因素

doi: 10.16462/j.cnki.zhjbkz.2020.09.013

1.
510000 广州, 广州华立科技职业学院健康学院护理大师工作室
510000 广州, 中山大学公共卫生学院
518000 深圳, 广东省深圳市福田区慢性病防治院
510000 广州, 广东省基层卫生协会
510000 广州, 广州卫生职业技术学院

基金项目:

国家自然科学基金面上项目 71673309

广东省自然科学基金 2019A1515011381

广东省科技发展专项基金 2016A020216006

广东普通高校特色创新项目 2018GKTSCX009

详细信息

通讯作者:
陈小瑜, E-mail:19856653@qq.com

中图分类号: R181
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出版历程
- 收稿日期: 2020-01-05
- 修回日期: 2020-06-26
- 刊出日期: 2020-09-29

Analysis of influencing factors of healthy self-management ability of adults over 45 years old in rural area

1.
Nursing Master Studio, Health College, Huali Guangzhou Technology Vocational College, Guangzhou 510000, China
School of Public health, Sun Yat-Sen University, Guangzhou 510000, China
Chronic Disease Prevention and Treatment Institute in Futian District of Shenzhen, Shenzhen 518000, China
Guangdong Provincial Primary Health Association, Guangzhou 510000, China
Health Vocational and Technical College, Guangzhou 510000, China

Funds:

General Program of National Natural Science Foundation of China 71673309

Natural Science Foundation of Guangdong Province 2019A1515011381

Fund of Science and Technology Development of Guangdong Province 2016A020216006

Characteristic Innovation Project of Guangdong Ordinary Universities 2018GKTSCX009

More Information

Corresponding author: CHEN Xiao-yu, E-mail:19856653@qq.com

摘要

摘要: 目的探讨农村地区成年人健康自我管理能力的影响因素。方法使用成年人健康自我管理能力测评量表对广州市从化区良口镇1 217名45岁以上成年人进行调查，采用单因素方差分析、多元线性回归、结构方程模型分析影响因素。结果单因素及多因素分析显示年龄、文化程度、职业、是否患有慢性病和自评健康状况是成年人健康自我管理能力的影响因素（均有P < 0.05）；采用结构方程模型对潜在变量进行验证性分析，结果显示对健康自我管理能力影响最大的是公共卫生资源利用（路径系数0.740），其次为环境自我管理（路径系数0.714）、饮食自我管理（路径系数0.685）、运动自我管理（路径系数0.618）、健康信念（路径系数0.592）、自我效能（路径系数0.585）、疾病应对（路径系数0.585）。结论农村成年人群健康自我管理能力较低，农村地区应加大基本公共卫生服务供给，继续拓宽医疗保险覆盖面，推进慢性病规范化管理与全科医学团队建设。
- 成年人健康自我管理能力 /
- 影响因素 /
- 结构方程
Abstract: Objective To explore the influencing factors of adults health self-management ability in rural areas. Methods A total of 1 217 adults aged 45 years and above in Liangkou Town of Conghua District from Guangzhou City were included in this study. The influencing factors were analyzed using one-way analysis of variance, multiple linear regression models and structural equation models. Results Age, education level, occupation, whether suffering from chronic diseases and self-assessed health status were influencing factors of adults' self-management ability (all P < 0.05). After verifying the potential variables with structural equation model, the greatest impact on health self-management ability was the utilization of public health resources (path coefficient was 0.74), followed were environmental self-management (path coefficient was 0.714), diet self-management (path coefficient was 0.685), and exercise self-management (path coefficient was 0.618), health beliefs (path coefficient was 0.592), self-efficacy (path coefficient was 0.585), and disease response (path coefficient was 0.585). Conclusions The adults health self-management ability is relatively low in rural areas. We should increase the supply of basic public health services, expand the coverage of medical insurance, promote standardized management of chronic diseases and facilitate general practice teams building.
- Adult health self-management ability /
- Influencing factor /
- Structure equation

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表 1 研究对象基线资料

Table 1. Baseline data of study subjects

变量	人数	构成比(%)
性别
男	638	52.42
女	579	47.58
年龄(岁)
＞45	667	54.81
56~	265	21.77
66~75	285	23.42
婚姻
未婚	59	4.85
已婚	1 000	82.17
离异	18	1.48
丧偶	134	11.01
其他	6	0.49
文化程度
文盲	147	12.08
小学	391	32.13
初中	414	34.02
高中	164	13.48
大专	64	5.26
本科及以上	37	3.04
职业
农民	535	43.96
工人	225	18.49
公务员	59	4.85
医药卫生	30	2.47
教师	35	2.88
在家	59	4.85
其他	274	22.51

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表 2 成年人健康自我管理能力影响因素的单因素分析

Table 2. One-way analysis of variance for influencing factor of adult health self-management ability

变量	总能力分值(x±s)	F值	P值
年龄(岁)		7.373	< 0.001
45~	143.31±18.74
56~	142.34±20.16
66~75	137.39±20.34
文化程度		21.859	< 0.001
文盲	129.73±20.85
小学	138.69±18.03
初中	143.02±19.43
高中	147.28±16.54
大专	150.63±16.35
本科及以上	158.14±18.96
职业		11.774	< 0.001
农民	137.32±18.59
工人	142.74±18.24
公务员	143.72±20.36
在家	145.61±16.56
医药卫生	154.10±16.39
教师	157.34±17.44
其他	143.53±21.14
是否患慢性病		25.043	< 0.001
是	137.27±19.15
否	142.69±19.53
自评健康状况		29.236	< 0.001
非常好	155.36±22.46
好	144.94±17.63
一般	137.37±17.75
较差	130.88±28.17
差	128.68±18.16

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表 3 成年人健康自我管理能力影响因素的多元线性回归分析

Table 3. Multiple linear regression for influencing factor of adult health self-management ability

变量	β值	S_x	β值	t值	OR(95% CI)值	P值
常量	145.296	2.787	－	52.134	143.845(139.828~150.763)	< 0.001
年龄(岁)	-3.458	1.319	-0.143	-2.687	-3.197(-5.011~-1.142)	0.007
文化程度	3.401	0.535	0.204	6.358	3.769(2.351~4.450)	< 0.001
职业
农民	1.960	1.390	0.042	1.410	2.732(-0.767~4.687)	0.159
工人	1.552	1.489	0.031	1.043	3.018(-1.369~4.472)	0.297
公务员	3.108	2.552	0.034	1.218	5.372(-1.899~8.114)	0.224
教师	10.477	3.334	0.090	3.142	10.924(3.935~17.018)	0.002
医药卫生	4.147	3.608	0.033	1.150	7.329(-2.931~11.226)	0.251
在家	6.195	2.470	0.068	2.507	8.371(1.348~11.042)	0.012
自评健康状况	-5.916	0.628	-0.257	-9.424	-5.176(-7.148~-4.684)	< 0.001
是否患有慢性病	2.474	0.771	0.158	3.221	2.598(1.887~3.789)	0.002

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表 4 结构方程模型拟合优度分析

Table 4. Analysis of fitness of structural equation

适配度检验指标	适配标准	模型结果	结论
CMIN/DF	1~3	2.967	良好
RMSEA	< 0.08	0.040	良好
SRMR	< 0.08	0.051	良好
AGFI	>0.90	0.919	良好
CFI	>0.90	0.953	良好
IFI	>0.90	0.953	良好
PNFI	>0.50	0.851	良好

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表 5 结构方程模型路径分析

Table 5. Analysis path of structural equation model

因素	路径关系	能力	标准路径系数	标准误差	组合信度	P值
饮食自我管理	< ---	总能力	0.685
运动自我管理	< ---	总能力	0.618	0.096	13.281	< 0.001
环境自我管理	< ---	总能力	0.714	0.088	13.906	< 0.001
公共卫生资源利用	< ---	总能力	0.740	0.087	13.944	< 0.001
健康信念	< ---	总能力	0.592	0.077	13.273	< 0.001
自我效能	< ---	总能力	0.585	0.056	12.138	< 0.001
疾病应对	< ---	总能力	0.585	0.081	12.519	< 0.001

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参考文献(22)

唐钧, 刘蔚玮.中国老龄化发展的进程和认识误区[J].北京工业大学学报(社会科学版), 2018, 18(4):8-18.

Tang J, Liu WW. China's aging process and some misunderstandings on it[J]. Journal of Beijing university of technology (social sciences), 2018, 18(4):8-18.

中共中央, 国务院.中共中央国务院印发《"健康中国2030"规划》[EB/OL]. (2016-10-25)[2020-01-04].http://www.gov.cn/gongbao/content/2016/content_5133024.htm.

The Central Committee of the Communist Party of China, the State Council. "Healthy China 2030" plan issued by the CPC Central Committee and the State Council[EB/OL]. (2016-10-25)[2020-01-04]. http://www.gov.cn/gongbao/content/2016/content_5133024.htm.

国家卫计委, 国家发改委, 国家中医药局, 等.国家卫计委、国家发改委、国家中医药局、全国老龄办等13部门联合印发《"十三五"健康老龄化规划》(正国卫家庭发[2017] 12号)[EB/OL]. (2017-03-29)[2020-01-04]. http://health.people.com.cn/n1/2017/0329/c14739-29176696.html.

National Health and Family Planning Commission, National Development and Reform Commission, State Administration of Traditional Chinese Medicine, et al. National Health and Family Planning Commission, National Development and Reform Commission, State Administration of Traditional Chinese Medicine and National Aging Office jointly issued the 13th five year plan for healthy aging.[EB/OL]. (2017-03-29)[2020-01-04]. http://health.people.com.cn/n1/2017/0329/c14739-29176696.html.

广东省卫生计生委等13部门关于印发广东省"十三五"健康老龄化规划的通知(粤卫[2017] 153号)[EB/OL]. (2018-04-15)[2020-01-04].http://ihpi.org.cn/policiesandregulations/shownews.php?lang=cn&id=202.

Guangdong Health and Family Planning Commission. Notice of 13 departments including Guangdong Health and Family Planning Commission on printing and distributing the 13th five year plan for healthy aging in Guangdong Province[EB/OL]. (2018-04-15)[2020-01-04]. http://ihpi.org.cn/policiesandregulations/shownews.php?lang=cn&id=202.

杨俭, 李远庆, 陈晓禹, 等.我国中老年慢性病患者疾病直接经济负担研究[J].中国卫生经济, 2019, 38(5):71-73. DOI: 10.7664/CHE20190517.

Yang J, Li YQ, Chen XY, et al. Economic burden among middle-aged and elderly patients with chronic[J]. Chinese Health Economics, 2019, 38(5):71-73. DOI: 10.7664/CHE20190517.

彭扬帆.中年慢性病人的自我认同危机研究[D].武汉: 华中师范大学, 2014.

Peng YF. The research on self-identity crisis of middle age patients with chronic diseases[D]. Wuhan: Central China Normal University, 2014.

姚康景, 朱建丽, 黄琼, 等.延续性护理对提高老年慢性病患者健康管理水平与治疗依从性的效果评价[J].卫生职业教育, 2018, 36(20):142-144. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=wszyjy201820073

Yao KJ, Zhu JL, Huang Q, et al. Effect evaluation of continuous nursing on improving health management level and treatment compliance of elderly patients with chronic diseases[J]. Health Vocational Education, 2018, 36(20):142-144. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=wszyjy201820073

赵秋利, 黄菲菲.成年人健康自我管理能力测评量表的编制及信度和效度检验[J].中华现代护理杂志, 2011, 17(8):869-872. DOI: 10.3760/cma.j.issn.1674-2907.2011.08.001.

Zhao QL, Huang FF. Developm entand thereliability and validity test of the rating scale of health serf-management for adults[J]. Chinese Journal of Modern Nursing, 2011, 17(8):869-872. DOI: 10.3760/cma.j.issn.1674-2907.2011.08.001.

吴明隆.问卷统计分析实务-SPSS操作与应用[M]. 2010版.重庆:重庆大学出版社, 2010.

Wu ML. The operation and application of SPSS in questionnaire statistical analysis[M]. Chongqing:Chongqing University Press, 2010.

吴明隆.结构方程模型-AMOS的操作与应用[M]. 2010版.重庆:重庆大学出版社, 2010.

Wu ML. Operation and application of AMOS structural equation model[M]. Chongqing:Chongqing University Press, 2010.

Schuurmans H, Steverink N, Frieswijk N, et, al. How to measure self-management abilities in older people by self-report. The development of the SMAS-30[J]. Qual Life Res, 2005, 14(10):2215-2228. DOI: 10.1007/s11136-005-8166-9.

Marilyn S, Townsend. Outcome measures for health education and other health care interventions[M]. Thousand Osks:Sage Publications, 1996:1-23.

Gallagher R, Donoghue J, Chenoweth L, et al. Self-management in older patients with chronic illness[J]. Int J Nurs Pract, 2008, 14(5):373-382. DOI: 10.1111/j.1440-172X.2008.00709.x.

王爱平, 冯茂玲.血液透析患者自我管理行为问卷的开发[J].中国卫生统计, 2005, 22(6):368-371. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwstj200506005

Wang AP, Feng ML. Development of a self-management behavior scale for hemodialysis patients[J]. Chin J Heal Statis, 2005, 22(6):368-371. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwstj200506005

陈永进, 陈和平, 侯丽杰, 等.青少年自我管理问卷的初步编制[J].中国临床心理学杂志, 2008, 16(3):272-273. DOI: 10.16128/j.cnki.1005-3611.2008.03.023.

Chen YJ, Chen HP, Hou LJ, et al. Preliminary development of the questionnaire of self-management for the youth[J]. Chin J Clin Psychol, 2008, 16(3):272-273. DOI: 10.16128/j.cnki.1005-3611.2008.03.023.

邹志超.大学生自我管理量表的修订及区域性常模的建立[D].长沙: 湖南师范大学, 2007.

Zou ZC. Revision of college student self-management scale and the establishment of a territorial norm[D]. Changsha: Hunan Normal University, 2007.

王娟, 于西亮, 刘巧梅, 等.湖南省农村空巢老人健康自我管理能力及影响因素[J].中国老年学杂志, 2018, 38(5):1239-1242. DOI: 10.3969/j.issn.1005-9202.2018.05.084.

Wang J, Yu XL, Liu QM, et al. The level and influencing factors of health self-management skill among rural empty nesters in Hunan Province[J]. Chin J Gerontol, 2018, 38(5):1239-1242. DOI: 10.3969/j.issn.1005-9202.2018.05.084.

张秋实, 张晓夏, 陈静, 等.河南省农村地区脑卒中患者健康自我管理能力现状及影响因素分析[J].现代预防医学, 2019, 46(14):2579-2583. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xdyfyx201914022

Zhang QS, Zhang XX, Chen J, et al. The level and influencing factors of health self-management skill among rural stroke patients in Henan Province[J]. Modern Preventive Med, 2019, 46(14):2579-2583. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=xdyfyx201914022

焦润基, 张雁儒.我国基本公共卫生服务均等化研究综述[J].中国公共卫生管理, 2019, 35(4):485-488. DOI: 10.19568/j.cnki.23-1318.2019.04.014.

Jiao RJ, Zhang YR. Review of the equalization of basic public health services in China[J]. Chin J of PHM, 2019, 35(4):485-488. DOI: 10.19568/j.cnki.23-1318.2019.04.014.

李翔, 王晓霞, 陈雯, 等.中部经济欠发达地区农村基本公共卫生服务利用情况调查[J].中国卫生事业管理, 2016, 33(8):608-610. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwssygl201608014

Li Xiang, Wang XX, Chen W, et al.Surveying the utilization of basic public health services in undeveloped rural areas of central China[J]. Chin Health Service Manage, 2016, 33(8):608-610. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwssygl201608014

李媛, 乔慧, 高忠飞, 等.宁夏农村老年人卫生服务需求与利用现状[J].中国公共卫生, 2017, 33(4):548-552. DOI: 10.11847/zgggws2017-33-04-09.

Li Y, Qiao H, Gao ZF, et al. Demand and utilization of health service among rural elderly people in Ningxia Hui Autonomous Region[J]. Chin Publ Heal, 2017, 33(4):548-552. DOI: 10.11847/zgggws2017-33-04-09.

郭斌, 程怀志, 刘艳瑞, 等.健康老龄化视角下农村老年人卫生服务利用影响因素研究[J].中国医学伦理学, 2019, 32(2):241-245. DOI: 10.12026/j.issn.1001-8565.2019.02.22.

Guo B, Chen HZ, Liu YR, et al. Study on influencing factors of health service utilization of rural elderly from the perspective of healthy aging[J]. Chin Med Ethics, 2019, 32(2):241-245. DOI: 10.12026/j.issn.1001-8565.2019.02.22.

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