基于健康信念模式的慢性HBV感染者随访依从性影响因素研究

潘登; 谢今朝; 顾菁; 郝元涛

doi:10.16462/j.cnki.zhjbkz.2023.05.013

基于健康信念模式的慢性HBV感染者随访依从性影响因素研究

doi: 10.16462/j.cnki.zhjbkz.2023.05.013

潘登¹,
谢今朝¹,
顾菁^{1, 2, 3, ,},
郝元涛^{1, 2, 3, 4}

1.
510080 广州，中山大学公共卫生学院医学统计学系
2.
510080 广州，中山大学全球卫生研究中心
3.
510080 广州，中山大学卫生信息研究中心
4.
100191 北京，北京大学公众健康与重大疫情防控战略研究中心

基金项目:

十三五”国家科技重大专项 2018ZX10715004

详细信息

通讯作者:
顾菁，E-mail：gujing5@mail.sysu.edu.cn

中图分类号: R512.62
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出版历程
- 收稿日期: 2022-10-29
- 修回日期: 2023-03-21
- 刊出日期: 2023-05-10

Influencing factors of adherence to follow-up among patients with chronic HBV infection based on health belief model

PAN Deng¹,
XIE Jinzhao¹,
GU Jing^{1, 2, 3
, ,},
HAO Yuantao^{1, 2, 3, 4}

1.
Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
2.
Center of Global Health Research, Sun Yat-Sen University, Guangzhou 510080, China
3.
Center for Health Information Research, Sun Yat-Sen University, Guangzhou 510080, China
4.
Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing 100191, China

Funds:

National Science and Technology Major Project of China 2018ZX10715004

More Information

Corresponding author: GU Jing，E-mail：gujing5@mail.sysu.edu.cn

摘要

摘要: 目的基于健康信念模式(health belief model, HBM)初步探索慢性HBV感染者随访依从性的影响因素，为慢性HBV感染者的科学管理提供依据。方法于“十三五”期间对广东省重大传染病示范区的慢性HBV感染者开展问卷调查和现场体检。收集感染者的基本特征、HBM相关变量和随访依从情况。采用logistic回归分析模型分析感染者随访依从性的影响因素。结果 33.8%的慢性HBV感染者随访依从性差。多因素逐步logistic回归分析模型分析结果提示，HBM相关变量中，障碍认知(OR=1.494, P < 0.001)是依从性差的危险因素，易感性认知(OR=0.796, P < 0.001)、行为线索(OR=0.701, P < 0.001)和自我效能(OR=0.674, P < 0.001)是依从性差的保护因素。将研究对象按照HBV DNA分层，同样发现障碍认知是依从性差的危险因素，行为线索和自我效能是依从性差的保护因素。结论易感性认知、障碍认知、行为线索、自我效能均是慢性HBV感染者随访依从性的影响因素，未来可重点通过降低障碍认知和提高自我效能设计干预措施提高感染者随访依从性。
- 健康信念模式 /
- 乙型肝炎 /
- 慢性 /
- 随访 /
- 影响因素
Abstract: Objective To explore the factors influencing the adherence to follow-up among patients with chronic HBV infection using the health belief model (HBM) and provide a basis for the effective management of patients with chronic HBV infection. Methods A questionnaire survey and on-site medical examination were conducted among patients with chronic HBV infection in the demonstration areas of major infectious diseases in Guangdong Province during the 13th Five-Year Plan period. Data on basic characteristics, HBM-related variables, and adherence to follow-up were collected. Logistic regression was used to analyze the factors influencing adherence to follow-up among patients with chronic HBV infection. Results 33.8% of patients with chronic HBV infection had poor adherence to follow-up. The results of multivariate logistic regression (stepwise) suggested that among the HBM-related variables, perceived barriers (OR=1.494, P < 0.001) was a risk factor for poor adherence, while perceived susceptibility (OR=0.796, P < 0.001), cues to action (OR=0.701, P < 0.001) and self-efficacy (OR=0.674, P < 0.001) were protective factors for poor adherence. Stratification of participants by HBV DNA also revealed that perceived barriers was a risk factor for poor adherence, while cues to action and self-efficacy were protective factors for poor adherence. Conclusions Perceived susceptibility, perceived barriers, cues to action, and self-efficacy all influence adherence to follow-up among patients with chronic HBV infection. Future interventions can be designed to improve adherence to follow-up by focusing on reducing perceived barriers and improving self-efficacy.
- Health belief model /
- Hepatitis B /
- Chronic /
- Follow-up /
- Influencing factors

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表 1 不同随访依从性慢性HBV感染者的基本特征描述[n(%)]

Table 1. Characteristics of patients with chronic HBV infection stratified by different adherence to follow-up [n(%)]

变量	合计(N=3 519)	依从性好(n=2 330)	依从性差(n=1 189)	t/$\chi$²/z值	P值
社会人口学特征
年龄(x ±s，岁)	57.87±11.74	57.37>±11.17	58.84±12.73	3.358	< 0.001
男性	1 719(48.8)	1 213(52.1)	506(42.6)	28.455	< 0.001
居住地址				207.170	< 0.001
广州市	2 258(64.2)	1 304(56.0)	954(80.2)
中山市	1 211(34.4)	993(42.6)	218(18.3)
其他地区	50(1.4)	33(1.4)	17(1.4)
婚姻状况				28.316	< 0.001
未婚	131(3.7)	76(3.3)	55(4.6)
已婚	3 173(90.2)	2 144(92.0)	1 029(86.5)
丧偶/离婚/分居	215(6.1)	110(4.7)	105(8.8)
教育水平				1.549	0.461
小学及以下	829(23.6)	542(23.3)	287(24.1)
初中	1 067(30.3)	696(29.9)	371(31.2)
高中及以上	1 623(46.1)	1 092(46.9)	531(44.7)
就业情况				12.155	0.002
已就业	1 563(44.4)	1 062(45.6)	501(42.1)
失业/不详	338(9.6)	242(10.4)	96(8.1)
离退休/学生/家务	1 618(46.0)	1 026(44.0)	592(49.8)
个人年收入(万元)				16.125	0.001
< 3	1 007(28.6)	660(28.3)	347(29.2)
3~ < 5	1 300(36.9)	822(35.3)	478(40.2)
5~ < 8	817(23.2)	558(23.9)	259(21.8)
≥8	395(11.2)	290(12.4)	105(8.8)
吸烟饮酒史
有吸烟史	565(16.1)	379(16.3)	186(15.6)	0.226	0.669
有饮酒史	512(14.5)	357(15.3)	155(13.0)	3.308	0.077
HBV相关特征
长期服用抗病毒药物	159(4.5)	140(6.0)	19(1.6)	35.499	< 0.001
HBV感染阶段				22.809	< 0.001
免疫耐受期	17(0.5)	6(0.3)	11(0.9)
免疫清除期	221(6.3)	155(6.7)	66(5.6)
免疫控制期	2 522(71.7)	1 710(73.4)	812(68.3)
再活动期	759(21.6)	459(19.7)	300(25.2)
出现HBV相关症状	591(16.8)	363(15.6)	228(19.2)	7.287	0.008
出现HBV相关体征	336(9.5)	228(9.8)	108(9.1)	0.449	0.542
腹部超声结果异常	1 722(48.9)	1 250(53.6)	472(39.7)	61.316	< 0.001
HBV DNA阳性	2 024(57.5)	1 290(55.4)	734(61.7)	13.064	< 0.001
HBeAg阳性	238(6.8)	161(6.9)	77(6.5)	0.235	0.679
ALT[M(P₂₅, P₇₅)]	22.0(16.0, 32.0)	22.0(16.0, 32.0)	22.0(15.0, 31.0)	0.545	0.586
AST[M(P₂₅, P₇₅)]	26.0(22.0, 33.0)	26.0(22.0, 33.0)	26.0(22.0, 33.0)	0.269	0.788

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表 2 HBM各维度得分及其对随访依从性的影响(x ±s)

Table 2. Scores on the dimensions of the HBM and their impact on adherence to follow-up (x ±s)

维度	依从性好(n=2 330)	依从性差(n=1 189)	OR_u值(95% CI)	P值	OR_a值(95% CI)	P值
易感性认知	3.10±0.97	3.03±0.77	0.919(0.851~0.993)	0.032	0.823(0.756~0.895)	< 0.001
严重性认知	2.74±0.98	2.77±0.84	1.036(0.961~1.116)	0.358	0.986(0.911~1.068)	0.737
益处认知	3.97±0.72	3.78±0.77	0.706(0.643~0.775)	< .001	0.705(0.639~0.778)	< 0.001
障碍认知	2.31±0.93	2.64±0.94	1.454(1.349~1.568)	< 0.001	1.393(1.288~1.507)	< 0.001
行为线索	3.91±0.74	3.53±0.89	0.565(0.516~0.617)	< 0.001	0.635(0.578~0.696)	< 0.001
自我效能	4.03±0.67	3.69±0.79	0.519(0.468~0.574)	< 0.001	0.545(0.490~0.605)	< 0.001
注：OR_u为单因素分析OR值；OR_a为校正后OR值，校正了单因素分析中有统计学意义的变量(年龄、性别、居住地址、婚姻状况、就业情况、个人年收入、长期服用抗病毒药物、HBV感染阶段、出现HBV相关症状、腹部超声结果、HBV DNA阳性)。

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表 3 慢性HBV感染者随访依从性差的影响因素

Table 3. Factors associated with poor adherence to follow-up among people with chronic HBV infection

变量^a	β值	s_x	Wald值	OR_m值(95% CI)	P值
社会人口学特征
年龄(岁)	0.007	0.003	2.106	1.007(1.001~1.014)	0.035
居住地址
广州市				1.000
中山市	-1.019	0.099	10.241	0.361(0.297~0.438)	< 0.001
其他地区	-0.132	0.323	0.409	0.876(0.456~1.631)	0.682
HBV相关特征
长期服用抗病毒药物	-1.529	0.259	5.894	0.217(0.127~0.352)	< 0.001
HBV感染阶段
免疫耐受期				1.000
免疫清除期	-1.415	0.564	2.509	0.243(0.076~0.713)	0.012
免疫控制期	-1.351	0.549	2.463	0.259(0.083~0.736)	0.014
再活动期	-1.186	0.550	2.155	0.305(0.097~0.872)	0.031
腹部超声结果异常	-0.197	0.085	2.328	0.821(0.696~0.969)	0.020
健康信念模式维度
易感性认知	-0.228	0.047	4.869	0.796(0.726~0.872)	< 0.001
障碍认知	0.402	0.044	9.202	1.494(1.372~1.628)	< 0.001
行为线索	-0.355	0.063	5.631	0.701(0.620~0.793)	< 0.001
自我效能	-0.394	0.075	5.242	0.674(0.582~0.781)	< 0.001
注：OR_m为多因素OR值，将单因素logistic回归分析模型中P < 0.05的基本特征和校正logistic回归分析模型中P < 0.05的健康信念变量纳入多因素逐步回归分析。^a仅展示有统计学意义的变量。无统计学意义的变量为婚姻状况、出现HBV相关症状、HBV DNA阳性和益处认知。

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参考文献(14)

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变量	合计(N=3 519)	依从性好(n=2 330)	依从性差(n=1 189)	t/$\chi$²/z值	P值
社会人口学特征
年龄(x ±s，岁)	57.87±11.74	57.37>±11.17	58.84±12.73	3.358	< 0.001
男性	1 719(48.8)	1 213(52.1)	506(42.6)	28.455	< 0.001
居住地址				207.170	< 0.001
广州市	2 258(64.2)	1 304(56.0)	954(80.2)
中山市	1 211(34.4)	993(42.6)	218(18.3)
其他地区	50(1.4)	33(1.4)	17(1.4)
婚姻状况				28.316	< 0.001
未婚	131(3.7)	76(3.3)	55(4.6)
已婚	3 173(90.2)	2 144(92.0)	1 029(86.5)
丧偶/离婚/分居	215(6.1)	110(4.7)	105(8.8)
教育水平				1.549	0.461
小学及以下	829(23.6)	542(23.3)	287(24.1)
初中	1 067(30.3)	696(29.9)	371(31.2)
高中及以上	1 623(46.1)	1 092(46.9)	531(44.7)
就业情况				12.155	0.002
已就业	1 563(44.4)	1 062(45.6)	501(42.1)
失业/不详	338(9.6)	242(10.4)	96(8.1)
离退休/学生/家务	1 618(46.0)	1 026(44.0)	592(49.8)
个人年收入(万元)				16.125	0.001
< 3	1 007(28.6)	660(28.3)	347(29.2)
3~ < 5	1 300(36.9)	822(35.3)	478(40.2)
5~ < 8	817(23.2)	558(23.9)	259(21.8)
≥8	395(11.2)	290(12.4)	105(8.8)
吸烟饮酒史
有吸烟史	565(16.1)	379(16.3)	186(15.6)	0.226	0.669
有饮酒史	512(14.5)	357(15.3)	155(13.0)	3.308	0.077
HBV相关特征
长期服用抗病毒药物	159(4.5)	140(6.0)	19(1.6)	35.499	< 0.001
HBV感染阶段				22.809	< 0.001
免疫耐受期	17(0.5)	6(0.3)	11(0.9)
免疫清除期	221(6.3)	155(6.7)	66(5.6)
免疫控制期	2 522(71.7)	1 710(73.4)	812(68.3)
再活动期	759(21.6)	459(19.7)	300(25.2)
出现HBV相关症状	591(16.8)	363(15.6)	228(19.2)	7.287	0.008
出现HBV相关体征	336(9.5)	228(9.8)	108(9.1)	0.449	0.542
腹部超声结果异常	1 722(48.9)	1 250(53.6)	472(39.7)	61.316	< 0.001
HBV DNA阳性	2 024(57.5)	1 290(55.4)	734(61.7)	13.064	< 0.001
HBeAg阳性	238(6.8)	161(6.9)	77(6.5)	0.235	0.679
ALT[M(P₂₅, P₇₅)]	22.0(16.0, 32.0)	22.0(16.0, 32.0)	22.0(15.0, 31.0)	0.545	0.586
AST[M(P₂₅, P₇₅)]	26.0(22.0, 33.0)	26.0(22.0, 33.0)	26.0(22.0, 33.0)	0.269	0.788

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基于健康信念模式的慢性HBV感染者随访依从性影响因素研究

doi: 10.16462/j.cnki.zhjbkz.2023.05.013

通讯作者:
顾菁，E-mail：gujing5@mail.sysu.edu.cn

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Influencing factors of adherence to follow-up among patients with chronic HBV infection based on health belief model

Corresponding author: GU Jing，E-mail：gujing5@mail.sysu.edu.cn

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基于健康信念模式的慢性HBV感染者随访依从性影响因素研究

doi: 10.16462/j.cnki.zhjbkz.2023.05.013

通讯作者: 顾菁，E-mail：gujing5@mail.sysu.edu.cn

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出版历程

Influencing factors of adherence to follow-up among patients with chronic HBV infection based on health belief model

Corresponding author: GU Jing，E-mail：gujing5@mail.sysu.edu.cn

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出版历程

目录

通讯作者:
顾菁，E-mail：gujing5@mail.sysu.edu.cn