【作者】 杨华；

【导师】 王翠丽；

【作者基本信息】 山东大学 ， 护理学， 2015， 硕士

【摘要】 目的：调查慢性阻塞性肺疾病(COPD)患者自我管理现状,结合保护动机理论,研究各种影响因素与COPD患者自我管理水平、自我管理理行为意向的关系。方法：2014年12月至2015年7月抽取聊城市两家三级综合医院346名COPD患者进行问卷调查,测量工具包括基本情况调查表(含一般社会人口学资料与疾病相关资料)、COPD知识问卷、保护动机因素和保护动机意向问卷、COPD患者自我管理行为量表。采用SPSS13.0统计软件进行数据统计分析。利用统计方法包括统计描述、t检验、单因素方差分析、Pearson相关分析及多元层次回归分析COPD自我管理水平和自我管理行为意向的影响因素。结果1.COPD自我管理水平指标化得分平均为2.82±0.53分、其各维度得分从高到低依次为情绪管理、日常生活管理、症状管理、信息管理；COPD患者行为意向得分最高35分,最低13分,平均28.05±4.49分；2.不同年龄、性别、婚姻状况、文化程度、收入水平、居住方式、居住地、肺功能、住院史的COPD患者自我管理水平存在显著性差异；不同居住地、居住方式、肺功能的患者自我管理行为意向存在显著性差异；3.反应代价与自我管理行为及行为意向均无显著性相关(r=0.022,r=0.101,P>0.05),自我管理行为与自我效能中度正相关(r=0.622,P<0.01),与保护动机其他因素低度正相关(r=0.144-0.387,P<O.01)；自我管理行为意向与严重性、易感性、反应效能、威胁呈中度正相关(r=0.587-0.646,P<0.01),与自我效能不相关(r=0.076,P>0.05)。4.多元回归分析表明,总模型对自我管理行为及行为意向变异的解释率分别为60.8%与61.1%,其中保护动机因素对自我管理及行为意向变异的解释率分别是25.2%与42.7%,自我管理行为的显著预测因素有自我效能(β=0.563,P<0.001)、保护动机(β=0.232,P<0.001)、COPD知识(β=0.197,P<0.001)、易感性(β=0.159,P<0.05)；自我管理行为意向的显著预测因素有威胁(β=0.291,P<0.001)、反应效能(β=0.263,P<0.001),严重性(β=0.240,P<0.001), COPD知识(β=0.111,P<0.01)。结论1.COPD患者的自我管理水平处于中等水平。2.年龄大、男性、有配偶、非独居、文化程度高、收入高、肺功能好、有住院史的城市COPD患者自我管理水平较高；城市、非独居、肺功能差的患者自我管理行为意向较强。3.除反应代价外的保护动机各因素与COPD患者自我管理行为及其行为意向呈显著性正相关关系,但相关程度不同。4.保护动机理论能很好地解释和预测COPD患者自我管理行为及行为意向,影响行为的最主要认知因素为自我效能,影响行为意向的最主要认知因素为威胁、反应效能、严重性认知。更多还原

【Abstract】 Objectives:To investigate the present situation of management behavior among patients with Chronic Obstructive Pulmonary Disease. To analyze the influential factors associated with self-management behavior and self-management behavior intentions based on protection motivation theory.Methods:A total of 346 patients were recruited by convenient sampling in two top-ranked general hospitals from December 2014 to July 2015 in Liaocheng City. We used sociodemographic and clinical questionnaire, Chronic Obstructive Pulmonary Disease Knowledge Questionnaire (COPD-Q), Protective motivation factor and Protective motivation questionnaire,and Self-management Scale(SMS). Statistical analysis was conducted using SPSS 13.0. Descriptive analysis,t test, F test, Pearson correlation analysis and multivariate linear regression were used to identify the predictors of self-management behavior and self-management behavior intentions..Results1.The average score of COPD Patients Self-Management Behavior Rang Scale was 2.82±0.53. The level of mood management was the highest, followed by daily life management, symptom management and information management. The score of self-management intentions among patients with COPD ranged from 13 to 35, with an average of (28.05±4.49).2. The level of self-management significantly varied by age, gender, marriage, education, income, living arrangement, residence, pulmonary function, and hospitalization history. Self-management intentions differed by residence, living arrangement and pulmonary function.3. Response costs were not significantly correlated with self-management and intentions to self-manage, respectively (r=0.022, r=0.101, P> 0.05). Self-management was moderately correlated with self-efficacy (r=0.622, P<0.01), but modestly with other variables of PMT (r=0.144-0.387, P<0.01). Intentions to self-manage was moderately correlated with perceived severity, vulnerability, response efficacy, and threat(r=0.587-0.646, P<0.01), but not significantly correlated with self-efficacy (r=0.076, P>0.05).4. Multivariate regression analyses showed that the constructed model explained 60.8%and 61.1% of the variance in self-management and intentions to self-manage. Wherein, the variables of PMT accounted for 25.2% of the variance of self-management and 42.7% of intentions to self-manage, respectively. The significant predictors of self-management included self-efficacy (β=0.563, P<0.001), intentions to self-management (β=0.232, P<0.001), COPD knowledge (β=0.197, P<0.001), perceived vulnerability(β=0.159, P<0.05). The significant predictors of intentions to self-manage included perceived threat (β=0.291, P<0.001), response efficacy (β=0.263, P<0.001), perceived severity (β=0.240, P<0.001), COPD knowledge (β=0.111, P<0.01).Conclusions1. The self-management behavior of patients with COPD in Liaocheng City is at a moderate level.2. The level of self-management is higher among male married COPD patients with older age, higher education and income, better pulmonary function and hospitalization history, living with families in city. The level of intentions to self-manage is stronger among COPD patients with better pulmonary function and living with families in city.3. The protective motivation related factors except response costs positively correlate with self-management and intentions to self-manage among COPD patients, while the magnitudes of correlation differ.4. The protection motivation theory can well explain and forecast the self-management and intentions to self-manage among COPD patients. The main cognitive predictor is self efficacy for self-management, while threat, response efficacy, and perceived severity for intentions to self-manage.更多还原