【作者】 朱艳；

【导师】 贾平；

【作者基本信息】 电子科技大学 ， 护理（专业学位）， 2025， 硕士

【摘要】 目的基于COM-B理论模型中的能力-机会-动机-行为框架,从个体健康素养(Capability)、社会支持(Opportunity)、自我效能(Motivation)三维度解析健康促进生活方式(Behaviour)的形成机制,验证“健康素养→社会支持→自我效能→健康促进生活方式”的链式多重中介路径,为建立规范化、标准化糖尿病健康管理方法提供理论依据。方法本研究采用方便抽样的方法,选取成都市某三甲综合医院332名2型糖尿病患者为研究对象,采用一般人口学资料调查表、中文版糖尿病健康素养量表、社会支持评定量表、糖尿病自我效能感量表、糖尿病患者健康促进量表进行问卷调查。采用SPSS 25.0完成统计分析,运用Mplus8.0软件构建结构方程模型进行路径分析,采用偏差校正Bootstrap法检验“健康素养→社会支持→自我效能→健康促进生活方式”的链式中介路径显著性。结果1.2型糖尿病患者的整体情况:332名患者的平均年龄为60.91±11.63岁,男性占比61.7%,女性38.3%。研究对象以城镇(77.1%)、已婚居民(89.5%)为主,90.7%与家人同住,86.7%通过医保支付医疗费用,44.3%家庭人均月收入超5000元;文化程度偏低,30.7%为小学及以下学历。62.3%的患者糖尿病病程达10年及以上。2.2型糖尿病患者的健康促进生活方式、健康素养、社会支持、自我效能现状:332名患者健康促进生活方式总分为97.53±16.73分,处于中等水平,压力处置维度得分最高,风险规避维度得分最低。健康素养得分为38.73±11.53分;社会支持得分为42.26±6.67分;自我效能得分为35.01±6.88分。3.2型糖尿病患者的健康促进生活方式得分在文化程度、婚姻状况、居住地、居住方式、家庭人均月收入、职业、医疗费用支付方式上具有统计学差异(P<0.05)。相关分析显示:健康素养、社会支持、自我效能与健康促进生活方式四者间均存在正相关关系(P<0.01)。4.中介分析结果显示:社会支持在2型糖尿病患者健康素养与健康促进生活方式间起部分中介作用,效应比为19.82%;自我效能在2型糖尿病患者健康素养与健康促进生活方式间起部分中介作用,效应比为72.79%;社会支持和自我效能在2型糖尿病患者健康素养与健康促进生活方式间的起链式中介效应值为0.059,链式中介效应显著,总间接效应占总效应的79.28%。结论1.2型糖尿病患者健康促进生活方式处于中等水平,且受多因素影响。其中“风险规避”和“健康责任”维度得分显著偏低,表明患者在疾病风险防控意识和健康管理参与度方面存在明显不足。文化程度、经济水平、职业类型等社会人口学因素显著影响其生活方式,提示需针对低收入、低学历等弱势群体设计差异化的健康干预策略。2.2型糖尿病患者健康素养水平呈现“功能性>互动性>评判性”的阶梯式特征,提示其获取和理解基础健康信息的能力较强,但批判性分析与决策能力较弱。性别、文化程度、经济状况等因素显著影响健康素养水平,提示需通过健康教育强化患者对复杂健康信息的判断与应用能力,尤其需关注农村地区及低社会经济地位人群。3.2型糖尿病患者健康素养、社会支持与自我效能均与健康促进生活方式呈显著正相关,其中自我效能的关联性最强,提示提升自我效能可能是改善生活方式的核心切入点。4.研究验证了COM-B理论模型在慢性病管理中的适用性,2型糖尿病患者的健康素养不仅直接促进健康行为,还通过“社会支持→自我效能”的链式路径间接影响。该发现揭示了能力建设(健康素养)需与环境支持(社会支持)、动机强化(自我效能)形成协同效应,符合COM-B模型中“三位一体”的行为改变机制。提示临床干预需整合健康教育、社会网络构建与赋能训练的多维策略。更多还原

【Abstract】 ObjectivesBased on the Capability-Opportunity-Motivation-Behavior(COM-B)framework,this study analyzes the formation mechanism of health-promoting lifestyles(Behaviour)from three dimensions:individual health literacy(Capability),social support(Opportunity),and self-efficacy(Motivation).It aims to validate the chain multiple mediation pathway of"health literacy→social support→self-efficacy→health-promoting lifestyle,"thereby providing a theoretical basis for establishing standardized and normative diabetes health management approaches.MethodsThis study employed a convenience sampling method to select 332 patients with type 2 diabetes from a tertiary Grade A general hospital in Chengdu as research subjects.A self-designed questionnaire was used,including general demographic information,the Chinese version of the Diabetes Health Literacy Scale,the Social Support Rating Scale,the Diabetes Self-Efficacy Scale,and the Health-Promoting Lifestyle Scale for Diabetic Patients.Basic statistical analyses were performed using SPSS 25.0.Structural equation modeling(SEM)was conducted via Mplus8.0 software to execute path analysis.The significance of the sequential mediation pathway’health literacy→social support→self-efficacy→health-promoting lifestyles(HPL)’was tested using the bias-corrected bootstrap method.Results1.Overall profile of type 2 diabetes patients:The study cohort comprised 332patients with an average age of 60.91±11.63 years,ranging from 23 to 87.The majority were male(61.7%).Participants were primarily urban residents(77.1%),married(89.5%),and living with family members(90.7%).Medical expenses were predominantly covered by health insurance(86.7%),with 44.3%reporting a per capita monthly household income exceeding 5,000 RMB.Educational attainment was relatively low,with 30.7%having a primary school education or below.Notably,62.3%of patients had a diabetes duration of 10 years or longer.2.Current status of health-promoting lifestyle,health literacy,social support,and self-efficacy in patients with type 2 diabetes:Among the 332 patients,the total score for health-promoting lifestyle was 97.53±16.73 points,indicating a moderate level overall,with the highest score observed in the stress management dimension and the lowest in risk avoidance.Health literacy scored 38.73±11.53 points,social support 42.26±6.67points,and self-efficacy 35.01±6.88 points.3.Health-promoting lifestyle scores exhibited statistically significant differences across educational level,marital status,residential area,living arrangement,per capita monthly household income,occupation,and medical payment methods(P<0.05).Correlation analysis revealed positive correlations among health literacy,social support,self-efficacy,and health-promoting lifestyle(P<0.01).4.The mediation analysis demonstrated the following results:social support partially mediated the relationship between health literacy and health-promoting lifestyles in patients with type 2 diabetes,accounting for 19.82%of the total effect.Self-efficacy also partially mediated this relationship,contributing 72.79%of the total effect.A significant chain mediation effect was observed through both social support and self-efficacy(effect value=0.059),with the total indirect effects representing 79.28%of the total effect.Conclusions1.The health-promoting lifestyle of patients with type 2 diabetes mellitus is at a moderate level and influenced by multiple factors.Notably,the dimensions of"risk avoidance"and"health responsibility"scored significantly lower,indicating significant deficiencies in patients’awareness of disease risk prevention and participation in health management.Sociodemographic factors such as educational attainment,economic status,and occupational type significantly influence their lifestyle behaviors.These findings suggest the need to develop differentiated health intervention strategies targeting vulnerable groups,particularly those with low income and limited education,to address disparities in health behavior outcomes.2.The health literacy level of patients with type 2 diabetes mellitus exhibits a"functional>interactive>critical"tiered pattern,indicating that their ability to acquire and comprehend basic health information is relatively strong,but critical analysis and decision-making abilities remain underdeveloped.Sociodemographic factors such as gender,educational attainment,and socioeconomic status significantly influence health literacy levels.These findings highlight the need to strengthen patients’capacity to evaluate and apply complex health information through targeted health education programs,with special attention to rural populations and individuals from low socioeconomic backgrounds.3.In patients with type 2 diabetes,health literacy,social support,and self-efficacy all demonstrate significant positive correlations with health-promoting lifestyles,with self-efficacy showing the strongest association.This suggests that enhancing self-efficacy may serve as a key entry point for improving lifestyle behaviors.4.The study validates the applicability of the COM-B model in chronic disease management,demonstrating that type 2 diabetes patients’health literacy not only directly promotes healthy behaviors but also exerts indirect influence through the"social support→self-efficacy"chain pathway.These findings reveal that capacity building(health literacy)requires synergistic effects with environmental support(social support)and motivation enhancement(self-efficacy),which aligns with the"trinity"behavior change mechanism in the COM-B model.This suggests that clinical interventions should adopt multidimensional strategies integrating health education,social network construction,and empowerment training.更多还原