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| 基于结构方程模型的老年糖尿病患者自我管理水平影响因素分析 |
| 张枫,秉岩,刘骥,刘丽娟* |
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(海军军医大学(第二军医大学)卫生勤务学系健康管理学教研室, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 了解社区老年2型糖尿病患者自我管理现状，并利用结构方程模型分析其影响因素。方法 采用便利抽样法，以上海市虹口区65岁及以上2型糖尿病患者为研究对象，应用糖尿病自我管理量表、贝克抑郁量表、糖尿病自我效能量表及糖尿病痛苦量表对患者进行调查。采用Spearman相关分析探讨变量间的关系，通过构建结构方程模型分析患者的抑郁、自我效能、糖尿病痛苦对自我管理水平的影响。结果 共纳入588例老年2型糖尿病患者，糖尿病自我管理水平得分为32.00（28.00，38.00）分，糖尿病自我效能量表得分为158.50（135.25，172.00）分，贝克抑郁量表得分为0.00（0.00，2.00）分，糖尿病痛苦量表得分为23.00（18.00，31.00）分。构建的结构方程模型显示了良好的样本数据拟合，自我效能对自我管理水平（β＝0.558，P＜0.001）、抑郁对糖尿病痛苦（β＝0.599，P＜0.001）有正向影响；抑郁对自我效能（β＝－0.314，P＜0.001）、糖尿病痛苦对自我效能（β＝－0.267，P＜0.001）有负向影响。对自我管理水平影响最大的因素是自我效能（总效应为0.558），产生直接影响；其次是抑郁（总效应为－0.264）、糖尿病痛苦（总效应为－0.149），产生间接影响。自我效能在抑郁和自我管理的关系中发挥中介作用，间接效应为－0.175，占总效应的66.3%；自我效能和糖尿病痛苦在抑郁和自我管理之间发挥链式中介作用，间接效应为－0.089，占总效应的33.7%。结论 自我效能对老年糖尿病患者自我管理水平的作用效应最大，抑郁和糖尿病痛苦通过自我效能的中介作用间接影响自我管理水平。社区和临床医务工作者应当注重提高糖尿病患者的自我效能感，对其抑郁和糖尿病痛苦的症状进行针对性干预，以提高糖尿病患者的自我管理水平。 |
| 关键词: 2型糖尿病 自我管理 自我效能 结构方程模型 抑郁 糖尿病痛苦 |
| DOI：10.16781/j.CN31-2187/R.20240073 |
| 投稿时间：2024-01-26修订日期：2024-08-26 |
| 基金项目:国家社会科学基金（14BGL142）. |
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| Influencing factors of self-management competence in elderly patients with diabetes mellitus based on structural equation model |
| ZHANG Feng,BING Yan,LIU Ji,LIU Lijuan* |
(Department of Health Management, Faculty of Health Service, Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the status of self-management ability in elderly patients with type 2 diabetes mellitus (T2DM) in community, and to analyze the influencing factors using structural equation model. Methods A convenient sampling method was used to investigate patients aged 65 years and above with T2DM in Hongkou district of Shanghai. The patients were assessed using diabetes self-management questionnaire (DSMQ), Beck depression inventory (BDI), diabetes management self-efficacy scale (DMSES), and diabetes distress scale (DDS). Spearman correlation analysis was conducted to explore the relationship among the variables. A structural equation model was constructed to analyze the effect of depression, self-efficacy, and diabetes distress on self-management levels among the patients. Results A total of 588 elderly patients with T2DM were included in this survey, the DSMQ score was 32.00 (28.00, 38.00), the DMSES score was 158.50 (135.25, 172.00), the BDI score was 0.00 (0.00, 2.00), and the DDS score was 23.00 (18.00, 31.00). The final model demonstrated good fit to the sample data, self-efficacy had a positive impact on self-management levels (β＝0.558, P＜0.001), and depression had a positive impact on diabetes distress (β＝0.599, P＜0.001). Conversely, depression had a negative impact on self-efficacy (β＝－0.314, P＜0.001), and diabetes distress also had a negative impact on self-efficacy (β＝－0.267, P＜0.001). Self-efficacy had the greatest impact on self-management level (the total effect was 0.558), and it was a direct impact. Depression (the total effect was －0.264) and diabetes distress (the total effect was －0.149) had indirect effects. Self-efficacy played a mediating role between depression and self-management, with an indirect effect of －0.175, accounting for 66.3% of the total effect. Self-efficacy and diabetes distress played a chain mediating role between depression and self-management, with an indirect effect of －0.089, accounting for 33.7% of the total effect. Conclusion Self-efficacy has the greatest effect on the self-management level of elderly patients with diabetes mellitus. Depression and diabetes distress indirectly affect self-management levels through the mediating role of self-efficacy. Community and clinical healthcare workers should focus on enhancing the self-efficacy of patients with diabetes mellitus and implementing targeted interventions for their symptoms of depression and diabetes distress, so as to improve their self-management capabilities. |
| Key words: type 2 diabetes mellitus self-management self-efficacy structural equation model depression diabetes distress |
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