【摘要】：目的:本研究通過循證的方法,探索最有效、最廣泛的跌倒預(yù)防措施,并基于循證結(jié)果,進(jìn)一步應(yīng)用德爾菲法編制腦卒中患者跌倒風(fēng)險(xiǎn)認(rèn)知和行為意向問卷并調(diào)查其現(xiàn)狀,構(gòu)建結(jié)構(gòu)方程模型分析各相關(guān)變量的影響路徑。方法:計(jì)算機(jī)檢索Cochrane library、PubMed、CNKI等國內(nèi)外數(shù)據(jù)庫中有關(guān)腦卒中成年人跌倒預(yù)防的隨機(jī)對(duì)照試驗(yàn),對(duì)符合納入與排除標(biāo)準(zhǔn)的文獻(xiàn)進(jìn)行系統(tǒng)評(píng)價(jià),采用RevMan5.3軟件進(jìn)行統(tǒng)計(jì)分析;基于循證結(jié)果和認(rèn)知理論,運(yùn)用德爾菲(Delphi)法編制《跌倒風(fēng)險(xiǎn)認(rèn)知和行為意向問卷》,并進(jìn)行信效度檢驗(yàn);采用便利抽樣法選取腦卒中患者,使用編制的問卷調(diào)查其跌倒風(fēng)險(xiǎn)認(rèn)知和行為意向的現(xiàn)狀并構(gòu)建結(jié)構(gòu)方程模型,分析、評(píng)價(jià)其變量間路徑,探討行為意向前因變量對(duì)行為意向的解釋力及在意向階段行為意向與自我效能變量對(duì)執(zhí)行意向變量的中介作用。所得數(shù)據(jù)采用SPSS17.0及AMOS17.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理及分析。結(jié)果:1 22項(xiàng)隨機(jī)對(duì)照試驗(yàn)的meta分析顯示:與空白或常規(guī)干預(yù)相比,不同形式的干預(yù)對(duì)腦卒中成年人跌倒發(fā)生人數(shù)綜合效果差異無統(tǒng)計(jì)學(xué)意義[OR=0.80,95%CI 0.61-1.05],但多因素干預(yù)與對(duì)照組相比,腦卒中跌倒發(fā)生的人數(shù)的下降存在顯著差異[OR=0.33,95%CI0.16-0.68];不同干預(yù)時(shí)長下,干預(yù)對(duì)腦卒中成年人跌倒發(fā)生人數(shù)影響的差異無統(tǒng)計(jì)學(xué)意義[OR=1.00,95%CI0.77-1.30];干預(yù)對(duì)腦卒中成年人跌倒率影響的差異無統(tǒng)計(jì)學(xué)意義[OR=0.79,95%CI0.39-1.62],且結(jié)果均穩(wěn)定可信。2經(jīng)2輪德爾菲專家函詢,預(yù)調(diào)查,正式調(diào)查后形成《跌倒風(fēng)險(xiǎn)認(rèn)知和行為意向問卷》共包括57個(gè)條目,探索性因子分析提取10個(gè)公因子,累積方差貢獻(xiàn)率為75.17%,提取的公因子與預(yù)先根據(jù)理論框架設(shè)計(jì)的結(jié)構(gòu)假設(shè)的組成相符,組成6個(gè)理論變量,分別為風(fēng)險(xiǎn)認(rèn)知、結(jié)果預(yù)期、跌倒自我效能、行為意向、執(zhí)行意向、應(yīng)對(duì)自我效能。量表整體Cronbach's a系數(shù)為0.934,各個(gè)變量的a系數(shù)分別為0.897、0.822、0.979、0.892、0.929、0.940,問卷內(nèi)部一致性良好。3腦卒中跌倒風(fēng)險(xiǎn)認(rèn)知和行為意向修正模型擬合良好,可被接受(χ2=5.737,P=0.676,χ2/df=0.7172,NFI=0.991,RFI=0.968,IFI=1.004,TLI=1.013,CFI=1.000,RMSEA=0.0000.08),模型可解釋行為意向的47%,行為計(jì)劃的41%和應(yīng)對(duì)計(jì)劃的51%。跌倒自我效能、風(fēng)險(xiǎn)認(rèn)知是行為意向的決定因素,存在直接正預(yù)測效應(yīng),同時(shí)應(yīng)對(duì)自我效能對(duì)跌倒自我效能、風(fēng)險(xiǎn)認(rèn)知和行為意向、執(zhí)行意向起部分中介作用;行為意向在跌倒自我效能、風(fēng)險(xiǎn)認(rèn)知和執(zhí)行意向之間起完全中介作用。結(jié)論:將HAPA理論引入腦卒中跌倒預(yù)防研究制定的《跌倒風(fēng)險(xiǎn)認(rèn)知和行為意向問卷》有良好的信效度且與假設(shè)理論框架相一致;HAPA模型可有效描述、解釋、預(yù)測跌倒預(yù)防行為的轉(zhuǎn)變過程。
[Abstract]:Objective: to explore the most effective and extensive measures for the prevention of falls through the evidence-based method. Based on the results of the study, the Delphi method was used to compile the questionnaire on the cognition and behavior intention of stroke patients' fall risk, and to investigate the present situation of the questionnaire. The structural equation model is constructed to analyze the influence path of each related variable. Methods: a randomized controlled trial on the prevention of cerebral apoplexy in adults with cerebral apoplexy was searched by computer in Cochrane library.PubMedi and other databases at home and abroad. The literatures that met the criteria of inclusion and exclusion were systematically evaluated, and the statistical analysis was carried out with RevMan5.3 software. Based on the evidence-based results and cognitive theory, Delphi (Delphi) method was used to compile the questionnaire of cognition and behavior intention of fall risk, and the reliability and validity of questionnaire were tested, and the convenience sampling method was used to select patients with cerebral apoplexy. The current situation of cognition and behavior intention of fall risk was investigated by questionnaire, and the structural equation model was constructed to analyze and evaluate the path between variables. This paper discusses the explanatory power of behavioral intention dependent variables to behavior intention and the mediating effect of behavior intention and self-efficacy variables on executive intention variables. The data are processed and analyzed by SPSS17.0 and AMOS17.0 software. Results the meta analysis of 22 randomized controlled trials showed that there was no significant difference in the comprehensive effect of different forms of intervention on the incidence of stroke in adults with stroke compared with blank or routine intervention [ORO 0.8095 CI 0.61-1.05], but the multivariate intervention was compared with the control group. There was a significant difference in the number of people who fell down after stroke [ORO 0.339 95 CI 0.16-0.68]; There was no significant difference in the effect of intervention on the incidence of stroke in adults with stroke [OR1. 00 and 95 CI0.77-1.30], but there was no significant difference in the effect of intervention on the fall rate of adults with stroke [OR0.79 ~ 95CI0.39-1.62], and the results were stable and reliable. A total of 57 items were included in the questionnaire on perceived and Behavioral intention of falling risk after formal investigation. Ten common factors were extracted by exploratory factor analysis. The contribution rate of cumulative variance was 75.17. The common factors extracted were consistent with the composition of the structural assumptions designed in advance according to the theoretical framework. The six theoretical variables were risk cognition, result expectation, fall self-efficacy, behavioral intention, executive intention, respectively. Coping with self-efficacy. The overall Cronbach's a coefficient of the scale was 0.934, and the a coefficient of each variable was 0.897 / 0.8220.9790.8920.8920.9290.940 respectively. The internal consistency of the questionnaire was good. 3 the models of cognition and behavior intention correction of stroke fall risk were well fitted. It is acceptable (蠂 ~ 2 / dfr ~ (5.737) / p ~ (0.676), 蠂 ~ 2 / d ~ (dfU) 0.7172NFI ~ (0.991N) ~ (0.96) ~ (1.004) ~ (-1) TLI ~ (1.013) CFI ~ (1) 1.000 RMSEAE ~ (0.0008). The model can explain the behavior intention 471% of the behavior plan, the behavior plan (41%) and the coping plan (51). Fall self-efficacy, risk cognition is the decisive factor of behavior intention, there is direct positive predictive effect, and coping self-efficacy plays a part of intermediary role in fall self-efficacy, risk cognition and behavioral intention. Behavioral intention plays a complete intermediary role between fall self-efficacy, risk cognition and executive intention. Conclusion: the questionnaire on cognition and behavior intention of fall risk developed by the study of HAPA in the study of stroke prevention has good reliability and validity and is consistent with the hypothetical theoretical framework. The model can be effectively described and explained. Predict the course of change in fall prevention behavior.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.74

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 鄧穎;王靜;劉小娟;;不同臨床特征腦卒中病人跌倒預(yù)防知識(shí)、態(tài)度和行為研究[J];全科護(hù)理;2016年21期

2 陳瑜;姜小鷹;朱秀蘭;;養(yǎng)老機(jī)構(gòu)老年人跌倒預(yù)防知信行問卷的信度和效度研究[J];中華護(hù)理教育;2016年03期

3 鄧曉清;方芳;羅玉球;向平;張立湘;蔣紅焱;王曉磊;黃麗華;曾憲國;;經(jīng)康復(fù)治療出院的老年腦卒中患者家居一年跌倒的發(fā)生率、地點(diǎn)及預(yù)測因子的隨訪研究[J];中華腦科疾病與康復(fù)雜志(電子版);2016年01期

4 劉莉莉;林平;趙振娟;;自我效能、社會(huì)支持及應(yīng)對(duì)方式對(duì)急性心肌梗死患者心理彈性影響的路徑分析[J];中華護(hù)理雜志;2016年01期

5 ;2015年“世界卒中日”宣傳主題及提綱[J];疾病監(jiān)測;2015年10期

6 姜玉;胡越;胡嘉;周鵬;李玉華;張姣艷;夏慶華;;社區(qū)老年腦卒中患者跌倒的影響因素分析[J];中國慢性病預(yù)防與控制;2015年10期

7 楊亞娟;費(fèi)才蓮;荊瑤;吳林霞;彭飛;;醫(yī)護(hù)患一體化自我管理教育在腦卒中患者居家康復(fù)中的應(yīng)用[J];解放軍護(hù)理雜志;2015年17期

8 孔德華;陸?zhàn)?漢瑞娟;李娟;朱鑫華;董鶴;;跨理論模型在健康行為改變中應(yīng)用的研究進(jìn)展[J];解放軍護(hù)理雜志;2015年13期

9 林允照;馮晨;劉敏;顧華;馮磊;沈健;;基于行為轉(zhuǎn)變理論指導(dǎo)的階段性干預(yù)對(duì)2型糖尿病患者自我效能及生存質(zhì)量的影響[J];中國全科醫(yī)學(xué);2014年35期

10 李鶯;程云;;奧塔戈運(yùn)動(dòng)項(xiàng)目對(duì)老年腦卒中患者跌倒的影響[J];護(hù)理學(xué)雜志;2014年21期

相關(guān)碩士學(xué)位論文 前4條

1 李景;住院老年患者參與跌倒預(yù)防知信行量表的研究[D];北京中醫(yī)藥大學(xué);2016年

2 張寧;老年人運(yùn)動(dòng)功能量表的漢化及在肌肉骨骼系統(tǒng)性疾病中的應(yīng)用研究[D];河北醫(yī)科大學(xué);2016年

3 賀茜;構(gòu)建護(hù)士崗位培訓(xùn)效果評(píng)估指標(biāo)體系的初步研究[D];北京協(xié)和醫(yī)學(xué)院;2014年

4 郭欣穎;中文版尖銳濕疣患者生活質(zhì)量問卷的漢化及適用性研究[D];北京協(xié)和醫(yī)學(xué)院;2013年

，

本文編號(hào)：2179021