【摘要】：目的探索社區(qū)糖尿病患者對糖尿病認(rèn)知水平與自我管理行為、自我健康認(rèn)知間的關(guān)系,為糖尿病健康管理工作的改善提供依據(jù)。方法采用分層整群抽樣的方法,2014年7—12月選取天津市內(nèi)六區(qū)和四郊五縣以及濱海新區(qū)共16個社區(qū)衛(wèi)生服務(wù)中心或衛(wèi)生院的糖尿病健康管理對象共1 310例,調(diào)查社會人口學(xué)資料、患者自我管理情況(健康飲食、體育鍛煉、自我血糖監(jiān)測頻率、遵醫(yī)囑服藥)、用藥及治療滿意度評分、糖尿病知識知曉得分、自我健康評分、癥狀評分。采用結(jié)構(gòu)方程模型分析糖尿病患者社會經(jīng)濟(jì)水平、疾病認(rèn)知、日常行為、自我健康評價間的關(guān)系。結(jié)果剔除調(diào)查信息不全者,共1 038例納入分析。結(jié)構(gòu)方程模型分析結(jié)果顯示,文化程度(β=0.067,P=0.038)、家庭人均月收入(β=0.083,P=0.012)與糖尿病知識知曉得分存在正向關(guān)系;糖尿病知識知曉得分與健康飲食(β=0.079,P=0.011)、自我血糖監(jiān)測頻率(β=0.098,P=0.002)存在正向關(guān)系;健康飲食與用藥及治療滿意度評分(β=0.187,P0.001)、自我健康評分(β=0.065,P=0.038)存在正向關(guān)系,與癥狀評分(β=-0.099,P=0.001)存在負(fù)向關(guān)系;自我血糖監(jiān)測頻率與用藥及治療滿意度評分(β=-0.144,P0.001)、自我健康評分(β=-0.067,P=0.032)存在負(fù)向關(guān)系,與癥狀評分(β=0.143,P0.001)存在正向關(guān)系;家庭人均月收入與文化程度存在正向關(guān)系(β=0.370,P0.001);癥狀評分與自我健康評分存在負(fù)向關(guān)系(β=-0.270,P0.001);用藥及治療滿意度評分與自我健康評分存在正向關(guān)系(β=0.187,P0.001),與癥狀評分存在負(fù)向關(guān)系(β=-0.207,P0.001)。模型擬合優(yōu)度檢驗結(jié)果提示擬合良好[χ~2=206.419,自由度(df)=38,P0.001;擬合優(yōu)度指數(shù)(GFI)=0.971,調(diào)整擬合優(yōu)度指數(shù)(AGFI)=0.921;近似誤差均方根(RMSEA)=0.065,90%CI(0.051,0.074)]。結(jié)論社區(qū)糖尿病患者對糖尿病的認(rèn)知程度越高,對健康飲食和自我血糖關(guān)注度越高;關(guān)注日常自我管理行為有助于提高患者的自我健康認(rèn)知,減輕糖尿病癥狀;而關(guān)注醫(yī)療行為可能使患者提升對糖尿病癥狀的關(guān)注,主觀滿意度下降。
[Abstract]:Objective to explore the relationship between diabetes cognitive level, self-management behavior and self-health cognition in community diabetes patients, and to provide evidence for the improvement of diabetes health management. Methods using stratified cluster sampling, 1 310 diabetic health management subjects were selected from 16 community health service centers or hospitals in Tianjin from July to December 2014 in six districts and five counties in Tianjin and Binhai New District. Social demographic data, self-management (healthy diet, physical exercise, frequency of self-monitoring of blood glucose, taking medicine according to doctor's instructions), scores of satisfaction with medication and treatment, scores of knowledge about diabetes mellitus, self-health score were investigated. Symptom score. The relationship among social and economic level, disease cognition, daily behavior and self-health evaluation of diabetic patients was analyzed by structural equation model. Results 1038 cases were included in the analysis. The results of structural equation model analysis showed that there was a positive relationship between education level (尾 = 0.067 P0. 038) and average monthly income (尾 = 0. 083 P0. 012) of diabetic knowledge. There was a positive relationship between diabetes knowledge awareness score and healthy diet (尾 = 0.079) and self-monitoring frequency (尾 = 0.098). There was a positive relationship between healthy diet and satisfaction score of medication and treatment (尾 = 0.187), self-health score (尾 = 0.065), and a negative relationship with symptom score (尾 = -0.09 9 P ~ (0.001). There was a negative relationship between the frequency of self-blood glucose monitoring and the scores of medication and treatment satisfaction (尾 = -0.144), self-health score (尾 = -0.067) and symptom score (尾 = 0.143 P0.001), while there was a positive correlation between the frequency of self-blood glucose monitoring and the score of medication and treatment satisfaction (尾 = -0.144), the score of self-health (尾 = -0.067). There was a positive correlation between average monthly income and education level (尾 = 0.370, P 0.001), a negative relationship between symptom score and self-health score (尾 = -0.270, P 0.001), and a negative correlation between symptom score and self-health score (尾 = -0.270, P 0.001). There was a positive relationship between medication and treatment satisfaction score and self-health score (尾 = 0.187 P0.001), and a negative relationship between medication satisfaction score and symptom score (尾 = -0.207 P0.001). The results of model goodness of fit test showed good fit [蠂 ~ 2n 206.419, degree of freedom (df) = 38p 0.001, (GFI) = 0.971, adjusted goodness of fit index (AGFI) = 0.921]. The root mean square (RMSEA) of approximate error is 0.065 / 90 CI (0.051 / 0.074). Conclusion the higher the cognition of diabetes in community is, the more attention is paid to healthy diet and self-blood sugar, and the attention to daily self-management behavior is helpful to improve the self-health cognition and alleviate the symptoms of diabetes. Attention to medical behavior may increase the attention of patients to diabetes symptoms, subjective satisfaction decreased.
【作者單位】： 天津醫(yī)科大學(xué)公共衛(wèi)生學(xué)院流行病與衛(wèi)生統(tǒng)計學(xué)系;天津市社區(qū)衛(wèi)生協(xié)會;天津醫(yī)學(xué)高等專科學(xué)校;
【分類號】：R587.1

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