慢性病高危人群和健康人群休闲类身体活动健康信念模式的多组结构方程模型分析  

Application of multi-group structural equation model in comparative study of HBM related to recreational physical activity among population with high risk of chronic diseases and healthy people

作　　者：吴士艳 张旭熙 孙凯歌[1] 胡康[1] 刘思佳[2] 孙昕霙[1] WU Shi-yan1 , ZHANG Xu-xi1, SUN Kai-ge1, HU Kang, LIU Si-jia2 , SUN Xin-ying1(1. Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China; 2. Tongzhou Center for Disease Prevention and Control, Beijing 101100, Chin)

机构地区：[1]北京大学公共卫生学院社会医学与健康教育学系,北京100191 [2]北京市通州区疾病预防控制中心,北京101100

出　　处：《北京大学学报（医学版）》2018年第4期711-716,共6页Journal of Peking University:Health Sciences

摘　　要：目的:探讨应用健康信念模式构建的多组结构方程模型中,健康信念各因子间的作用机制,并比较慢性病高危人群和健康人群的差异,为今后有针对性地分类指导,实施休闲类身体活动干预和相关政策的制定提供依据。方法:慢性病高危人群组和健康人群组分别有2 736人和1 514人纳入本研究,调查内容包括问卷调查、体格检查和生化检测。采用结构方程模型(structural equation modeling,SEM)构建基准模型,并分别检验模型的形态和参数一致性,比较两组模型的差异。结果:北京市通州区慢性病高危人群休闲类身体活动每日量为0.0(0.0,4.6)千步当量,健康人群为0.0(0.0,4.0)千步当量,SEM结果显示客观障碍(β=-0.245)、主观障碍(β=-0.057)、自我效能(β=0.117)和提示因素(β=-0.043)对休闲类身体活动的直接效应显著,自我效能是最主要的中介变量。多组结构方程分析结果显示模型形态一致,但模型参数不同(Δχ2=27.4,P<0.05)。慢性病高危人群组提示因素和主观障碍到休闲类身体活动这两条路径差异均有统计学意义,客观障碍到主观障碍(P=0.007)在两组间差异有统计学意义。结论:两组人群休闲类身体活动量均不足,且健康信念的作用强度不同,路径也存在差异,因此针对不同人群需采取不同的策略进行干预,慢性病高危人群更应该着重采取措施减少主观和客观障碍,提升自我效能,以提高不同人群休闲类身体活动量,达到延缓或防止慢性病发生,提高生活质量的目的。Objective： To explore mechanism of health beliefs by application of health belief model（HBM） and structural equation modeling（SEM） with regard to recreational physical activity（PA）,to identify the differences of among population with high risk of chronic diseases and healthy people,and to provide the specific interventions of recreational physical activity and reference for health relevant policymaking in the future. Methods： A total of 2 736 residents with high risk of chronic diseases and 1 514 healthy people were involved. A questionnaire survey,physical examination and biochemical examination were conducted. The questionnaire based on HBM had acceptable validity and reliability. The proposed model based on the total sample size of the two groups was developed using the structural equation modeling and multi-comparison in the ways of appearance and parameters were also validated. Results： The median amount of recreational（PA） among population with high risk of chronic diseases and healthy people were 0. 0 thousand-step equivalent with quartile of（0. 0,4. 6） and 0. 0 thousand-step equivalent with quartile of（0. 0,4. 0） respectively. The results of SEM suggested that the direct effects of perceived objective barriers（β =-0. 245）,perceived subjective barriers（β =-0. 057）,cues to action（β =-0. 043） and self-efficacy（β = 0. 117） on recreational（PA） were significant. Self-efficacy was the most important mediator. The multi-group comparisons indicated that the models of the two groups had the same appearance but the parameters between them were significant（Δ χ2= 27. 4,P〈0. 05）. The multigroup structural equation model（MSEM） indicated that two paths from cues to action and from perceived subjective barriers to recreational（PA） were not statistically significant among the population with highrisk of chronic diseases. In the two groups,one path coefficient from perceived objective barriers to subjective barriers（P = 0. 007） was statistically signi

关 键 词：休闲类身体活动 健康信念模式 多组结构方程模型 慢性病高危人群 健康人群 

分 类 号：R193[医药卫生—卫生事业管理]