基于计划行为理论的中青年肥胖性非酒精性脂肪性肝病患者中医健康管理行为意向的结构方程模型分析  

Theory of Planned Behavior-based Structural Equation Model Analysis of Behavioral Intention for Young and Middleaged Patients with Obesity-related Nonalcoholic Fatty Liver Disease in TCM Health Management

作　　者：高小莲[1] 郑文清[1] 肖明中[2,3] 陶军秀[2,3] 曾聃 艾亚婷[1] GAO Xiaolian;ZHENG Wenqing;XIAO Mingzhong;TAO Junxiu;ZENG Dan;AI Yating(Hubei University of Chinese Medicine,Wuhan 430065,China;Hubei Provincial Hospital of TCM,Wuhan 430061,China;Hubei Provincial Institute of TCM,Wuhan 430074,China)

机构地区：[1]湖北中医药大学,湖北省武汉市430065 [2]湖北省中医院,湖北省武汉市430061 [3]湖北省中医药研究院,湖北省武汉市430074

出　　处：《中国全科医学》2019年第35期4362-4369,共8页Chinese General Practice

基　　金：2015年度国家中医临床研究基地业务建设第二批科研专项（JDZX2015168）;湖北省卫计委面上项目（WJ2017M147）

摘　　要：背景中青年肥胖性非酒精性脂肪性肝病(NAFLD)的发病率逐年升高,但中医健康管理的实践效果不尽如人意,依然存在积极性不高、依从性较差、中医资源利用率较低等问题。健康管理的主体是患者,而结合计划行为理论(TPB)进行患者的疾病意识和中医健康管理认知研究尚不多见。目的基于TPB探讨中青年肥胖性NAFLD患者参与中医健康管理的影响因素。方法选取2016年10-12月在湖北省中医院肝病研究型门诊进行体检并被纳入肝病研究型门诊超重/肥胖人群生物样本库建档的志愿者,发放调查问卷552份,收回552份,有效问卷432份,有效回收率为78.26%。采用深度访谈和文献法收集问卷指标池,通过专家咨询和课题组多轮修订后形成初始问卷,经预调查后反复修正调整,形成了正式问卷《中青年肥胖性非酒精性脂肪性肝病患者中医健康管理行为意向调查表》。采用探索性因子分析寻找潜在因子,构建中青年肥胖性NAFLD患者中医健康管理行为意向的结构方程模型,进行验证性因子分析。结果探索性因子分析在65个测量指标体系中找出主观规范、自我效能、负性态度、身体健康感知、感知行为控制、中医健康管理意向及实际行为7个潜在因子;验证性因子分析验证了上述7个潜在因子的相互关系,结构方程模型拟合评价较好〔比较拟合指数(CFI)=0.949,本特勒-波内特规范拟合指数(NFI)=0.977,Tucker-Lewis指数(TLI)=0.932,拟合优度指数(GFI)=0.868,χ^2/df=2.436,近似均方根残差(RMSEA)=0.065〕;假设检验结果显示:主观规范、感知行为控制与中医健康管理意向具有正相关性(路径系数分别为0.144、0.098,P<0.001),负性态度、身体健康感知与中医健康管理意向具有负相关性(路径系数分别为-0.097、-0.168,P<0.001),自我效能与中医健康管理意向不具有相关性(路径系数为-0.023,P=0.471);主观规范、自我效能、身体健康感�Background The incidence of obesity-related nonalcoholic fatty liver disease(NAFLD)in obese young and middle-aged people is gradually increasing,but the practice of Traditional Chinese Medicine health management(TCM-HM)is unsatisfied.The problems such as low motivation,poor compliance,and low utilization of TCM resources still exist.Patients are the key to health management.However,there are rare studies seeking patients’awareness of disease and TCM-HM based on the social behavioral theory.Objective To explore the influencing factors of young and middle-aged people with obesity-related NAFLD participating in TCM-HM based on the theory of planned behavior(TPB).Methods Participants were volunteers who underwent physical examination in the Hepatology Research clinic of Hubei Provincial Hospital of TCM and enrolled into the biological sample database of overweight/obesity from October to December 2016.A total of 552 questionnaires were issued,552 were collected,and 432 were valid,with an effective recovery rate of 78.26%.The questionnaire pool was established by in-depth interviews and literature method.An initial questionnaire was formed through expert consultation and multiple rounds of revision by the research group.After preliminary investigation,it was revised and adjusted for several times.The formal questionnaire was produced named the survey of behavioral intention for young,middle-aged patients with obesity-related NAFLD participating in TCM-HM.Exploratory factor analysis(EFA)was used to catch potential factors.The Structural Equation Model(SEM)for behavioral intention of TCM-HM for the young and middle-aged patients with obesity-related NAFLD was constructed,and confirmatory factor analysis(CFA)was performed.Results EFA identified seven potential factors including subjective norm,self-efficacy,negative attitude,health perception,perceived behavior control,TCM-HM intention and actual behavior in 65 measurements;CFA confirmed the correlation between the seven potential factors mentioned,and the SEM had a go

关 键 词：肝疾病 脂肪肝 非酒精性脂肪性肝病 肥胖 中医健康管理 计划行为理论 模型 结构 

分 类 号：R575.5[医药卫生—消化系统]