基于结构方程模型的老年人社区临终关怀服务需求的影响因素  

Influencing factors of community hospice care service needs of the elderly based on structural equation model

作　　者：汪雨欣 吕芯芮 王子尧 刘爽 邓宇含 刘宝花[1] Yuxin Wang;LüXinrui;Ziyao Wang;Shuang Liu;Yuhan Deng;Baohua Liu(School of Public Health,Peking University,Beijing 100191,China;Healthcare Security Bureau of Shenzhen Municipality,Shenzhen 518038,China)

机构地区：[1]北京大学公共卫生学院,北京100191 [2]深圳市医疗保障局,深圳518038

出　　处：《中华健康管理学杂志》2022年第9期628-633,共6页Chinese Journal of Health Management

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究专项(2018YFC1311700, 2018YFC1311703)。

摘　　要：目的分析基于结构方程模型的老年人社区临终关怀服务需求的影响因素。方法运用多阶段抽样方法, 于2020年9—11月对北京市朝阳区4个片区40家社区卫生服务中心的564例老年人采用自行设计的问卷进行调查, 调查内容包括倾向特征、使能资源和需求因素3个维度, 应用χ2检验、秩和检验分析老年人社区临终关怀服务需求的影响因素, 同时基于安德森理论, 应用结构方程模型分析影响因素的作用路径及效应大小。结果户籍、职业、社区养老服务了解程度、社区就医便捷认同度、社区卫生服务减轻家庭负担认同度、社区卫生服务改善自身健康认同度、社区临终关怀服务了解程度、家庭平均月收入、收入满足程度、前一年自付医疗费、居住状态、社区就诊费用接受度、社区医护人员数量满意度、健康状况自评、过去2周是否患病以及患慢病种类数均是老年人社区临终关怀服务需求的影响因素(均P<0.05)。在安德森模型3个维度中, 使能资源可直接产生影响, 也可通过需求因素间接产生影响, 总效应值为0.404;需求因素可直接产生影响, 效应值为0.193;倾向特征可通过使能资源和需求因素间接产生影响, 总效应值为0.176。使能资源维度中社区卫生服务就诊费用接受度影响最大(FL=0.535), 需求因素维度中患慢病种类数影响最大(FL=1.018), 倾向特征维度中社区卫生服务减轻家庭负担认同度影响最大(FL=0.612)(均P<0.05)。结论影响老年人社区临终关怀服务需求的因素和作用路径多样, 其中社区卫生服务就诊费用接受度、患慢病种类数、社区卫生服务减轻家庭负担认同度影响较大。Objective To analyze the influencing factors of community hospice care service needs of the elderly based on structural equation model.Methods A multi-stage sampling method was used to survey 564 elderly people from 40 community health service centers in four districts of Chaoyang District in Beijing from September to November 2020 with a self-designed questionnaire.The survey content included three dimensions:tendency characteristics(population characteristics,health beliefs),enabling resources and demand factors.The chi-square test and rank sum test were used to analyze the influencing factors of the community hospice care needs of the elderly.At the same time,based on Anderson theory,structural equation model was used to analyze the action path and effect size of the influencing factors.Results Registered residence,occupation,understanding of community elderly care services,recognition of community medical convenience,recognition of community health services in reducing family burden,recognition of community health services in improving their own health,understanding of community hospice care services,mean monthly income of their families,degree of income satisfaction,self-paid medical expenses of the previous year,living status,acceptance of community medical expenses,satisfaction with the number of community medical staff,self-assessment of health status,whether the elderly was ill in the last two weeks and the number of chronic diseases and etc affected the needs of the elderly for community hospice care services(all P<0.05).In the three dimensions of Anderson model,enabling resources had a direct effect,and could also be affected by demand factors indirectly,the total effect value was 0.404;demand factors had direct impact,and the effect value was 0.193;propensity characteristics exerted impact indirectly through enabling resources and demand factors,and the total effect value was 0.176.Among them,the acceptance of community health service fees in the enabling resource dimension has the greatest impact(FL=

关 键 词：老年人 临终关怀医疗 影响因素 结构方程模型 安德森理论 

分 类 号：R48[医药卫生—临床医学]