家庭健康与慢性病控制:健康素养、健康行为与基层服务信任度的中介作用  

Family Health and Chronic Disease Control:the Mediating Role of Health Literacy,Health Behavior and Trust in Primary Care Services

作　　者：李浩淼 吴一波 孙菊[1] 姚强[1] LI Hao-miao;WU Yi-bo;SUN Ju;YAO Qiang(School of Political Science and Public Administration,Wuhan University,Wuhan 430072,China;School of Public Health,Peking University,Beijing 100191,China)

机构地区：[1]武汉大学政治与公共管理学院,湖北武汉430072 [2]北京大学公共卫生学院,北京100191

出　　处：《人口与发展》2023年第5期145-160,共16页Population and Development

基　　金：国家社会科学基金一般项目“城乡居民医疗保险基金风险评估与管控机制研究(16BGL150)”;国家自然科学基金面上项目“激励相容视角下农村居民慢性病经济风险协同治理机制研究(项目号:72174149)”的资助

摘　　要：本研究旨在分析家庭健康对慢性病控制水平的影响,并探讨可能的作用机制。方法:基于2022年开展的一项全国性横断面调查数据,使用中文简化版家庭健康量表测度家庭健康水平,使用健康相关生命质量(由健康效用和EQ-VAS分别测量)和自感慢病控制程度表征慢性病控制水平,将健康素养、健康行为(吸烟、饮酒、运动、久坐)、基层慢性病管理服务信任度作为潜在中介变量,通过普通最小二乘法回归模型分析家庭健康对慢性病控制水平的影响,然后基于Sobel中介效应检验和KHB分解法,分析家庭健康对慢病管理效果作用的路径及中介效应大小。结果:家庭健康水平与慢性病控制水平呈显著正相关;慢性病患者较高的健康素养、健康行为如减少吸烟、增强运动、减少久坐等、基层服务(签约服务、慢性病管理服务)高信任度,在家庭健康与慢性病控制水平的正相关关系中发挥显著中介效应。结论:需要重视家庭健康在慢性病管理中的重要意义,增强家庭内部关系,有针对性地弥补家庭结构和功能上的空缺,增强家庭的外部支持,完善家庭社会网络,以家庭为单位开展慢性病管理和控制,并逐步建立起“个人-家庭-社区-服务体系”多方联动的慢性病管理模式,提升管理效能。This study aims to analyze the association between family health and control level of chronic disease,and explore the possible mechanism.Method:Based on the data of a national cross-sectional survey conducted in 2022,family health was measured by a short form of family health scale,and chronic disease controlling status was measured by health-related quality of life(including health utility and EQ-VAS)and self-assessed degree of chronic disease control.Health literacy,health behaviors(smoking,drinking,exercise and sedentary),and trust in primary chronic disease management services were used as potential mediators.The association between family health and control level of chronic disease was assessed by ordinary least squares regression model.Mediating effects,as well as effect sizes,were assessed through Sobel mediation effect test and KHB decomposition method.Results:The study found that family health was significantly positively correlated with the level of chronic disease control.Higher health literacy,health behaviors such as reducing smoking,increasing exercise,reducing sedentary,and high trust in primary care services(family doctor contract services,and chronic disease management services)play significant mediating effects in the positive correlation between family health and chronic disease control level.Conclusion:It is necessary to pay attention to the importance of family health in the management of chronic diseases,strengthen the relationship within the family,make up for the gaps in family functions,strengthen the external support of the family,improve the family social network,and carry out the management and control of chronic diseases with the family as a unit,and gradually establish a multi-party chronic disease management model of“personal-family-community-service system”to improve management efficiency.

关 键 词：家庭健康 慢性病 健康相关生命质量 自感控制程度 健康素养 健康行为 服务信任度 

分 类 号：C913.4[经济管理]