基于社会生态学模型和理论域框架的社区老年2型糖尿病病人自我管理影响因素的质性研究  

Influencing factors of self-management in elderly type 2 diabetes patients in community based on socio-ecological model and theoretical domain framework:a qualitative study

作　　者：李笑琳 黄霞[2] 贾培培[2] 郭晓菡 王宁[1] 祝凯[2] LI Xiaolin;HUANG Xia;JIA Peipei;GUO Xiaohan;WANG Ning;ZHU Kai(School of Nursing,Qingdao University,Shandong 266071 China)

机构地区：[1]青岛大学护理学院,266071 [2]青岛大学附属医院,266000

出　　处：《全科护理》2024年第20期3882-3886,共5页Chinese General Practice Nursing

基　　金：青岛大学纵向科研项目,编号:RZ2100005113。

摘　　要：目的:结合病人和医护人员的不同视角分析社区老年2型糖尿病病人自我管理的影响因素,以选择更有针对性和全面性的行为改变技术。方法:2022年8月—11月基于社会生态学模型设计访谈提纲,采用目的抽样法抽取青岛市不同社区的11例老年2型糖尿病病人以及8名医护人员进行半结构式访谈,采用主题框架分析法,基于理论域框架对访谈资料进行演绎分类,采用内容分析法归纳总结。结果:共提炼出4个主题与19个亚主题,即病人个人层面(知识、技能、情绪、乐观、结果信念、能力信念、社会/职业角色认同、记忆力/注意力及决策过程、目标、强化、意向、行为调节、环境和资源)、社区环境层面(环境和资源、社会/职业角色认同、意向、能力信念)、人际关系层面(社会影响)、政策环境层面(环境和资源)。结论:社区老年2型糖尿病病人自我管理行为的维持受多重因素影响,需识别和关注行为改变的潜在决定因素,以便针对因素选择有效的个体化行为改变技术,进而规范病人自我管理行为。Objective:To combine the different perspectives of patients and medical staff to analyze the influencing factors of self-management of elderly type 2 diabetes patients in the community,so as to select more targeted and comprehensive behavior change techniques.Methods:From August to November 2022,the interview outline was designed based on the social ecological model,and 11 elderly patients with type 2 diabetes and 8 medical workers from different communities in Qingdao were selected by the purpose sampling method for semi-structured interviews.The interview data were deductively classified based on the theoretical domain framework by the subject framework analysis method,and summarized by the content analysis method.Results:A total of 4 themes and 19 sub-themes were extracted.That is,the patient′s personal level(knowledge,skills,emotions,optimism,outcome beliefs,ability beliefs,social/occupational role identity,memory/attention and decision making,goals,reinforcement,intention,behavioral regulation,environment and resources),the community environment level(environment and resources,social/occupational role identity,intention,ability beliefs),the interpersonal level(social impact),and the policy circle environmental dimension(environment and resources).Conclusions:The maintenance of self-management behavior in elderly patients with type 2 diabetes mellitus in the community is affected by multiple factors,and it is necessary to identify and pay attention to the potential determinants of behavior change,so as to select effective individualized behavior change techniques according to the factors,and then standardize the self-management behavior of patients.

关 键 词：社区 2型糖尿病 社会生态学模型 理论域框架 自我管理 质性研究 

分 类 号：R473.2[医药卫生—护理学]