维持性血液透析患者健康素养与衰弱间的链式中介作用

曹敏; 李琴; 冯莉; 马欣; 亢丽; 杨茜

doi:10.16766/j.cnki.issn.1674-4152.002900

维持性血液透析患者健康素养与衰弱间的链式中介作用

doi: 10.16766/j.cnki.issn.1674-4152.002900

曹敏¹,
李琴²,
冯莉³,
马欣²,
亢丽²,
杨茜^1, ,

1.
成都医学院护理学院，四川成都 610083
2.
成都医学院第一附属医院肾病科，四川成都 610500
3.
四川省第二中医医院护理部，四川成都 610014

基金项目:

国家自然科学基金项目 82200823

四川省中医药管理局科技项目 2021MS153

成都医学院研究生创新基金项目 YCX2022-01-46

详细信息

通讯作者:
杨茜，E-mail: 309167046@qq.com

中图分类号: R459.5
计量
- 文章访问数: 268
- HTML全文浏览量: 111
- PDF下载量: 16
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-12
- 网络出版日期: 2023-04-19

Chain mediating effect between health literacy and frailty in maintenance hemodialysis patients

CAO Min¹,
LI Qin²,
FENG Li³,
MA Xin²,
KANG Li²,
YANG Qian^{1
, ,}

1.
School of Nursing, Chengdu Medical College, Chengdu, Sichuan 610083, China

摘要

摘要: 目的探讨维持性血液透析患者社会支持和心理弹性在健康素养与衰弱间的多重中介作用，以期为衰弱管理策略的制定提供一定参考和依据。方法采用便利抽样法选取2021年11月—2022年4月四川省3所医院的382例维持性血液透析患者作为研究对象。使用一般资料调查问卷、慢性病患者健康素养量表、社会支持评定量表、心理弹性量表和Tilburg量表进行调查。使用Amos 23.0软件构建结构方程模型图，并检验链式中介模型。结果维持性血液透析患者健康素养、社会支持、心理弹性和衰弱得分分别为(94.23±11.49)分、(34.89±7.87)分、(63.20±14.26)分和3.00(2.00, 7.00)分。维持性血液透析患者社会支持、心理弹性在健康素养与衰弱间的特定中介效应和链式中介效应均成立，社会支持的特定中介效应占总效应的31.19%，心理弹性的特定中介效应占总效应的8.09%，链式中介效应占总效应的7.86%。结论维持性血液透析患者社会支持和心理弹性在健康素养与衰弱间的多重中介效应成立。医护人员应重视并采取针对性措施帮助患者树立健康信念，提高健康素养水平，拓展社会支持网络，开发心理弹性，进而改善衰弱症状。
- 衰弱 /
- 健康素养 /
- 社会支持 /
- 心理弹性 /
- 血液透析
Abstract: Objective To explore the multiple mediating roles of social support and psychological resilience between health literacy and frailty in patients with maintenance hemodialysis and to provide some reference and basis for the development of frailty management strategies. Methods A convenience sampling method was used to select 382 maintenance hemodialysis patients in three hospitals in Sichuan Province from November 2021 to April 2022 as the study population. The survey was conducted by using the general information questionnaire, health literacy management scale, social support rating scale, connor-davidson resilience scale and Tilburg scale. Amos 23.0 software was used to construct the structural equation-model diagram and perform the intermediary effect test. Results The scores of health literacy, social support, psychological resilience and frailty were (94.23±11.49) points, (34.89±7.87) points, (63.20±14.26) points and 3.00 (2.00, 7.00) points, respectively. The specific mediating effect and chain-mediating effect of social support and psychological resilience between health literacy and frailty were all established. The specific mediating effect of social support accounted for 31.19% of the total effect, and that of psychological resilience accounted for 8.09% of the total effect. The chain-mediating effect accounted for 7.86% of the total effect. Conclusion There are multiple mediating effects of social support and psychological resilience on maintenance hemodialysis patient ' s health literacy and frailty. Healthcare professionals should take targeted measures to help maintenance hemodialysis patients establish health beliefs, improve health literacy, expand social support networks, and develop psychological resilience, thereby improving frailty symptoms.
- Frailty /
- Health literacy /
- Social support /
- Psychological resilience /
- Hemodialysis

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图 1 链式中介效应模型图

Figure 1. Diagram of the chain mediation effect model

下载: 全尺寸图片幻灯片

表 1 382例MHD患者健康素养、社会支持、心理弹性和衰弱现状

Table 1. Health literacy, social support, resilience, and frailty status of 382 MHD patients

项目	条目	得分范围	得分
健康素养总分(x±s，分)	24	62~118	94.23±11.49
信息获取能力	9	24~45	34.08±5.32
交流互动能力	9	17~40	36.82±4.44
改善健康意愿	4	4~20	15.95±2.52
经济支持意愿	2	2~10	7.37±1.43
社会支持总分(x±s，分)	10	21~57	34.89±7.87
主观支持	4	10~32	18.98±4.54
客观支持	3	3~16	8.80±3.06
支持利用度	3	3~12	7.11±1.99
心理弹性总分(x±s，分)	25	22~97	63.20±14.26
坚韧性	13	7~52	32.37±8.85
力量性	8	6~32	20.57±5.08
乐观性	4	2~16	10.26±2.62
衰弱总分[M(P₂₅, P₇₅)，分]	15	0~14	3.00(2.00, 7.00)
身体衰弱	8	0~8	1.00(1.00, 3.00)
心理衰弱	4	0~4	1.00(0.00, 3.00)
社会衰弱	3	0~3	1.00(0.00, 2.00)

下载: 导出CSV

表 2 中介效应检验及Bootstrap分析的效应量

Table 2. Effect sizes of mediation effect tests and Bootstrap analyses

效应类型	路径	效应值	效应量 (%)	95% CI
直接效应	健康素养-衰弱	-0.222	52.86	-0.369~-0.068
间接效应1	健康素养-心理弹性-衰弱	-0.034	8.09	-0.089~-0.004
间接效应2	健康素养-社会支持-衰弱	-0.131	31.19	-0.229~-0.051
间接效应3	健康素养-社会支持-心理弹性-衰弱	-0.033	7.86	-0.073~-0.006
总间接效应		-0.198	47.14	-0.283~-0.123
总效应		-0.420	100.00	-0.544~-0.292

下载: 导出CSV

参考文献(26)

[1]	LEE H J, SON Y J. Prevalence and associated factors of frailty and mortality in patients with end-stage renal disease undergoing hemodialysis: a systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2021, 18(7): 3471. doi: 10.3390/ijerph18073471
[2]	LIU Y, MENG H D, TU N D, et al. The relationship between health literacy, social support, depression, and frailty among community-dwelling older patients with hypertension and diabetes in China[J]. Front Public Health, 2020, 8(2): 280.
[3]	陈管洁, 张海林. 维持性血液透析病人衰弱影响因素及干预研究进展[J]. 护理研究, 2021, 35(4): 669-672. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202104021.htm CHEN G J, ZHANG H L. Research progress on influencing factors and intervention of frailty in maintenance hemodialysis patients[J]. Chinese Nursing Research, 2021, 35(4): 669-672. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202104021.htm
[4]	蒋维连, 李芳, 杨平, 等. 老年慢性心力衰竭患者的多学科健康素养管理实践[J]. 中华全科医学, 2021, 19(3): 416-420. doi: 10.16766/j.cnki.issn.1674-4152.001825 JIANG W L, LI F, YANG P, et al. Multidisciplinary health literacy management practices in elderly patients with chronic heart failure[J]. Chinese Journal of General Practice, 2021, 19(3): 416-420. doi: 10.16766/j.cnki.issn.1674-4152.001825
[5]	HUANG C H, LAI Y C, LEE Y C, et al. Impact of health literacy on frailty among community-dwelling seniors[J]. J Clin Med, 2018, 7(12): 481. doi: 10.3390/jcm7120481
[6]	YUAN H H, ZHANG Y J, XUE G F, et al. Exploring psychosocial factors associated with frailty incidence among patients undergoing maintenance hemodialysis[J]. J Clin Nurs, 2020, 29(9-10): 1695-1703. doi: 10.1111/jocn.15225
[7]	侯瑞, 宋明芬, 亢俊俊, 等. 维持性血液透析患者疲乏影响因素及其与心理弹性、希望之间的相关性分析[J]. 中华全科医学, 2021, 19(2): 266-269. doi: 10.16766/j.cnki.issn.1674-4152.001784 HOU R, SONG M F, KANG J J, et al. Influencing factors of fatigue in maintenance hemodialysis patients and their correlation with psychological resilience and hope[J]. Chinese Journal of General Practice, 2021, 19(2): 266-269. doi: 10.16766/j.cnki.issn.1674-4152.001784
[8]	魏云, 朱大乔, 李玉梅. 成年人慢性病患者心理弹性对健康结局影响的研究进展[J]. 中国实用护理杂志, 2019, 35(5): 391-395. doi: 10.3760/cma.j.issn.1672-7088.2019.05.015 WEI Y, ZHU D Q, LI Y M. Research progress on the influence of resilience on health outcomes in adults with chronic diseases[J]. Chinese Journal of Practical Nursing, 2019, 35(5): 391-395. doi: 10.3760/cma.j.issn.1672-7088.2019.05.015
[9]	XIAO X L, XIAO J S, YAO J Q, et al. The role of resilience and gender in relation to infectious-disease-specific health literacy and anxiety during the COVID-19 pandemic[J]. Neuropsychiatr Dis Treat, 2020, 16: 3011-3021. doi: 10.2147/NDT.S277231
[10]	黄雷晶. 社会支持理论研究初探[J]. 心理月刊, 2020, 15(16): 238-239. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202016221.htm HUANG L J. A preliminary study of social support theory[J]. Psy, 2020, 15(16): 238-239. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202016221.htm
[11]	孙浩林, 彭慧, 傅华. 慢性病患者健康素养量表信效度的研究[J]. 复旦学报(医学版), 2012, 39(3): 268-272. doi: 10.3969/j.issn.1672-8467.2012.03.009 SUN H L, PENG H, FU H. Study on the reliability and validity of Health Literacy Scale for chronic disease patients[J]. Fudan University Journal of Medical Sciences, 2012, 39(3): 268-272. doi: 10.3969/j.issn.1672-8467.2012.03.009
[12]	肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994(2): 98-100. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS402.019.htm XIAO S Y. Theoretical basis and research application of Social Support Rating Scale[J]. Journal of Clinical Psychiatry, 1994(2): 98-100. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS402.019.htm
[13]	于肖楠, 张建新. 自我韧性量表与Connor-Davidson韧性量表的应用比较[J]. 心理科学, 2007, 30(5): 1169-1171. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX200705037.htm YU X N, ZHANG J X. Comparison of Self-Resilience Scale and Connor-Davidson Resilience Scale[J]. Journal of Psychological Science, 2007, 30(5): 1169-1171. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX200705037.htm
[14]	奚兴, 郭桂芳, 孙静. 中文版Tilburg衰弱评估量表的信效度研究[J]. 护理学报, 2013, 20(16): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201316000.htm XI X, GUO G F, SUN J. Reliability and validity of Chinese version of Tilburg Frailty Indicator[J]. Journal of Nursing, 2013, 20(16): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL201316000.htm
[15]	汤丹丹, 温忠麟. 共同方法偏差检验: 问题与建议[J]. 心理科学, 2020, 43(1): 215-223. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX202001030.htm TANG D D, WEN Z L. Statistical approaches for testing common method bias: problems and suggestions[J]. Journal of Psychological Science, 2020, 43(1): 215-223. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX202001030.htm
[16]	谢亚兰, 何彩云, 唐艳, 等. 维持性血液透析患者的健康素养现状及影响因素分析[J]. 齐鲁护理杂志, 2019, 25(6): 59-61. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL201906023.htm XIE Y L, HE C Y, TANG Y, et al. Status quo and influencing factors of health literacy in maintenance hemodialysis patients[J]. Journal of Qilu Nursing, 2019, 25(6): 59-61. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL201906023.htm
[17]	LUO Y, MURRAY A M, GUO Y D, et al. Cognitive impairment and associated risk factors in older adult hemodialysis patients: a cross-sectional survey[J]. Sci Rep, 2020, 10(1): 12542. DOI: 10.1038/s41598-020-69482-1.
[18]	康雄, 徐建萍, 王国红, 等. 维持性血液透析病人主观幸福感现状及其影响因素[J]. 护理研究, 2021, 35(11): 2032-2037. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202111036.htm KANG X, XU J P, WANG G H, et al. Status quo of subjective well-being of maintenance hemodialysis patients and its influencing factors[J]. Chinese Nursing Research, 2021, 35(11): 2032-2037. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202111036.htm
[19]	罗静, 张颖君, 陈林. 中青年维持性血液透析患者心理弹性与领悟社会支持及生活质量的相关性研究[J]. 中国血液净化, 2020, 19(5): 350-352. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJH202005017.htm LUO J, ZHANG Y J, CHEN L. Study on the correlation between resilience, perceived social support and quality of life in young and middle-aged maintenance hemodialysis patients[J]. Chinese Journal of Blood Purification, 2020, 19(5): 350-352. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJH202005017.htm
[20]	周雨婷, 蔡小霞, 林亚妹, 等. 老年维持性血液透析患者衰弱及其影响因素[J]. 中国老年学杂志, 2021, 41(8): 1667-1670. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202108036.htm ZHOU Y T, CAI X X, LIN Y M, et al. Status quo and its influencing factors of frailty in elderly maintenance hemodialysis patients[J]. Chinese Journal of Gerontology, 2021, 41(8): 1667-1670. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202108036.htm
[21]	SAGONG H, YOON J Y. Pathways among frailty, health literacy, acculturation, and social support of middle-aged and older Korean immigrants in the USA[J]. Int J Environ Res Public Health, 2021, 18(3): 1245.
[22]	马丹丹, 任洁, 乔够梅, 等. 膀胱癌尿流改道腹壁造口患者健康素养与社会支持及健康信念的相关性[J]. 护理学杂志, 2021, 36(17): 33-35. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202117009.htm MA D D, RENG J, QIAO G M, et al. Relationship among health literacy, social support and health belief in bladder cancer patients undergoing abdominal ostomy for urinary diversion[J]. Journal of Nursing Science, 2021, 36(17): 33-35. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202117009.htm
[23]	王璐, 何江娟. 器官移植受者心理弹性研究进展[J]. 护理研究, 2018, 32(22): 3518-3521. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201822010.htm WANG L, HE J J. Research progress on mental resilience of organ transplant recipients[J]. Chinese Nursing Research, 2018, 32(22): 3518-3521. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201822010.htm
[24]	庞建萍, 陈小军, 伍惠玲. 老年慢性心力衰竭患者疾病不确定感和健康素养现状及相关性分析[J]. 齐鲁护理杂志, 2020, 26(9): 99-102. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL202009035.htm PANG J P, CHEN X J, WU H L. Status quo and correlation analysis of the disease uncertainty and health literacy in elderly patients with chronic heart failure[J]. Journal of Qilu Nursing, 2020, 26(9): 99-102. https://www.cnki.com.cn/Article/CJFDTOTAL-QLHL202009035.htm
[25]	李亚娟, 岳荣铮. 维持性血液透析病人健康素养与症状负担、自我管理的相关性研究[J]. 蚌埠医学院学报, 2019, 44(12): 1713-1717. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG201912039.htm LI Y J, YUE R Z. Correlation of health literacy with symptom burden and self-management in maintenance hemodialysis patients[J]. Journal of Bengbu Medical College, 2019, 44(12): 1713-1717. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG201912039.htm
[26]	SEHGAL P, UNGARO R C, FOLTZ C, et al. High levels of psychological resilience associated with less disease activity, better quality of life, and fewer surgeries in inflammatory bowel disease[J]. Inflamm Bowel Dis, 2021, 27(6): 791-796.