保护动机在2型糖尿病患者健康素养与自我管理行为间的中介效应 [中文引用][英文引用]

目的  探讨 2 型糖尿病患者的保护动机在健康素养与自我管理行为间的中介效应。方法  采取便利抽样法，于2022 年 10 月至 2024 年 1 月在北京市某三级乙等综合医院内分泌科选取 380 例 2 型糖尿病患者作为研究对象，采用一般资料问卷、糖尿病自我管理活动问卷（summary of diabetes self-care activities，SDSCA）、2 型糖尿病患者自我护理保护动机量表和糖尿病健康素养量表（diabetes health literacy scale，HLS）进行问卷调查。应用 Pearson 相关分析健康素养、自我护理保护动机和自我管理行为的相关关系，应用 SPSS 中的 Process 插件，采用偏差校正的 Bootstrap 法检验保护动机在健康素养与自我管理行为间的中介效应。结果  共 351 例患者完成研究。2 型糖尿病患者的 SDSCA、自我护理保护动机和 HLS 的条目均分分别为（4.4±1.5）分、（3.5±0.7）分和（2.8±0.5）分，均处于中等水平。患者的自我护理保护动机、HLS 得分均与其 SDSCA 得分呈正相关（r=0.326，P<0.01；r=0.131，P<0.05）。健康素养对自我管理行为的总效应值为 0.369（95%CI：0.073~0.664，P<0.05），其中健康素养对自我管理行为的直接效应值为 0.180（95%CI：-0.109~0.470，P>0.05），占总效应的 48.8%，保护动机在健康素养与自我管理行为之间的中介效应值为 0.189（95%CI：0.084~0.320，P<0.05），占总效应的 51.2%。结论  保护动机是健康素养与自我管理行为的中介变量，临床护理人员在提升患者健康素养基础上，可采取针对性的护理策略激发患者的自我护理保护动机，进而促进自我管理行为的形成。

Objective To examine whether a protective motivation mediates the relationship between health literacy and selfmanagement in the patients with Type II diabetes. Methods From October 2022 to January 2024，380 patients with Type II diabetes were recruited from the Department of Endocrinology of a Tier-IIIA hospital in Beijing with convenience sampling method. Data were collected with a general information questionnaire，the summary of diabetes self-care activities，the self care protection motivation scale and the diabetes health literacy scale. Pearson correlations were used to analyse the associations among health literacy，protective motivation and self-management. Bias-corrected bootstrapping was used to examine the mediating role of protective motivation. Results Complete data were acquired from 351 patients. Standardised mean scores of self-management，protective motivation， and health literacy were 4.4±1.5，3.5±0.7 and 2.8±0.5，respectively. Both protective motivation and health literacy were positively correlated with self-management（r=0.326，P<0.01；r=0.131，P<0.05）. The total effect value of health literacy on self-management was 0.369（95%CI：0.073~0.664，P<0.05）. The direct effect value of health literacy on self-management was 0.180（95%CI：-0.109~0.470， P>0.05），accounting for 48.8% of the total effect. The value of mediating effect on protective motivation between health literacy and selfmanagement was 0.189（95%CI：0.084-0.320，P<0.05），accounting for 51.2% of the total effect. Conclusion Protective motivation significantly mediates the relationship between health literacy and self-management behaviour. Interventions that strengthen health literacy may enhance the self-management by improving protective motivation.