Ding Weiwei, Li Tong, Su Qiying, Yuan Maohua, Lin Aihua
Department of Epidemiology and Health Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China,
Department of Chronic Disease Management, Dadong Community Healthcare Center, Guangzhou, Guangdong, China.
Patient Prefer Adherence. 2018 Oct 15;12:2169-2178. doi: 10.2147/PPA.S180314. eCollection 2018.
Hypertension is considered a major public health issue worldwide because of its high frequency and concomitant risk of cardiovascular disease (CVD). Chronic-disease self-management has been proven to be cost-effective, but influencing factors and pathways remain complex and unclear. The purpose of this study was to integrate factors associated with hypertension self-management to provide a theoretical reference for community hypertension management.
A total of 268 community-dwelling hypertensive patients were enrolled in a cross-sectional study conducted from July to September in 2017. A questionnaire on demographic-disease characteristics, disease knowledge, social support, self-efficacy, and self-management was completed by patients. Structural equation modeling was performed to verify multiple factors in self-management based on the self-efficacy theory.
The final model showed a good fit to sample data, ie, younger patients with lower CVD risk, shorter disease course, and less disease knowledge and social support predicted less self-efficacy, less hypertension self-management, and less controlled hypertension. Furthermore, social support was negatively correlated with age, CVD risk, and disease course and positively with disease knowledge.
Medication adherence is the lowest dimension in self-management, and self-efficacy is vital to consider in the development of self-management interventions. Self-management education and mutual-help groups may be potential solutions with the power of technology. Younger patients with lower CVD risk and shorter disease course are vulnerable and need more attention.
由于高血压的高发病率以及随之而来的心血管疾病（CVD）风险，它被视为全球主要的公共卫生问题。慢性病自我管理已被证明具有成本效益，但其影响因素和途径仍然复杂且不明确。本研究的目的是整合与高血压自我管理相关的因素，为社区高血压管理提供理论参考。
2017年7月至9月，共有268名社区高血压患者参与了一项横断面研究。患者完成了一份关于人口统计学-疾病特征、疾病知识、社会支持、自我效能感和自我管理的问卷。基于自我效能理论，采用结构方程模型来验证自我管理中的多种因素。
最终模型与样本数据拟合良好，即心血管疾病风险较低、病程较短、疾病知识和社会支持较少的年轻患者，其自我效能感较低、高血压自我管理较少且血压控制较差。此外，社会支持与年龄、心血管疾病风险和病程呈负相关，与疾病知识呈正相关。
药物依从性是自我管理中最低的维度，自我效能感在自我管理干预措施的制定中至关重要。自我管理教育和互助小组可能是借助技术力量的潜在解决方案。心血管疾病风险较低且病程较短的年轻患者较为脆弱，需要更多关注。
