自我效能感在塑造 2 型糖尿病成人自我管理行为中的中介作用。
The Mediating Role of Self-Efficacy in Shaping Self-Management Behaviors Among Adults With Type 2 Diabetes.
机构信息
School of Nursing, Peking University, Beijing, China.
School of International Nursing, Hainan Medical University, Haikou, China.
出版信息
Worldviews Evid Based Nurs. 2019 Apr;16(2):151-160. doi: 10.1111/wvn.12354. Epub 2019 Mar 21.
BACKGROUND
Self-efficacy, diabetes distress, knowledge, and education level are likely the important factors affecting diabetes self-management (DSM) behaviors. However, the theoretical mechanisms underlying these variables remain unclear.
AIMS
The study aimed to test a model including variables of self-efficacy, diabetes distress, knowledge, and education level and DSM behaviors that were informed by social cognitive theory and the literature review among adults with type 2 diabetes.
METHODS
A cross-sectional study design was employed. Among a convenience sample of 320 adults with type 2 diabetes, 265 eligible participants (response rate = 82.81%) were investigated, using the demographic information questionnaire, the Summary of Diabetes Self-Care Activities, the Self-Efficacy for Diabetes Scale, the Diabetes-Related Knowledge Questionnaire, and the Diabetes Distress Scale. Structural equation modeling was performed with 10,000 bootstrap samples using AMOS 23.0.
RESULTS
The final model provided a good fit to the data (χ [22, N = 265] = 9.192, df = 5, p = .102, NFI = 0.972, RMSEA = 0.056). Self-efficacy had the strongest direct effect on DSM behaviors (β = 0.550, p = .000). Knowledge (β = 0.167, p = .004) and employment status (β = -0.130, p = .009) had a direct effect on DSM behaviors. The association between knowledge and DSM behaviors was partially mediated by self-efficacy (bootstrap mean = 0.160, 95% CI: 0.088, 0.237), explaining 49.08% of the total effect of knowledge on DSM behaviors. The association between diabetes distress and DSM behaviors (bootstrap mean = -0.113, 95% CI: -0.192, -0.043) and education level and DSM behaviors (bootstrap mean = 0.102, 95% CI: 0.047, 0.165) were completely mediated by self-efficacy.
CONCLUSIONS
Self-efficacy plays an important role in the mediation of the association between knowledge and DSM behaviors, diabetes distress and DSM behaviors, and education level and DSM behaviors, as well as a direct contributing role in the predication of DSM behaviors.
LINKING EVIDENCE TO ACTION
Self-efficacy plays a direct contributing and mediating role in shaping DSM behaviors. The results of the model can help to develop evidence- and theory-based and culturally sensitive interventions. Strategies including goal setting, practicing, recording, peer models, persuasion, positive feedback, and encouragement can be used to address self-efficacy of patients. Interventions led by nurses that increase knowledge, reduce diabetes distress, and emphasize self-efficacy have the potential to promote changes in DSM behaviors.
背景
自我效能感、糖尿病困扰、知识和教育水平可能是影响糖尿病自我管理（DSM）行为的重要因素。然而，这些变量背后的理论机制仍不清楚。
目的
本研究旨在检验一个模型，该模型包括自我效能感、糖尿病困扰、知识和教育水平等变量，这些变量是基于社会认知理论和文献综述，在 2 型糖尿病成年人中进行的。
方法
采用横断面研究设计。在 320 名 2 型糖尿病成年人的便利样本中，对 265 名符合条件的参与者（应答率为 82.81%）进行了调查，使用的问卷包括人口统计学信息问卷、糖尿病自我护理活动概述、糖尿病自我效能感量表、糖尿病相关知识问卷和糖尿病困扰量表。使用 AMOS 23.0 进行了 10,000 次 bootstrap 样本的结构方程建模。
结果
最终模型与数据拟合良好（χ[22，N=265]=9.192，df=5，p=0.102，NFI=0.972，RMSEA=0.056）。自我效能感对 DSM 行为的直接影响最大（β=0.550，p=0.000）。知识（β=0.167，p=0.004）和就业状况（β=-0.130，p=0.009）对 DSM 行为有直接影响。知识与 DSM 行为之间的关联部分通过自我效能感（bootstrap 均值=0.160，95%CI：0.088，0.237）介导，解释了知识对 DSM 行为总效应的 49.08%。糖尿病困扰与 DSM 行为（bootstrap 均值=-0.113，95%CI：-0.192，-0.043）和教育水平与 DSM 行为（bootstrap 均值=0.102，95%CI：0.047，0.165）之间的关联完全由自我效能感介导。
结论
自我效能感在知识与 DSM 行为、糖尿病困扰与 DSM 行为以及教育水平与 DSM 行为之间的关联的中介中起着重要作用，并且对 DSM 行为的预测也起着直接的贡献作用。
实践意义
自我效能感在塑造 DSM 行为方面起着直接贡献和中介作用。该模型的结果可以帮助制定基于证据和理论且具有文化敏感性的干预措施。可以使用目标设定、练习、记录、同伴模型、说服、积极反馈和鼓励等策略来解决患者的自我效能感问题。由护士主导的干预措施，增加知识、减少糖尿病困扰并强调自我效能感，有可能促进 DSM 行为的改变。
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