School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
J Clin Nurs. 2023 Aug;32(15-16):4915-4931. doi: 10.1111/jocn.16640. Epub 2023 Feb 5.
To explore the trajectories of self-care behaviours in patients with chronic obstructive pulmonary disease based on the latent class growth model and investigate the predictors of each trajectory based on the capability opportunity motivation and behaviour model.
Studies on self-care behaviours of patients with chronic obstructive pulmonary disease are mainly cross-sectional surveys. However, little is known about longitudinal trends of self-care behaviours changes among those population.
This was a prospective observational research performed according to STROBE Checklist.
One hundred and nineteen patients with chronic obstructive pulmonary disease were followed up at baseline, 3 and 6 months. Data collection included the scores of self-care behaviours, specific demographic and clinical characteristics, and scores for the predictors. A latent class growth model was used to explore the self-care behaviours trajectories. Multiple logistic regression analysis was conducted to identify predictors of self-care behaviours trajectories.
Three trajectories in the self-care behaviours of patients with chronic obstructive pulmonary disease were found: a persistently negative trajectory, a maintenance trajectory after a slight increase and an active trajectory with a slow upward improvement in self-care behaviours. Medical insurance and access to medical resources were the predictors of self-care behaviours.
The patients with poor medical resources and medical insurance are at high risk for the poor self-care behaviours and the negative trajectory. Thus, dynamic and individualised intervention should be continuously provided to ensure patients acquire adequate medical resources to comprehensively improve self-care behaviours.
People with better self-care trajectory may be patients who receive more medical resources or have less financial burden, which will help with the early identification of high-risk patients with a negative self-care trajectory. Intervention guided by Behaviour Change Wheel Theory should be conducted dynamically for patients for patients with different trajectories.
Thank the patients and their families for their cooperation in data collecting in this study.
运用潜在类别增长模型探讨慢性阻塞性肺疾病患者自我护理行为的轨迹，并基于能力-机会-动机-行为模型探讨各轨迹的预测因素。
关于慢性阻塞性肺疾病患者自我护理行为的研究主要是横断面调查，而对于该人群中自我护理行为变化的纵向趋势知之甚少。
本研究是根据 STROBE 清单进行的前瞻性观察性研究。
对 119 例慢性阻塞性肺疾病患者进行了基线、3 个月和 6 个月的随访。数据收集包括自我护理行为评分、特定人口统计学和临床特征以及预测因素评分。采用潜在类别增长模型探讨自我护理行为轨迹，采用多因素逻辑回归分析确定自我护理行为轨迹的预测因素。
发现慢性阻塞性肺疾病患者的自我护理行为存在 3 种轨迹：持续负向轨迹、轻度增加后维持轨迹和自我护理行为缓慢向上改善的积极轨迹。医疗保险和获得医疗资源是自我护理行为的预测因素。
医疗资源和医疗保险较差的患者发生不良自我护理行为和负向轨迹的风险较高。因此，应持续提供动态和个体化干预，以确保患者获得足够的医疗资源，全面提高自我护理行为。
具有较好自我护理轨迹的人群可能是获得更多医疗资源或经济负担较小的患者，这有助于早期识别自我护理轨迹不良的高危患者。对于不同轨迹的患者，应根据行为改变轮理论进行动态干预。
感谢患者及其家属在本研究数据收集过程中的合作。
