Study On Self-Management Behavior Of Patients With Diabetic Multimorbidity Based On Interaction Model Of Client Health Behavior

Objective:To understand the current situation of self-management behavior of patients with diabetic multimorbidity;to identify the factors that affect the self-management behavior of this group;and to explore the mechanism of influencing factors of self-management behavior of patients with diabetic multimorbidity from the perspective of psychological level and interpersonal interaction based on the Interaction Model of Client Health Behavior(IMCHB),in order to provide a reference for improving self-management behavior and formulating targeted nursing interventions.Methods:This study was a cross-sectional survey study in a non-experimental study.From April to September 2021,it was convenient to select 323 patients with diabetic multimorbidity who met the inclusion criteria in a grade-A tertiary hospital in Jilin Province for a questionnaire survey.The research tools included:general information questionnaire,multidimensional health locus of control scale(MHLC-B),patient perceptions of patient-empowering nurse behaviors scale(Chinese version PPPNBS),and the summary of diabetes self-care activities(SDSCA).SPSS26.0 was used for descriptive analysis,univariate analysis,Pearson correlation analysis,multiple stepwise regression analysis,and AMOS24.0 was used to construct the structural equation model.P<0.05 indicated statistically significant differences.Results:(1)Characteristics of participants:The average age of the 323 subjects was65.14±11.26(29～89)years old,including 178 males(55.1%),172 Hans(53.3%),203 urban residents(62.8%).92 patients(28.5%)had primary school education or below,164 patients(50.8%)had a course of diabetes of more than 10 years,148 patients(45.8%)had insulin injection,205 patients(63.5%)had glycosylated hemoglobin(HbA1c)≥ 7%,and 90 patients(27.9%)took multiple drugs every day.(2)Self-management behavior,health locus of control and empowerment of participants:The score of self-management behavior was 21.04 ± 5.18(7～39.5),including 2 patients(0.6%)of good self-management behavior,264 patients(81.7%)of medium self-management behavior,57 patients(17.6%)of poor self-management behavior.The score of internal health locus of control(I-HLC)was(27.48±2.88),the score of powerful-others health locus of control(P-HLC)was(29.31±3.36),and the score of chance health locus of control(C-HLC)was(16.85±5.71).The scores of P-HLC and C-HLC were higher than the domestic norm(both P<0.001),the score of I-HLC was lower than the domestic norm(P<0.001),and the participants preferred P-HLC.The score of empowerment was 211.93±14.79(151～252).(3)Correlation between health locus of control,empowerment and self-management behavior:I-HLC was positively correlated with empowerment(r=0.213.P<0.01)and self-management behavior(r=0.502.P<0.01);P-HLC was positively correlated with empowerment(r=0.206.P<0.01)and self-management behavior(r=0.229,P<0.01);C-HLC was negatively correlated with empowerment(r=-0.205,P<0.01)and self-management behavior(r=-0.130.P<0.05);empowerment was positively correlated with self-management behavior(r=0.395,P<0.01).(4)The influencing factors of self-management behavior of participants:age,course of diabetes,insulin injection,accompanying care,health education,I-HLC,P-HLC,C-HLC and empowerment,which jointly explained 49.5%of the total variance.(5)The influence path of health locus of control and empowerment on self-management behavior:The fit index of the structural equation model of the relationship between I-HLC,empowerment and self-management behavior was:χ2/df<3,GFI,AGFI,NFI,IFI,CFI>0.9,PNFI,PCFI>0.5,RMESA<0.08;the fit index of the structural equation model of the relationship between P-HLC,empowerment and self-management behavior was the same as above,and the fitting result was better.Empowerment had a partial mediating effect between I-HLC and self-management behavior,and the mediating effect accounted for 12.36%;empowerment had a partial mediating effect between P-HLC and self-management behavior,and the mediating effect accounted for 29.81%.Conclusion:(1)The self-management behavior of patients with diabetic multimorbidity is at a medium and low level,which needs to be improved;the health locus of control tends to be P-HLC,which needs dialectical nursing according to the psychological characteristics of patients;empowerment is at a medium level and needs to be improved.(2)The higher the I-HLC score,the better the level of empowerment and the better the self-management behavior;the higher the P-HLC score,the better the level of empowerment and the better the self-management behavior;the higher the C-HLC score,the worse the level of empowerment and the worse the self-management behavior;the higher the level of empowerment,the better the self-management behavior.(3)Based on IMCHB,the influencing factors of self-management behavior of patients with diabetic multimorbidity are summarized as demographic characteristics:age;social influence:accompanying care;previous health care experience:course of diabetes,insulin injection,health education;psychological factors:I-HLC,P-HLC,C-HLC;interaction factor:empowerment.(4)Empowerment plays a partial mediating role between I-HLC and self-management behavior,and empowerment plays a partial mediating role between P-HLC and self-management behavior.