| Risk perception is people’s comprehension and cognition on risk. Risk perception level related to people’s understanding of nature of risk, and it is also affected by the social-cultural factors and individual psychological cognition factors. The uncertainty of medical procedures and medical results, making health risks everywhere. Perception characteristics of medical risk will affect the medical care behavior of medical staff and their professional attitude, it can also affect the decision-making process of patients and adherence to treatment. So, in the field of medical, research risk perception has caught people’s attention. Chronic disease onset hidden, long duration, may increase not more, in the process of the treatment of diseases, patients often face various risks, how do they actually perceive these risks, what are the characteristics and influencing factors, at present, the related research is less. So, this topic on the basis of previous research, chronic diseases as the object, risk perception as the breakthrough point, integrated applied qualitative research and Delphi method, developed chronic diseases risk perception questionnaire. On this basis, used the survey research methods, to hypertension patients, diabetics, coronary patients, COPD patients, cancer patients as the research object, discussed risk perception characteristics and its influencing factors, the significance was understand the characteristics and regularity of risk perception on chronic diseases patients, to guide patients accurate judgment, understanding the various risks in the process of medical treatment, in order to increase the effectiveness of medical behavior decision-making, construct chronic diseases patients risk perception model and risk early warning mechanism to provide experimental basis.Objective 1.To clear risk perception structure dimension of chronic disease patients, develop the chronic patients’ risk perception questionnaire. 2. To determine the influence factors of risk perception of chronic disease patients. 3. Explore the relationship between risk perception and doctor-patient trust.Methods 1.On the basis of consulting literature materials, through the qualitative interviews and Delphi expert enquiry, formed risk perception evaluation questionnaire of chronic patients. Investigation of xi ’an in 3 first-class ternary hospitals, 315 cases of patients with chronic diseases, through correlation analysis, internal consistency check, homogeneity and load factor evaluation, factor analysis and other statistical analysis, to establish the initial questionnaire. 2. Used convenient sampling method, extraction of xi ’an 3 general hospitals, 210 cases of chronic patients, to verify the reliability and validity of the questionnaire, used the internal consistency reliability, split-half reliability, retest reliability, structure validity and confirmatory factor analysis and so on. 3. Used the risk perception questionnaire of chronic patient, to analyse 492 chronic patients’ risk perception of five general hospital in xi ’an. Then used Pearson correlation and multiple linear regression, to analyse the influence factors of chronic patients’ risk perception.Results 1. The development of chronic patients’ risk perception questionnaire 1.1 Preliminary developed the chronic patients risk perception questionnaire Through qualitative interviews, expert enquiry, correlation analysis, internal consistency check, homogeneity and load factor evaluation, factor analysis and other statistical methods, established the three dimensions(economic risks, physical diagnosis risk, psychosocial risk), 12 items of chronic patients’ risk perception assessment tool. Likert-5 grade evaluation method were adopted in this questionnaire, Among them, the theory of total of 12 ~ 60 points, theory score of economic risk, physical diagnosis risk, psychosocial risk respectively were 4 ~ 20 points, 5 ~ 25 points, 3 ~ 15 points. The higher the score, the higher risk perception level. Through exploratory factor analysis, three common factor extraction, cumulative variance contribution rate of 72.96%. 1.2 Verify and determine the chronic patient risk perception questionnaire This study of total Cronbach ’s alpha coefficient of the chronic patients’ risk perception evaluation tool was 0.884, the Cronbach ’s alpha coefficients of economic risk, physical diagnosis risk and psychosocial risk respectively were 0.826, 0.870, 0.832, split-half reliability was 0.756, retest reliability was 0.982, content validity was 0.943. Confirmatory factor analysis results showed that model fitting was good(2/df=4.207, RMSEA=0.042, AGFI=0.746, CFI=0.959, NFI=0.933) 2. The present situation and influence factors of the chronic patients’ risk perception 2.1 The present situation of chronic patients’ risk perception In the 492 chronic diseases patients, risk perception total score, economic risk score, physical diagnosis risk and psychosocial risk score were 39.90±8.50, 14.87± 3.62, 17.59 ±4.13, 7.43±2.70. Based on the mean line, High level group was higher than mean, below mean for the low level group. Results: the proportion of high risk perception of total score was 57.10%, the proportion of low risk perception of total score account for 42.90%; the proportion of high economic risk score was 61.60%, the proportion of low economic risk score was38.40%; the proportion of low risk perception of total score account for 42.90%; the proportion of high physical diagnosis risk score was 58.1%, the proportion of lowphysical diagnosis risk score was 41.9%; the proportion of high psychosocial risk score was 41.9%%, the proportion of low psychosocial risk score was 58.1%.Risk perception characteristics of chronic diseases patients was the overall level of risk perception was relatively higher, the proportion of high economic risk and physical diagnosis risk groups exceeded 50%. ①Sex:Female patients’ economic risk, physical diagnosis risk and risk perception total score were higher than males(15.57±3.34 VS 14.32±3.75; 18.00±3.86 VS 17.22±4.33; 41.05±7.94 VS 38.91±8.89). ②Age:66 ~ 75 years old patients’ economic risk perception level was significantly lower than 46 ~ 55 and 56 ~ 65- year- old patients(14.04±3.82 Vs 15.10±3.56; 14.04±3.82 Vs 15.49±3.46);56~65 years old patients’ physical diagnosis risk perception level is significantly higher than 36 ~ 45, 66 ~ 75- year- old patient(18.39±3.78 Vs 16.81±4.56; 18.39±3.78 Vs 16.92±4.60). ③Course of disease: course of 11 ~ 20 years of patients’ physical diagnosis risk perception were significantly higher than the patients of that of course 3 ~ 10 years(18.91±4.13 VS 17.38±4.15). ④Marital status: married patients’ risk perception total score and economic risk perception were significantly lower than unmarried patients’(34.00±7.37 Vs 40.50±10.48; 11.71±4.07 Vs 14.94±4.09),divorce patients’(34.00±7.37 Vs 39.84±8.53; 11.71±4.07 Vs 14.93±3.59), widowed patients’(34.00±7.37 Vs 41.21±7.75; 11.71±4.07 Vs 15.25±3.37). ⑤Domicile place:rural patients’ economic risk, physical diagnosis risk and risk perception total score were significantly higher than the city patients’(15.96±3.25VS13.81±3.66;18.14±4.03 VS 17.00±4.19;41.74±7.91 VS 38.02±8.75). ⑥With or without children:patients who had children, the economic risk, physical diagnosis risk and risk perception total score were significantly higher than patients who without children(14.95±3.58 Vs 13.50±4.03; 17.67±4.09 Vs 16.12±4.47; 40.07±8.14 Vs 36.81±9.42). ⑦Educational attainment: economic risks: bachelor degree and above group and junior college degree group economic risks were respectively lower than primary schooland below level group, junior high school level group, high school level group(12.70±3.90 VS 16.40±3.17; 12.70±3.90 VS 15.92±3.24; 12.70±3.90 VS 14.31±3.30; 12.93±3.81 VS 16.40±3.17; 12.93±3.81 VS 15.92±3.24; 12.93±3.81 VS 14.31±3.30); primary school and below level group economic risks higher than junior high school level group, junior high school level group economic risks was higher than high school level group(16.40±3.17 VS 15.92±3.24; 15.92±3.24 VS 14.31±3.30). Physical diagnosis risk: primary school and below level group physical diagnosis risk was higher than junior high school level group, high school level group, junior college group, bachelor degree and above group(19.04±3.21 VS 17.62±4.41; 19.04±3.21 VS 17.39±3.98; 19.04±3.21 VS 16.65±4.16; 19.04±3.21 VS 15.50±4.85); junior high school level group physical diagnosis risk was higher than bachelor degree and above group(17.62±4.41 VS 15.50±4.85). Psychosocial risk: primary school and below level group psychosocial risk was respectively higher than junior high school level group, high school level group, junior college degree group and bachelor degree and above group(8.26±2.97 VS 7.32±2.57; 8.26±2.97 VS 7.01±2.39; 8.26±2.97 VS 7.57±2.99; 8.26±2.97 VS 6.75±2.67). Total score: primary school and below level group risk perception total score was higher than junior high school level group, high school level group, junior college degree group and bachelor degree and above group(43.69±7.14 VS 40.85±8.44; 43.69±7.14 VS 38.72±7.70; 43.69±7.14 VS 37.15±8.85; 43.69±7.14 VS 34.95±10.15); junior high school level group risk perception total score was higher than high school level group, junior college degree group and bachelor degree and above group(40.85±8.44 VS 38.72±7.70; 40.85±8.44 VS 37.15±8.85; 40.85±8.44 VS 34.95±10.15); high school level group risk perception total score was higher than bachelor degree and above group(38.72±7.70 VS 34.95±10.15). ⑧Occupation: economic risk: peasants’ economic risk perception was significantly higher than the workers’(16.47±2.78 Vs 13.57±3.63),cadres’(16.47±2.78 Vs 12.95±3.98), teachers’(16.47±2.78 Vs 14.59±1.70), medical staff’s(16.47±2.78 Vs 13.25±2.96), retire patients’(16.47±2.78 Vs 13.50±3.80), and other vocational patients’(16.47±2.78 Vs14.88±3.95); other vocational patients’ was significantly higher than cadres’ and retire patients’(14.88±3.95 Vs 12.95±3.98;14.88±3.95 Vs13.50±3.80). Physical diagnosis risk: peasants’ physical diagnosis risk perception was significantly higher than the workers’(18.53±3.75 Vs 16.56±3.92),cadres’(18.53±3.75 Vs 16.61 ± 4.82), and retire patients’(18.53±3.75 Vs 16.76±4.05). Psychosocial risk: retire patients’ psychosocial risk was significantly lower than the workers’(6.50±2.17 Vs 7.37±2.29),peasants’(6.50±2.17 Vs 7.71±2.82),cadres’(6.50±2.17 Vs 7.50±2.59), teachers’(6.50±2.17 Vs 8.00±2.69),and other vocational patients’(6.50± 2.17 Vs 8.42±3.26). Total score: peasants’ total score was significantly higher than the workers’(42.72±7.28 Vs 37.50±8.17),cadres’(42.72±7.28 Vs 37.05±10.37),and retire patients’(42.72±7.28 Vs 36.76±8.01). ⑨Income: economic risk: income less than 1000 yuan patients’ economic risk perception level was significantly higher than the income in 1000 ~ 2999 yuan patients’(17.94±1.80 Vs 15.94±2.82),3000~4999 yuan patients’(17.94±1.80 Vs 12.64± 3.76),more than 5000 yuan patients’(17.94±1.80 Vs 13.15±3.64); Physical diagnosis risk: income less than 1000 yuan patients’ physical diagnosis risk was significantly higher than the income in1000 ~ 2999 yuan patients’(19.78±2.96 Vs 18.11±3.79), 3000~4999 yuan patients’(19.78±2.96 Vs 16.29±4.47), more than 5000 yuan patients’(19.78±2.96 Vs 16.41±4.44); Psychosocial risk: income 3000~4999 yuan patients’ psychosocial risk was significantly lower than the income less than 1000 yuan patients’(7.02±2.83 Vs 7.96±2.66), 1000 ~ 2999 yuan patients’(7.02±2.83 Vs 7.66±2.64); Total score: income less than 1000 yuan patients’ risk perception total score was higher than income in 1000 ~ 2999 yuan patients’(45.67±5.53 Vs 41.71±7.36), 3000~4999 yuan patients’(45.67±5.53 Vs 35.96±9.00), and income more than 5000 yuan patients’(45.67±5.53 Vs 36.46±9.02); income in 1000 ~ 2999 yuan patients’ risk perception total score was higher than 3000~4999 yuan patients’(41.71±7.36 Vs 35.96±9.00) and income more than 5000 yuan patients’(41.71±7.36 Vs 36.46±9.02).⑩Medical payment method : economic risk: rural cooperative medical service patients’ economic risk perception level was significantly higher than at public expense patients’(16.21±2.99 Vs 12.67±3.60), medical insurance patients’(16.21±2.99 Vs 13.76±3.74); Physical diagnosis risk: rural cooperative medical service patients’ physical diagnosis risk was significantly higher than medical insurance patients’(18.42±3.88 Vs 16.83±4.23); Total score: rural cooperative medical service patients’ risk perception total score was significantly higher than public expense patients’(42.33±7.67 Vs 38.00±9.52) and medical insurance patients’(42.33±7.67 Vs 37.77±8.69). 2.3 The study the influence of doctor-patient trust to risk perception of chronic diseases patients results displayed: the correlation coefficient of chronic patients’ risk total score,kindly dimension and technical skills dimension were-0.261,-0.886,-0.185(P<0.01). Multiple linear stepwise regression analysis showed that chronic doctor-patient trust and kindly dimension have negative impact on risk perception, regression coefficients were-0.645,-0.883(P<0.01).Conclusion 1.This study constructed the chronic patient risk perception evaluation tool had good reliability and validity, it can measure the chronic patient risk perception. 2.The related factors influencing the chronic patient risk perception were age, gender, registered permanent residence, course of disease, marital status, education, occupation, family per capita monthly income, medical payment method. 3.It was negative correlation with the chronic patients’ risk perception in doctor-patient trust, technical skills and kindheartedness, the influence factors of chronic patient risk perception was doctor-patient trust and kindheartedness. The higher the patient’s trust in the physician, the lower their risk perception level; the higher level of doctor to the patient’s kindheartedness, the lower patients’ risk perception level; and vice versa. |
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