Analysis Of Influence Factors Of Self-management Behavior Among Diabetic Patients Based On The Health Belief Model

Objective:The self-management behavior of diabetic patients was investigated by(DSMQ),which revealed the current situation of self-management behavior of diabetic patients.Taking the health belief model(HBM)as the theoretical framework,the questionnaire of influencing factors of self-management behavior was developed to provide a reliable tool for the objective evaluation of the influencing factors of self-management behavior of diabetic patients.The structural equation model was constructed to explore the factors affecting the self-management behavior of diabetic patients,and to provide the basis for carrying out health education activities and formulating effective intervention measures.Methods:438 diabetic patients who were hospitalized in a comprehensive tertiary first-class hospital were selected by fixed-point continuous sampling.Based on the Chinese version of diabetes self-management behavior scale(DSMQ)and the health belief model(HBM)as the theoretical framework,a self-designed questionnaire on the influencing factors of self-management behavior of diabetic patients was used to investigate the risk factors of self-management behavior of diabetic patients.Descriptive analysis was used to analyze the general data and the status of self-management behavior of diabetic patients.The questionnaire of influencing factors of self-management behavior of diabetic patients was analyzed by exploratory and confirmatory factor analysis.The influencing factors of self-management behavior were analyzed by two independent sample t-test,one-way ANOVA,correlation analysis and multiple linear regression analysis.Finally,the influence of each part of health belief model on self-management behavior was quantitatively analyzed by using structural equation model,and the main influencing factors of patients'self-management behavior were found out.Results:(1)Status of self-management behavior in patients with diabetes:The total score of self-management behavior in diabetic patients was(26.52±10.56),and the average score was(1.77±0.70).The standard scores from high to low were 60.33 for drug compliance,60.22 for blood glucose monitoring,60.11 for follow-up,59.33 for physical exercise and 56.17 for diet control.(2)Reliability and validity of questionnaire on influencing factors of self-management behavior in patients with diabetes:The total content validity(S-CVI)of the scale was 0.795,the content validity(I-CVI)of each item was between 0.8 and 1,the difference validity was between 0.022 and 0.671,and the cronbach's?value of the questionnaire was between 0.749and 0.90.After two exploratory factor analyses,60.937%of the total variation was explained.Confirmatory factor analysis shows that the ratio of chi-square value to degree of freedom(CMIN/DF)is 1.046<3.0,the comparison fitting index(CFI)is 0.998>0.90,and the goodness-of-fit index(GFI)is 0.945>0.90,The root mean square error of approximation(RMSEA)is 0.010<0.08,AGFI,NFI,TLI and IFI meet the criteria of above0.9,and the fitting index is in line with the research standard.Therefore,the fitting degree of the model is good.Finally,a questionnaire of influencing factors of 24 items in 6 dimensions was formed.(3)The factors of self-management in the patients with diabetes:The results of multivariate regression analysis showed that age,education,occupation,family per capita monthly income,complications and factors affecting self-management entered the regression equation.Complications,perceptual disturbance and influencing factors are the hindrance factors of behavioral occurrence.Age,perceived susceptibility,perceived severity,perceived benefit,cue factor,high school/secondary school and junior college,professional teacher,self-employed,family per person monthly income of 2000-3000 and 3000-4000 are the contributing factors of the behavior.R~2 shows that the above variables explain 63%of the total variation in self-management behavior.(4)The effect intensity and path of each part of health belief on self-management behavior:The results of structural equation model analysis show that perceived benefits have the strongest effect on self-management behavior and have a direct positive effect(the influence coefficient is 0.485).Perceived susceptibility,perceived severity and hint factors had a direct positive impact on self-management behavior(influence coefficients were0.223,0.278,0.275,respectively).Perceived disorder,and the influencing factors had a negative effect on self-management behavior(the influence coefficients were-0.243,0.351,respectively).The health belief model explains 74.1%of the variance in behavior.Conclusion:(1)The status of self-management in diabetic patients is still unsatisfactory.There are differences in different self-management behaviors,of which compliance with medicine is the best and diet control is the worst.(2)Self-management behavior of diabetic patients was influenced by age,education,occupation,family income per month,complications and influencing factors of self-management behavior.However,the explanatory degree of these factors to the dimensions of self-management is still low.(3)This study found that the health belief theory model has a strong ability to explain and predict the self-management behavior of diabetic patients.