| Objectives:To investigate the status quo of self-management of hypertensive patients and the relationship between the quality of discharge guidance and self-management,and to explore the mediating effect of discharge readiness and self-efficacy on the quality of discharge guidance and self-management,so as to provide a theoretical basis for the intervention of self-management of hypertensive patients.Methods:From March 2021 to August 2021,286 patients with hypertension were conveniently selected from one grade Ⅲ class A hospitals in Shandong Province.The measurement tools included general information questionnaire,hypertension self-management Scale,Discharge Guidance quality Scale,hypertension self-efficacy scale and discharge readiness scale.SPSS 23.0 was used for data entry,collation and analysis,including descriptive statistical analysis,independent sample T test,analysis of variance,Pearson correlation analysis and multiple linear regression analysis.The mediation effect was tested by the Bootstrap program in the Process plugin.Results:1.Status quo of hypertension patients’ self-management with the quality of discharge teaching,readiness for hospital discharge and self-efficacy The score of self-management in hypertensive patients was(85.77±6.12).The score of treatment management dimension was(31.63±3.73),diet and exercise management dimension was(21.36±2.75),lifestyle management dimension was(18.54±2.34),risk factor management dimension was(14.25±1.41).The scores of the quality of discharge teaching,readiness for hospital discharge and self-efficacy were(139.43±5.17),(99.60±4.68)and(39.06±2.39)respectively.2.Analysis of self-management,general demographic factors and disease-related factors in hypertension patients There were significant differences in hypertension self-management scores in age,marital status,residence,occupation,medical payment method,smoking,drinking,disease course and how often blood pressure was measured(P<0.05).There were no significant differences in gender,education level,residential status,monthly income,hypertension grade and family history(P>0.05).3.Correlation analysis of hypertension patients’ self-management with the quality of discharge teaching,readiness for hospital discharge and self-efficacy Pearson correlation analysis results showed there was a significant positive correlation between self-management and the quality of discharge teaching(r=0.428,P<0.01),with readiness for hospital discharge(r=0.402,P<0.01),and with self-efficacy(r=0.537,P<0.01).There was a significant positive correlation between the quality of discharge teaching and readiness for hospital discharge(r=0.593,P<0.01),and there was a significant positive correlation between self-efficacy(r=0.309,P<0.01).There was significant positive correlation between readiness for hospital discharge and self-efficacy(r=0.283,P<0.01).4.Mediating effect of readiness for hospital discharge on the quality of discharge teaching and self-management in hypertensive patients The results of multiple linear regression analysis showed that there was a significant positive correlation between the quality of discharge teaching and self-management(β=0.332,P<0.001).The relationship between the quality of discharge teaching and readiness for hospital discharge was significant(β=0.583,P<0.001).After adding readiness for hospital discharge,the regression coefficient of the quality of discharge teaching on hypertensive self-management decreased but was still significant(β=0.178,P<0.01),and there was still a significant relationship between readiness for hospital discharge and hypertensive self-management(β=0.264,P<0.001).Bootstrap test results showed that the Bootstrap 95%CI of readiness for hospital discharge was[0.061,0.253],excluding 0.The indirect effect of discharge guidance quality on hypertension self-management was 0.154(0.583*0.264)and 46.4%(0.154/0.332)through the mediating effect of readiness for hospital discharge.5.Mediating effect of self-efficacy on the quality of discharge teaching and self-management in hypertensive patients The results of multiple linear regression analysis showed that there was a significant positive correlation between the quality of discharge teaching and self-management(β=0.332,P<0.001);The relationship between the quality of discharge teaching and self-efficacy was significant(β=0.189,P<0.001);After adding self-efficacy,the regression coefficient of the quality of discharge teaching on hypertension self-management decreased but was still significant(β=0.259,P<0.001),and there was still a significant relationship between self-efficacy and self-management in hypertension(β=0.383,P<0.001).The Bootstrap test results showed that the Bootstrap 95%CI of self-efficacy was[0.028,0.122],excluding 0.The indirect effect of the quality of discharge teaching on hypertension self-management through the mediating effect of self-efficacy was 0.072(0.1 89*0.383),and the mediating effect was 21.7%(0.072/0.332).6.Test of the chain mediating effect of readiness for hospital discharge and self-efficacy on the quality of discharge teaching and self-management in hypertensive patients Self-management was taken as the dependent variable,the quality of discharge teaching as the independent variable,and readiness for hospital discharge and self-efficacy were all taken as the mediating variables to construct a multi-mediation model.Process plug-in was used to test the mediation model 6.The results showed that the predictive effect of the quality of discharge teaching on self-management through readiness for hospital discharge was 0.106(0.583*0.182).The 95%CI of Bootstrap test for the mediating effect of readiness for hospital discharge was[0.022,0.199],excluding 0,indicating the existence of the mediating effect.The predictive effect of the quality of discharge teaching on self-management through self-efficacy was 0.018(0.052*0.350),and the 95%CI of the mediating effect of Bootstrap self-efficacy was[-0.027,0.065],which was across 0.indicating that the mediating effect did not exist.The indirect prediction effect of the quality of discharge teaching on self-management through multiple mediating effects of readiness for hospital discharge and self-efficacy was 0.048(0.583*0.236*0.350),and the 95%CI of Bootstrap test was[0.018,0.082],excluding 0,indicating the existence of chain mediation effect.Conclusions:1.The self-management level of hypertensive patients is generally good,it shows that the hospital health education is effective to strengthen the consciousness of the patient’s disease management,prompt discharge guidance of medical staff should pay attention to the patient,and carried out according to the needs of patients with targeted intervention,to improve the self management compliance,reduce the occurrence of adverse outcomes such as reentry.2.Age,course of disease,occupation,place of residence,medical payment method,marital status smoking,drinking and how often to measure blood pressure are the predictors of hypertension patients’ self-management.In clinical work,corresponding health guidance can be provided to patients according to risk factors to improve self-management.3.The quality of discharge guidance in hypertensive patients can directly affect self-management,or indirectly affect self-management through the mediating effect of readiness for hospital discharge and self-efficacy.It is suggested that not only can self-management interventions be developed,but also self-management can be improved by improving patients’ discharge readiness and self-efficacy. |
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