| BackgroundChronic diseases has become a major public health problem that affects and threatens the life and health of the population because of their high incidence,persistence,serious health damage and economic burden.Chronic diseases has been associated with poor lifestyles such as obesity,smoking and alcohol consumption,and lacks of physical activity,and the development of health-promoting lifestyles can effectively improve the long-term quality of survival of patients,creating a virtuous cycle of "chronic diseases improving lifestyles to reduce illness".There is a need to explore the factors and mechanisms of influence of different mediating variables on the health promotion lifestyle of chronic disease patients,as there have been few in-depth studies specifically on the factors and pathways of influence of health promotion lifestyle of chronic disease patients.ObjectiveA health-promoting lifestyle for chronic disease patients can improve their knowledge,beliefs about disease recovery and health-promoting behaviors.This study investigated the current situation and influencing factors of health literacy,self-efficacy and health promotion lifestyle of chronic disease patients in Guangzhou,constructed a structural equation model,explored the dominant and potential factors influencing the health promotion lifestyle of chronic disease patients,analyzed their mechanisms of action,clarified the influencing pathways of each variable,and then proposed countermeasures and recommendations to promote the health promotion lifestyle of chronic disease patients,providing reference for the prevention and treatment of chronic disease,health promotion intervention strategies and the improvement of relevant policies in Guangzhou.MethodsA cross-sectional survey method was used to conduct the study.A combination of multi-stage stratified whole-group sampling and convenience sampling was used from May 2022 to September 2022 to select 530 patients with chronic diseases who met the inclusion and exclusion criteria from six medical and health institutions in Guangzhou as the study population for the questionnaire survey,with a total of 500 valid questionnaires collected and a valid return rate of 94.34%.Results1.A total of 234 men and 266 women were interviewed about chronic diseases in Guangzhou;their age was mostly concentrated between 60 and 69 years old(48.20%);more than half had two or more chronic diseases(64.20%)and 58.20%of the respondents indicated that they had received health education about chronic diseases.2.The health literacy score of chronic disease patients in Guangzhou was 3.69±0.71,the self-efficacy score was 6.76±1.75 and the health promotion lifestyle score was 2.81±0.47,all of which were at an intermediate level,with the scores of external and implicit behaviors being 2.64±0.53 and 2.93±0.49 respectively.The results of the univariate analysis showed that age,education level,household registration,average monthly income,health care payment method,type of chronic disease,whether or not they had received health education on chronic disease knowledge,and self-rated health status had an impact on health promotion lifestyle,external and implicit behaviors(all p<0.05).3.Results of correlation analysis:health promotion lifestyle was positively correlated with health literacy and positively correlated with self-efficacy among patients with chronic diseases;health literacy was positively correlated with self-efficacy(all p<0.01).4.Multiple linear regression results:type of chronic disease,health care payment method,whether or not they had received health education on chronic disease,health literacy and self-efficacy all influenced the health promotion lifestyle of the study participants,together explaining 55.10%of the total variance(p<0.05).5.The modified SEM showed that the model-related fitness indicators better met the fitness criteria,the model fitted well and the path coefficients between the variables were all statistically significant(p<0.05).Personal characteristics,health literacy,self-efficacy and externalizing behaviour all had a direct positive effect on implicit behaviour in people with chronic illness,with effect values of 0.134,0.358,0.243 and 0.113 respectively.In addition,health literacy,self-efficacy and externalizing behaviour were also used as mediating variables.The total effect sizes of the potential variables on the implicit behaviors of patients with chronic diseases were in the order of individual characteristics(0.463),health literacy(0.448),self-efficacy(0.272)and externalizing behaviors(0.113).Conclusion1.Health literacy,self-efficacy and health promotion lifestyles of people with chronic diseases were at an intermediate level and needed to be improved.Greater attention should be paid to the young,rural households,low educational attainment,low monthly income levels,medical payments in the form of NPA,multiple chronic diseases,unhealthy self-assessment and those who have not received health education on chronic diseases.2.There were positive effects between health promotion lifestyle and health literacy and self-efficacy,i.e.the better the level of health literacy,the higher the self-efficacy and the better the level of health promotion lifestyle for chronic disease patients.3.Model of factors influencing health promotion lifestyles of chronic disease patients was constructed and tested.The results showed that individual characteristics,health literacy and self-efficacy can influence implicit behaviors in both direct and indirect ways,and that externalized behaviors can directly influence implicit behaviors and play an important role as mediating variables.The total and indirect effects of individual characteristics were the largest,and the direct effect of health literacy was the largest.4.Proposed countermeasures and suggestions to promote health-promoting lifestyles for chronic disease patients.First,establish a sound multi-level medical protection system.Second,explore new pathways for chronic disease health communication in the community.Third,innovate"active health" service model for chronic diseases by increasing patient contracting rate.Fourth,strengthen the ability of self-health management with a goal-oriented approach.Last,deepen the integration of physical and health,and implement coordinated education for physical and mental health... |
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