The mediating effect of diabetes self-efficacy between perceived role demands and diabetes self-management among community patients with type 2 diabetes
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摘要:
目的 调查2型糖尿病患者角色需求认知现状，并探讨自我效能在角色需求认知与自我管理之间的中介效应。 方法 采用横断面调查法，于2016年5—6月在北京蓟门里社区卫生服务中心，对210例2型糖尿病患者使用角色需求认知问卷、糖尿病自我管理量表、糖尿病自我效能量表进行调查。 结果 2型糖尿病患者角色需求认知得分中位数为0，得分范围为0~9分，66.19%的患者承担着家务劳动的职责，其次是工作和照顾小孩。不同性别在工作、家务劳动、照顾小孩及照顾其他人的角色需求方面差异具有统计学意义(均P＜0.05);78.57%的患者自我效能得分处于中高水平; 65.24%的患者自我管理行为中等或偏下; 角色需求认知与自我效能、自我管理间均存在显著相关关系，其中角色需求认知与自我效能负相关，自我效能与自我管理正相关; 自我效能在角色需求认知和自我管理间存在中介效应，效应值为-0.101(P＜0.001)，其中，女性患者自我效能的中介效应显著而男性不显著，效应值为-0.130(P＜0.05)。 结论 2型糖尿病患者不同性别间角色需求认知不同; 自我效能在2型糖尿病患者角色需求认知与自我管理之间存在中介效应，并且主要体现在女性患者而非男性患者。建议对角色需求认知水平较强的患者，尤其是女性患者，可以通过加强自我效能来提高自我管理行为。 Abstract:Objective To investigate the status of perceived role demands, explore the mediating effect of self-efficacy between perceived role demands and self-management among people with type 2 diabetes (T2DM) in China. Methods A cross-sectional study was conducted in this study. A total of 210 patients with type 2 diabetes from Jimenli Community Health Service Center in Beijing from May 2016 to June 2016 were surveyed by using perceived role demands scale, self-efficacy scale and siabetes self-management scale for patients with T2DM. Results The score of perceived role demands scale ranged from 0 to 9, with median as 0; 66.19% percent of the patients were responsible for household chores, followed by work and child care. There were statistically differences in the perceived role demands of work, household chores and child care between different genders (all P < 0.05). Seventy-eight point five seven percent of patients' self-efficacy scores were in a relatively middle and high level; 65.24% patients' self-efficacy scores were in a middle to low level.Among them, perceived role demands were negatively associated with self-efficacy, and self-efficacy was positively associated with self-management. Perceived role demands were significantly correlated with self-efficacy and self-management (P < 0.05). Self-efficacy had a mediating effect between perceived role demands and self-management, the coefficient was -0.101 (P < 0.001). In addition, self-efficacy mediated the effect of perceived role demands on self-management for females but not males. Conclusion There is gender difference in perceived role demands of patients with T2DM. Self-efficacy significantly mediates the relationship between perceived role demands and self-management, especially for females. This finding suggests that for those who are with strong perceived role demands, especially for females with diabetes, Clinicians should consider improving self-efficacy to enhance diabetes self-management behaviors in future interventions. -
Key words:
- Type 2 diabetes /
- Perceived role demands /
- Self-management /
- Self-efficacy /
- Mediating effect
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表 1 210例2型糖尿病患者一般资料
项目 例数(%) 项目 例数(%) 年龄(岁) 患病时间(年) ≤45 7(3.33) ≤5 66(31.43) 45~60 53(25.24) 5~10 35(16.67) ≥60 150(71.43) ≥10 109(51.90) 婚姻状况 是否合并慢性病 未婚 1(0.48) 是 178(84.76) 已婚 188(89.52) 否 32(15.24) 丧偶 21(10.00) 有无并发症 家庭月收入(元) 有 125(59.52) ＜4 000 106(50.48) 无 85(40.48) 4 000~8 000 90(42.85) 教育程度 ＞8 000 14(6.67) 小学及以下 27(12.86) 就业状态 初中 62(29.52) 失业 5 (2.38) 中专及高中 59(28.10) 兼职 3 (1.43) 大专 26(12.38) 全职 28(13.33) 本科及以上 36(17.14) 退休 174(82.86) 
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表 1 2型糖尿病患者所承担的角色及角色需求认知得分情况
所承担角色 例数(%) 角色需求认知得分[M(P25，P75)，分] 男性角色需求认知得[M(P25，P75)，分] 女性角色需求认知得分[M(P25，P75)，分] 男性秩均值 女性秩均值 Z值 P值 工作 40(19.05) 0(0, 0) 0(0, 1) 0(0, 0) 117.70 94.62 -4.339 < 0.001 家务劳动 139(66.19) 0(0, 0) 0(0, 0) 0(0, 1) 96.54 113.50 -2.950 0.003 照顾小孩 39(18.57) 0(0, 0) 0(0, 0) 0(0, 0) 96.06 113.92 -3.784 < 0.001 照顾其他人 32(15.24) 0(0, 0) 0(0, 0) 0(0, 0) 100.27 110.17 -2.369 0.018 社区服务 13(6.19) 0(0, 0) 0(0, 0) 0(0, 0) 105.00 105.95 -0.944 0.345 课业 8(3.80) 0(0, 0) 0(0, 0) 0(0, 0) 105.68 105.34 -0.138 0.890
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表 3 2型糖尿病患者自我效能水平
维度 最小值 最大值 得分(x±s，分) 排序 药物治疗 0.00 10.00 9.52±1.24 1 血糖监测和足部检查 2.00 10.00 7.99±1.94 2 身体锻炼和体重 1.25 10.00 7.48±1.98 3 营养 0.11 10.00 6.85±2.30 4
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表 4 2型糖尿病患者自我管理行为得分
维度 最小值 最大值 得分(x±s，分) 排序 用药管理 1 5 4.56±0.92 1 并发症及危险因素管理 1 5 3.95±0.81 2 饮食管理 1 5 3.60±0.77 3 血糖监测 1 5 3.46±1.14 4 运动管理 1 5 3.23±1.14 5
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表 5 自我效能在角色需求认知和自我管理间的中介效应结果
效应 路径 β(总样本) β(男) β(女) 总效应 角色需求认知→自我管理 -0.313a -0.389a -0.290a 间接效应 角色需求认知→自我效能→自我管理 -0.101a -0.064 -0.130b 直接效应 角色需求认知→自我管理 -0.212a -0.325a -0.160b 注：aP < 0.001，bP < 0.01。β为具体效应值。
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