| 【Objective】To investigate the self-management status of elderly patients with type2 diabetes,to understand the level of self-management and its influencing factors,and to explore the role of alexithymia and health empowerment in self-management of elderly patients with type 2 diabetes.The correlation between the above three variables was analyzed to further explore the mediating role of health empowerment in alexithymia and self-management.Taking alexithymia and health empowerment as the breakthrough point,this paper discusses the effective ways to improve the self-management level of elderly type 2 diabetes patients from the psychological level,in order to improve the quality of life of elderly type 2 diabetes patients.【Methods】In this study,210 elderly patients with type 2 diabetes were selected from endocrinology departments of 3 hospitals from June to September,2020 by means of convenient sampling method.The general data questionnaire,Toronto alexithymia scale,health empowerment scale for chronic elderly patients and diabetes self-care scale for diabetes mellitus were used.Demographic data and variable scores were analyzed by descriptive statistics.The influences of demographic factors on self-management were analyzed by independent sample t test,one-way analysis of variance and multiple linear stepwise regression.The correlation between the three variables was analyzed by Pearson correlation.The effects of alexithymia and health empowerment on self-management were analyzed by multiple linear stepwise regression.The mediating role of health empowerment between alexithymia and self-management was verified by structural equation modeling.SPSS21.0 and AMOS21.0 were used for statistical analysis.【Results】1.The total score of self-management of elderly T2 DM patients was(87.18±11.07)points,and the items were(3.35±0.43)points.The scores of six dimensions from high to low were as follows: taking medicine as prescribed by doctors(3.64±0.63)points,managing high and low blood glucose(3.50±0.57)points,foot care(3.37±0.48)points,diet control(3.33±0.64)points,exercise(3.26±0.69)points and blood glucose monitoring(3.10±0.52)points.The total score of alexithymia was(57.53±10.09),and all items were(2.88±0.50).Dimensional scores ranged from high to low: emotional recognition disorder(2.91±0.60),extraverted thinking(2.89±0.51)and emotional expression disorder(2.81 ± 0.59).The total score of health empowerment was(91.69±10.67)points,and all items were(3.53±0.41)points.The highest score was in the responsibility belief dimension(3.63±0.62),and the lowest score was in the treatment participation dimension(3.40±0.49).2.The total score of alexithymia was negatively correlated with the total score of self-management(r=-0.541,P < 0.01),the total score of health empowerment was positively correlated with the total score of self-management(r=0.590,P < 0.05),and the total score of alexithymia was negatively correlated with the total score of health empowerment(r=-0.485,P<0.01).3.The single factor analysis,according to the results of age,gender,course of disease,degree of culture,monthly family income per capita,medical payment and the number of hospitalized from diabetes is the influencing factors of senile patients with type 2 diabetes self-management(P<0.05),multiple linear stepwise regression analysis showed that gender,course of the disease,medical payment,number of hospitalized from diabetes,difficult describing feelings to others,responsibility belief,knowledge growth,participate in treatment of health empowerment is a significant predictor in self-management(P<0.05).4.The structural equation model was used to analyze the mediating effect of health empowerment,and the fitting indexes were CMIN/DF= 1.498,GFI=0.935,AGFI= 0.904,RMSEA= 0.049.The 95% confidence interval of indirect effect and direct effect was(-0.426,-0.190)and(-0.556,-0.217)respectively.Alexithymia indirectly predicted self-management with health empowerment as a mediating variable in elderly patients with type 2 diabetes mellitus,and its standardized path coefficient was-0.535×0.530≈-0.284.The overall effect value of alexithymia on self-management was-0.400+(-0.284)=-0.684,and the mediating effect of health empowerment accounted for 41.52% of the total effect.【Conclusion】1.The overall self-management level of elderly type 2 diabetes patients is not high,and self-management ability needs to be improved.The selfmanagement of elderly type 2 diabetes patients with different individual background characteristics was significantly different,alexithymia and health empowerment were both in the middle level.2.Gender,course of disease,payment method of medical treatment and number of hospitalized from diabetes were the main influencing factors of self-management of elderly patients with type 2 diabetes;Emotional expression disorders in alexithymia can negatively predict self-management level;Responsibility belief,knowledge growth,and participation in treatment of health empowerment can all positively predict self-management.3.Health empowerment plays a partial mediating role between alexithymia and self-management.Alexithymia may play a role in self-management in older patients with type 2 diabetes either directly or indirectly by affecting health empowerment. |
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