| Objective To understand the prevalence of chronic diseases in a district of Gansu Province,and to identify the main chronic diseases and key groups for intervention in the district,and to analyze the status and the improvement of dietary behaviors among the patients with major chronic diseases in order to explore the influencing factors of their initiative improvement of dietary behaviors,and to provide a scientific basis for improving the self-management of patients with chronic diseases,promoting their healthy dietary behaviors and improving their quality of life targetedly.Methods The data for this study came from an evaluation survey on the construction of a demonstration region in Gansu Province for complete prevention and control of chronic diseases.A multi-stage stratified cluster random selection of adult residents aged 18 and up was conducted in the district in September 2020.Questionnaires,physical measurements,and laboratory tests were administered,with the contents ranging from basic personal information to chronic disease,knowledge about healthy dietary,social environment support,attitude toward healthy dietary,autonomous improvement of dietary behavior,height,weight,waist circumference,hip circumference,heart rate,blood pressure,and fasting blood glucose.A descriptive epidemiological approach was used to describe the chronic disease prevalence of adult residents in the district and to understand the current situation of dietary behavior improvement among people with major chronic diseases;one-way logistic regression was used to analyze the factors affecting dietary behavior improvement among people with major chronic diseases;factor analysis and structural equation model were also used to explore the action mechanistic.Results(1)Among the 10055 responders in the district,the top five chronic diseases were hypertension in 2525 cases(25.11%),diabetes in 1535 cases(15.27%),obesity in 1101 cases(10.95%),coronary heart disease in 1046 cases(10.40%),and hyperlipidaemia in 953 cases(9.48%).The demographic characteristics of high prevalence of hypertension,diabetes mellitus,obesity,and coronary heart disease were60 years of age and above,primary school education and below,unemployed/jobwaiting/stay at home,and a family history of chronic diseases.The demographic characteristics of diabetes,obesity,and hyperlipidemia are male and have a family history of chronic diseases.The co-morbidity rates for hypertension,diabetes mellitus,obesity,coronary heart disease and hyperlipidaemia were 72.25%,87.75%,55.22%,92.54% and 92.65% respectively.(2)Combining patients alone with hypertension and/or coronary heart disease and/or hyperlipidaemia as cardiovascular disease(CVD),a total of 1078 patients had improved dietary behavior in the following order: salt consumption(60.20%),fats and oils(55.67%),fresh fruits and vegetables(54.45%),sugar(48.79%),beans and bean products(44.19%),milk and milk and milk products(42.86%).The dietary behavior of 188 patients alone with diabetes improved in sequence of salt(58.51%),fats and oils(57.98%),fresh fruits and vegetables(50.00%),sugar(47.87%),milk and milk products(42.02%),and beans and bean products(38.30%).493 patients alone with obesity improved their dietary behavior in the order of fresh fruits and vegetables(50.00%),sugar(47.87%),milk and milk products(42.02%),and beans and bean products(38.30%).The improvement in behavior of the 493 patients with obesity alone was in the order of fresh fruits and vegetables(59.03%),edible salt(53.14%),fats and oils(50.51%),sugars(43.81%),beans and bean products(41.38%)and milk and milk products(40.37%).(3)The results of the one-way logistic regression analysis of the factors influencing the improvement of dietary behavior among patients with major chronic diseases showed that among patients alone with CVD,the proportion of dietary behavior improvement was higher among those with the lower age,those with high socio-economic status(urban,high education level,stable job,high average monthly expenditure)and those with a family history of chronic diseases.Among the patients alone with diabetes,those in urban,being jobless/ job-waiting/stay at home,working in industry,commerce or transport,being with a family history of chronic disease had higher proportion of the improvement in dietary behavior.Among the patients alone with obesity,the improvement in dietary behavior was higher among men,those with high education and high per capita monthly expenditure.Among patients with cardiovascular disease,or diabetes,or obesity,those with knowledge of healthy diets,attitudes towards healthy diets and supporters of the social environment all had higher proportions of dietary behavior improvement than those with no knowledge of healthy diets,no attitudes towards healthy diets and no support from the social environment.all exist P <0.05.(4)The results of the structural equation model showed: In the model of the improvement of dietary behavior in patients with CVD alone,the total effects of the four potential variables including personal social characteristics,social environment support,health-related knowledge awareness and healthy dietary attitudes were 0.134,0.658,0.381 and 0.491,respectively;The direct effects were 0.000,0.424,0.171 and0.491,indirect effects were 0.134,0.234,0.211 and 0.000,respectively;The indirect effects were 0.134,0.234,0.211 and 0.000 respectively;Personal social characteristics had an indirect positive effect on improvement of dietary behavior through the separate mediation of health knowledge and healthy dietary attitudes and the chain mediation of the two,with mediating effects of 0.035,0.056 and 0.043 respectively(all exist P <0.05);social environment support had an indirect positive effect on improvement of dietary behavior through the separate mediation of knowledge and attitudes and the chain mediation of the two,with mediating effects of 0.046,0.132 and 0.056respectively(all exist P < 0.05);Health-related knowledge awareness had an indirect effect on improvement of dietary behavior through the separate mediation of attitudes,with a mediating effect of 0.211(P < 0.05).In the model of diabetic patients’ improvement of dietary behavior,the total effects of the four potential variables including personal social characteristics,social environment support,health-related knowledge awareness and healthy dietary attitudes were 0.264,0.624,0.442 and 0.599,respectively;The direct effects were 0.000,0.176,0.254 and 0.599,respectively;The indirect effects were 0.264,0.448,0.187 and 0.000,respectively;Personal social characteristics had an indirect positive effect on dietary behavior improvement through the separate mediation of their health knowledge and healthy dietary attitudes and the chain mediation of the two,with a mediating effect of0.065,0.150 and 0.048 respectively(all exist P < 0.05);Social environment support had an indirect positive effect on dietary behavior improvement through the separate mediation of knowledge and attitudes and the chain mediation of the two,with a mediating effect of 0.090,0.291 and 0.067 respectively(all exist P < 0.05);Healthrelated knowledge awareness had an indirect effect on improvement of dietary behavior through the separate mediation of attitudes,with an effect of 0.187(P < 0.05).In the model of improvement of dietary behavior in patients with obesity alone,the total effects of the four potential variables including personal social characteristics,social environmental support,health-related knowledge awareness and healthy dietary attitudes were 0.146,0.620,0.243 and 0.747,respectively;the direct effects were 0.000,0.205,0.000 and 0.747,respectively;The indirect effects were 0.146,0.415,0.244 and0.000,respectively;Personal social characteristics and social environment support mediated the effect on improvement of dietary behavior through the order of health knowledge awareness and healthy dietary attitudes,the effect were 0.119 and 0.368(all exist P < 0.05),respectively;Healthy dietary knowledge awareness had an indirect effect on improvement of dietary behavior through the separate mediation of attitudes was 0.244(P < 0.05).Conclusion The top five major chronic diseases among adult residents in the district were hypertension,diabetes,obesity,coronary heart disease and hyperlipidemia,with the key populations being men,60 years old and above,rural areas,primary school education and below,per capita monthly expenditure <1000 RMB,and those with a family history of chronic diseases;the proportion of dietary behavior improvement among patients with major chronic diseases needs to be improved,with the main influencing factors including personal social characteristics,health-related knowledge awareness,social environment support and healthy dietary attitude,all of which directly contributed to the improvement of patients’ dietary behavior,except for personal social characteristics.Among them,personal social characteristics have an indirect positive influence on patients’ dietary behavior improvement through health-related knowledge awareness and healthy dietary attitude;Health-related knowledge awareness has an indirect influence on dietary behavior improvement through healthy dietary attitude;social environment support has an indirect influence on dietary behavior improvement through health knowledge and healthy dietary attitude respectively.The health departments should adopt targeted dietary interventions for different priority disease groups and for their dietary behavior improvement behavior mechanisms. |
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