Study On Self-management Status And Influencing Factors Of Hemodialysis Patients Based On COM-B Model

Objective:Based on the COM-B model,the promotion and hindrance factors of hemodialysis patients’ self-management were identified.This paper analyzes the status quo and influencing factors of hemodialysis patients’ self-management,clarifies the prediction effect of each influencing factor on self-management,the relationship between influencing factors,and the path and effect coefficient of each factor on selfmanagement,and constructs the structural equation model of hemodialysis patients’ self-management and influencing factors.To provide a scientific and reasonable basis for the self-management intervention program of hemodialysis patients,improve the intervention measures,and improve the quality of life of patients.Methods:Based on the COM-B model and literature review,a hypothetical model of selfmanagement and influencing factors of hemodialysis patients was constructed.Convenience sampling method was adopted.The research subjects were 370 patients regularly undergoing hemodialysis in the blood purification centers of two hospitals in Changchun from July to November in 2020.The general data,health literacy questionnaire,knowledge level questionnaire,chronic disease management selfefficacy scale,family care index questionnaire,revised disease perception questionnaire and self-management scale were used to investigate the patients,and the data indicators of self-management and influencing factors were collected.Epi Data3.1was used to establish the database,and double entry was used for the collected data.Software SPSS25.0 was used to sort out,analyze and process the acquired clinical data,and software AMOS24.0 was used to construct and verify the model.According to the data analysis,the hypothesis model was fitted,discriminated and modified.Results:1.The score of self-management in this study was(49.55±8.52).Among all dimensions of self-management,the highest score(18.16±3.66)was executive selfmanagement,while the lower score(8.82±2.48)was emotional processing.There were statistically significant differences in age and occupation(P<0.05).2.The score of knowledge level in this study was(15.75±3.66),and there were statistical differences in age,education and education level,occupation,family income,medical payment method and primary disease(P<0.05).3.The scores of health literacy in this study were(19.87±4.58),including functional health literacy(6.96±1.98),interactive health literacy(4.87±1.98),and critical health literacy(7.77±1.29).The differences in scores were statistically significant in terms of dialysis age and occupation(P<0.05).4.The disease perception score of hemodialysis patients was(59.69±7.26),the disease course score was the highest(8.44±1.25),and the treatment control score was the lowest(5.58±2.10).5.The self-efficacy score of this study was(5.71±1.41),including symptom management score(5.71±1.46)and disease commonality score(5.71±1.41),with statistically significant differences in age,marital status and employment status(P<0.05).6.The score of family care of hemodialysis patients was(5.93±1.64),the highest degree of intimacy was(1.33±0.59),and the lowest degree of cooperation was(0.81±0.53).The difference of scores in occupation and employment status was statistically significant(P<0.05).7.Pearson correlation analysis results showed that knowledge level,health literacy,self-efficacy and family care were positively correlated with self-management,while disease perception was negatively correlated with self-management of hemodialysis patients.8.Self-efficacy had a partial mediating effect between family care and selfmanagement,and the mediating effect value was 0.4754;Self-efficacy had a partial mediating effect between disease perception and self-management,and the mediating effect value was-0.0707.Knowledge level had a partial mediating effect between health literacy and self-management,and the mediating effect value was 0.4303.Disease perception played a partial mediating role between knowledge level and selfmanagement,and the mediating effect value was 0.2984.9.In structural equation model,knowledge level has a positive effect on selfmanagement(total effect 0.506,direct effect 0.370,indirect effect 0.136);The degree of family care had a positive effect on self-management(total effect 0.479,direct effect0.285,indirect effect 0.194).Health literacy had a positive effect on self-management(total effect 0.363,direct effect 0.191,indirect effect 0.171);Self-efficacy had a positive effect on self-management(total effect 0.237);Disease perception had a negative effect on self-management(total effect-0.429,direct effect-0.397,indirect effect-0.033).Conclusion:1.General information has a certain influence on self-management,disease knowledge,health literacy,disease perception,self-efficacy and family care.Higher health literacy and family care are the promoting factors of self-management,while lack of hemodialysis knowledge,low self-efficacy and poor disease perception are the hindering factors of self-management.2.The structural equation model of self-management and influencing factors of hemodialysis patients was successfully constructed.Health literacy,disease knowledge,self-efficacy and family care have a direct and positive impact on self-management.Disease perception has a direct negative effect on self-management.Health literacy has a positive and indirect effect on self-management through disease knowledge,disease perception and self-efficacy.Disease perception has a negative indirect effect on selfmanagement through self-efficacy.Disease knowledge can have a positive and indirect effect through disease perception and self-efficacy.Family care has direct and indirect influence on self-management through disease knowledge,disease perception and selfefficacy.3.In the structural equation model,the effect of each influencing factor on selfmanagement is as follows: disease knowledge is the largest,followed by the effect of family care,and self-efficacy has the least effect on self-management.Future intervention plans for self-management of hemodialysis patients should focus on the influence of disease knowledge,family care,disease perception and other factors in the COM-B model on self-management,so as to improve the overall self-management level and quality of life of patients.