基于自然决策理论的多病共存老年患者自我管理行为影响因素的组态路径分析OA
Pathways to self-management among older adults with multimorbidity in rural China:A fuzzy-set qualitative comparative analysis
目的 基于自然决策理论,从组态视角探讨个体、疾病与环境等多维情境因素如何通过非线性组合路径影响农村多病共存老年患者的自我管理行为.方法 采用横断面研究设计.2022年7月至2023年5月,选取浙江省9所医疗机构的487例农村多病共存老年患者作为调查对象.通过问卷调查和电子病历收集社会人口学、自我效能、心理韧性、身体症状、查尔森合并症指数、社会支持及资源可及性数据.运用多元线性回归分析和模糊集定性比较分析进行统计分析.结果 自我管理行为与自我效能、心理韧性、社会支持与资源可及性之间呈正相关性(r=0.690～0.850,P＜0.001);其中,自我效能(r=0.784)与社会支持(r=0.850)的相关性最强.多元线性回归分析结果表明,自我效能(β=0.385)与社会支持(β=0.372)是影响自我管理行为最显著的相关因素.模糊集定性比较分析共识别出6条驱动不同水平自我管理行为的组态路径,进一步被归纳为4种代表性情境类型:"三维赋能型""症状-资源驱动型""资源匮乏型"与"症状-疾病压倒型".其中,自我效能在所有组态配置中均为核心条件.结论 农村多病共存老年患者的自我管理行为具有明显的情境依赖性,存在多条等效驱动路径,为针对不同情境特征制订精准化自我管理行为护理干预策略提供了实证依据.
Objectives:This study aimed to investigate how individual,problem-related,and environmental factors interact to influence self-management behaviours among rural older adults with multimorbidity in China,to inform more context-sensitive interventions. Methods:A cross-sectional study was conducted in 9 healthcare facilities across Zhejiang Province,China,from July 2022 to May 2023,involving 487 rural older adults with multimorbidity via conve-nience sampling,who had been diagnosed with 2 or more chronic conditions.Data were collected through questionnaires and electronic health records to assess self-efficacy,psychological resilience,physical symptoms,the Charlson Comorbidity Index,social support,and resource accessibility.Fuzzy-set qualitative comparative analysis was employed to explore the complex,non-linear interactions between contextual factors,ultimately determining the sufficient conditions for self-management behaviours. Results:Correlation analyses revealed positive associations between self-management behaviours and self-efficacy,psychological resilience,social support,and resource accessibility(r=0.690-0.850,all P＜0.001),with self-efficacy(r=0.784)and social support(r=0.850)demonstrating the strongest correlations.Regression analysis revealed that self-efficacy(β=0.385)and social support(β=0.372)were the strongest factors of self-management behaviours.Fuzzy-set qualitative comparative analysis identified six factor configurations,categorized into four contextual types:"triple-enabling context,""symptom-resource driven context,""resource deficiency context,"and"symptom-disease over-whelmed context."Self-efficacy was consistently identified as a core condition across all configurations.Conclusions:Self-management among rural older adults with multimorbidity is shaped by complex,context-dependent interactions.Effective interventions should prioritize enhancing self-efficacy,expanding access to resources,and tailoring strategies to distinct contextual profiles.The study also demonstrates the utility of fuzzy-set qualitative comparative analysis for advancing context-sensitive healthcare solutions.
于嘉柠;邵静;陈丹丹;傅雨佳;杜昊阳;王丽娜;赵彬雨;陈莉瑾;郑子浩;刘晓婷
模糊集定性比较分析健康行为多病共存自然决策理论护理老年人自我管理
Fuzzy-set qualitative comparative analysisHealth behaviourMultimorbidityNaturalistic Decision-Making theoryNursingOlder adultsSelf-management
《国际护理科学（英文）》 2026 (2)
130-139,10
This work was supported by the Zhejiang Provincial Natural Science Foundation(Grant No.LY23G030008).
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