基于保护动机理论的妊娠期糖尿病孕妇血糖管理决策行为模型的构建

摘要：

目的 在保护动机理论指导下，构建妊娠期糖尿病（gestational diabetes mellitus，GDM）孕妇血糖管理决策行为模型。 方法 采用便利抽样法，于2019年9月—2020年7月选取上海市和江苏省6所医院的1 261例GDM孕妇作为调查对象，采用GDM血糖管理决策行为问卷、保护动机问卷、知识问卷及一般资料调查表进行调查，采用多元线性回归分析决策行为的影响因素，依据多因素分析结果构建决策行为初始模型，并采用结构方程模型对模型进行修正和优化。 结果 该调查共收回有效问卷1 181份。保护动机中的易感性、严重性、反应效能、自我效能、反应代价是GDM孕妇血糖管理决策行为的影响因素（P<0.001）。结构方程模型结果显示，GDM孕妇在血糖管理中对严重性（β=0.204）、易感性（β=0.196）的感知及自我效能（β=0.336）对其决策行为产生直接正向影响，同时易感性也通过自我效能对决策行为产生间接正向影响（β=0.136）；反应代价对决策行为产生直接负向影响（β=-0.186），血糖管理知识通过影响反应代价对决策行为产生间接影响（β=0.016）。模型适配度检验指标均达到可接受的标准，各路径系数均达到显著水平（P<0.05）。 结论 产科护理人员可通过强化GDM孕妇对血糖管理不佳的易感性和严重性的感知，提高其血糖管理信心，并提供血糖管理的相关知识，以减少对血糖管理障碍的感知，促进GDM孕妇积极的血糖管理决策行为。

关键词: 妊娠期糖尿病, 血糖管理, 决策行为, 模式构建, 保护动机理论, 产科护理

Abstract:

Objective To construct the decision-making behavior model of blood glucose management among pregnant women with gestational diabetes mellitus（GDM） based on protection motivation theory. Methods A total of 1 261 pregnant women with GDM from 6 hospitals in Shanghai and Jiangsu province were selected by convenient sampling and investigated through the cross-sectional survey. The Self-Developed Blood Glucose Management Decision-Making Behavior Questionnaire，Protection Motivation Questionnaire，Knowledge Questionnaire and General Information Questionnaire were used to collect data. Multi-linear regression analysis was used to identify the influencing factors of decision-making behavior. Structural equation model was used to establish and revise the decision-making behavior model of blood glucose management. Results 1 181 pregnant women with GDM were included in this study. Vulnerability，severity，response efficacy，self-efficacy and response costs were influencing factors of blood glucose management decision-making behavior（P<0.001）. Perceived severity（β=0.204），vulnerability （β=0.196） and self-efficacy（β=0.336） had a direct positive influence on decision-making behavior. Perceived vulnerability had an indirect positive influence on decision-making behavior mediated by self-efficacy（β=0.136）. Response costs（β=-0.186） had a direct negative influence on decision-making behavior. Knowledge had an indirect influence on decision-making behavior mediated by response costs（β=0.016）. All the indicators for fit test were acceptable or optimal，and the path coefficients of model reached significant level（P<0.05）. Conclusion The decision-making behavior of blood glucose management among pregnant women with GDM could be improved through increasing perceived severity，vulnerability and confidence，providing more knowledge and decreasing barriers related to blood glucose management.

Key words: Gestational Diabetes Mellitus, Blood Glucose Management, Decision-Making Behavior, Model Construction, Protection Motivation Theory, Obstetric Nursing

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