社会认知理论视角下晚期癌症患者健康参与水平影响因素及作用路径分析-现代医学

社会认知理论视角下晚期癌症患者健康参与水平影响因素及作用路径分析

单位：南京医科大学护理学院, 江苏南京 211166

分类号：R473.73

出版年·卷·期（页码）：2026·54·第五期（755-762）

摘要：

目的：分析晚期癌症患者健康参与水平的影响因素并探究其作用路径，为临床实践提供实证依据。方法：选取南京市三级甲等肿瘤专科医院及综合医院肿瘤科216例住院晚期癌症患者为研究对象，采用一般资料问卷、患者健康参与量表(PHE-S^®)、安德森症状评估量表(MDASI)、慢性病患者健康素养量表(CHLS)、中文版癌症患者自我效能感量表(C-SUPPH)和领悟社会支持量表(PSSS)进行问卷调查。结果：72.7%(157/216) 的晚期癌症患者处于低水平参与。单因素分析及相关性分析表明，职业、TNM分期、症状负担、健康素养、自我效能感和社会支持均与健康参与水平显著相关(均P<0.05)；而Logistic回归分析显示，仅有自我效能感(OR=1.205，P<0.001)与社会支持(OR=1.141，P=0.010)是健康参与水平的独立影响因素。结构方程模型则呈现了变量间的复杂路径，自我效能感与健康参与水平呈直接正相关(β=0.739，P<0.001)；健康素养(β=0.263，P<0.001)和社会支持(β=0.497，P<0.001)可能通过自我效能感这一路径与健康参与水平间接正相关，症状负担(β=-0.148，P<0.01)则可能通过这一路径与健康参与水平间接负相关。结论：在临床实践中，可探索构建以心理赋能为核心，融合症状管理、健康教育和社会支持的综合性干预模式，以提升晚期癌症患者的健康参与水平。

Objective: To identify factors associated with health engagementlevels and explore their potential pathways in patients with advanced cancer, so as to providean evidence base for clinical practice. Methods: A total of 216 hospitalized patients with advanced cancer were recruited from oncology departments of tertiary hospitals(including cancer centers and general hospitals) in Nanjing. Participants completed the General Information Questionnaire, the Patient Health Engagement Scale(PHE-S^®), the M.D. Anderson Symptom Inventory(MDASI), theChronic Patients Patients' Health Literacy Scale(CHLS), the Chinese version of the Strategies Used by People to Promote Health(C-SUPPH), and the Perceived Social Support Scale(PSSS).Results:Overall, 72.7%(157/216) of the patients had a low level of health engagement. Univariate analysis and correlation analyses showed that occupation, cancer stage, symptom burden, health literacy, self-efficacy, and social support were all significantly correlated with health engagement level(all P<0.05). However, Logistic regression analysis indicated that only self-efficacy(OR=1.205,P<0.001) and social support(OR=1.141,P=0.010) were independently associated with a higher level of health engagement. Structural equation modeling showed complex interrelationships among these variables: self-efficacy was directly and positively associated with health engagement(β=0.739,P<0.001); health literacy(β=0.263,P<0.001) and social support(β=0.497,P<0.001) were indirectly associated with health engagement through self-efficacy; and symptom burden(β=-0.148,P<0.01) was indirectly and negatively associated with health engagement through the same pathway. Conclusion: In clinical practice, an integrated intervention model centered on psychological empowerment, combining symptom management, health education, and social support, may be explored to promote health engagement in advanced cancer patients.

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