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浙江大学学报（医学版）
浙江大学学报（医学版）  2022, Vol. 51 Issue (1): 19-26    DOI: 10.3724/zdxbyxb-2021-0377
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应对适应能力和社会支持介导主观压力感知对代谢综合征患者健康促进行为的影响
邵静1,陈丹丹1,2,张慧1,2,王喜益3,吴静洁1,2,汤磊雯1,2,叶志弘1,2,*()
1.浙江大学医学院护理学研究所，浙江 杭州 310058
2.浙江大学医学院附属邵逸夫医院护理部，浙江 杭州 310016
3.上海交通大学护理学院，上海 200025
Influence of perceived stress on health-promoting behaviors in patients with metabolic syndrome: the multiple mediating roles of adaptability and social support
SHAO Jing1,CHEN Dandan1,2,ZHANG Hui1,2,WANG Xiyi3,WU Jingjie1,2,TANG Leiwen1,2,YE Zhihong1,2,*()
1. Institute of Nursing Research, Zhejiang University School of Medicine, Hangzhou 310058, China;
2. Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;
3. School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
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摘要：

目的：基于慢性病适应中域理论探讨主观压力感知与健康促进行为之间的作用关系。方法：2021年1月—5月，采用便利抽样法选取在浙江大学医学院附属邵逸夫医院健康体检住院中心进行体检的230名中青年代谢综合征患者作为调查对象，应用健康促进生活方式量表Ⅱ、压力知觉量表、应对适应过程量表和多维度感知社会支持量表进行横断面调查。采用Mplus软件构建的链式中介效应程序及Bootstrap抽样检验法检验应对适应能力和社会支持在主观压力感知和健康促进行为之间的中介作用。结果：受调查对象健康促进行为平均（100.0±14.6）分，主观压力感知平均（22.0±6.9）分，应对适应能力平均（47.0±6.1）分，社会支持平均（63.8±10.8）分。主观压力感知与健康促进行为存在负相关关系（r=–0.309，P<0.05），两者之间的关系受到应对适应能力（效应值=–0.112，95%CI:–0.199~–0.038）和社会支持（效应值=–0.032，95%CI:–0.083~–0.004）的中介作用以及应对适应能力和社会支持的链式中介作用（效应值=–0.045，95%CI:–0.093~–0.020）。结论：应对适应能力和社会支持水平在中青年代谢综合征患者压力感知和健康行为之间起到中介作用，健康管理工作者可通过构建基于应对适应能力和社会支持的干预策略来引导患者形成适应外部环境变化的健康行为模式。
关键词： 代谢综合征;  健康促进行为;  压力感知;  社会支持;  应对适应能力    
Abstract:

Objective: To explore the potential associations between perceived stress and health-promoting behaviors based on the theoretical schema of the middle-range theory of adaptation to chronic illness. Methods: From January to May 2021, a convenience sampling method was used to recruit 230 young and middle-aged patients with metabolic syndrome who underwent physical examination in the inpatient center of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The Health-Promoting Health Profile-Ⅱ, Chinese Perceived Stress Scale, Coping and Adaptation Processing Scale-Short Form, and Multi-dimensional Scale of Perceived Social Support were used in the cross-sectional study. The chain mediation effect procedure and bootstrap sampling test were used to examine the mediating role of adaptability and social support between perceived stress and health-promoting behaviors. Results: The mean score of health-promoting behaviors was 100.0±14.6, the mean score of perceived stress was 22.0± 6.9, the mean score of adaptability was 47.0±6.1, and the mean score of social support was 63.8±10.8. Perceived stress had a negative impact on patients’ health-promoting behaviors (r=–0.309, P<0.05). The adaptability (effect size= –0.112, 95%CI:–0.199~–0.038) and social support (effect size= –0.032, 95%CI:–0.083~–0.004) played a mediating role and a chain mediating role in the process of perceived stress influencing patients’ health-promoting behaviors (effect size= –0.045, 95%CI:–0.093~–0.020). Conclusions: Adaptability and social support play an intermediary role between perceived stress and health-promoting behaviors in young and middle-aged patients with metabolic syndrome. Healthcare professionals can motivate patients to develop healthy behaviors by developing intervention strategies on adaptability and social support.
Key words: Metabolic syndrome    Health-promoting behavior    Perceived stress    Social support    Psychologic adaptation
收稿日期: 2021-12-09 出版日期: 2022-05-17
CLC:  R47  
基金资助: 国家自然科学基金（72004193）；浙江省博士后科研项目择优（zj2019022）；上海市青年科技英才扬帆计划（21YF1422400）
通讯作者: 叶志弘     E-mail: yezh@zju.edu.cn
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引用本文:

邵静,陈丹丹,张慧,王喜益,吴静洁,汤磊雯,叶志弘. 应对适应能力和社会支持介导主观压力感知对代谢综合征患者健康促进行为的影响[J]. 浙江大学学报（医学版）, 2022, 51(1): 19-26.

SHAO Jing,CHEN Dandan,ZHANG Hui,WANG Xiyi,WU Jingjie,TANG Leiwen,YE Zhihong. Influence of perceived stress on health-promoting behaviors in patients with metabolic syndrome: the multiple mediating roles of adaptability and social support. J Zhejiang Univ (Med Sci), 2022, 51(1): 19-26.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0377    或    https://www.zjujournals.com/med/CN/Y2022/V51/I1/19

变量

年龄

民族

学历

性别

婚姻

家庭月收入

职业

主观压力感知

健康促进行为

社会支持

应对适应能力

年龄

1.000

—

—

—

—

—

—

—

—

—

—

民族

?0.035

1.000

—

—

—

—

—

—

—

—

—

学历

–0.151*

?0.079

1.000

—

—

—

—

—

—

—

—

性别

0.001

0.040

–0.129

1.000

—

—

—

—

—

—

—

婚姻

0.088

0.002

–0.058

–0.037

1.000

—

—

—

—

—

—

家庭月收入

–0.162*

?0.063

0.308*

–0.204*

0.014

1.000

—

—

—

—

—

职业

0.067

0.106

–0.343*

0.240*

0.007

–0.185*

1.000

—

—

—

—

主观压力感知

–0.373*

0.067

0.097

0.138*

–0.121

–0.189*

0.066

1.000

—

—

—

健康促进行为

0.144*

?0.063

0.111

0.079

0.037

0.043

?0.084

–0.309*

1.000

—

—

社会支持

0.065

?0.104

0.093

0.077

–0.039

0.072

?0.047

–0.366*

0.372*

1.000

—

应对适应能力

0.135*

?0.101

0.183*

–0.188*

–0.044

0.222*

–0.130*

–0.485*

0.397*

0.513*

1.000
表 1  研究变量之间的相关性分析结果（值）

路径

β值

标准误

Bootstrap（95% CI）

P值

F1→F2

–0.485

0.049

–0.581~–0.384

<0.05

F1→F3

–0.153

0.076

–0.307~–0.010

<0.05

F1→F4

–0.120

0.077

–0.265~–0.032

0.12

F2→F3

0.439

0.065

0.308~0.562

<0.05

F2→F4

0.232

0.081

0.069~0.384

<0.05

F3→F4

0.210

0.062

0.104~0.345

<0.05
表 3  模型估计的路径系数
图 1  主观压力感知与健康促进行为的多重中介模型实线表明路径系数值小于0.05，虚线表示路径系数值大于0.05.

间接效应

效应值

标准误

Bootstrap（95% CI）

P值

F1→F4

?–0.189

0.042

?–0.278~–0.113

<0.05

F1→F2→F4

?–0.112

0.041

?–0.199~–0.038

<0.05

F1→F3→F4

?–0.032

0.019

?–0.083~–0.004

0.09

F1→F2→F3→F4

?–0.045

0.018

?–0.093~–0.020

<0.05
表 2  模型估计的效应值
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