慢性肾脏病患儿-家长过渡期准备与双方生活质量的互依关系分析

doi:10.3969/j.issn.1674-8115.2021.12.007

摘要/Abstract

摘要：

目的·运用主-客体互依模型探究慢性肾脏病患儿及其家长对患儿过渡期准备的评估及其与双方生活质量之间的关系。方法·采用方便抽样法选取2018年10月—2021年4月于上海交通大学医学院附属儿童医学中心和上海交通大学附属儿童医院肾脏科住院治疗的12~18岁慢性肾脏病患儿及其家长177对，进行一般资料问卷、自我照护及过渡期准备和生活质量问卷调查，应用AMOS 24.0软件构建模型并分析关联性。结果·177例慢性肾脏病患儿及家长对患儿过渡期准备的评估均不理想，患儿自评条目平均得分（3.39±0.62）分，家长评价条目平均得分（3.31±0.63）分；患儿及家长生活质量条目平均得分分别为（75.35±15.28）分和（70.27±18.56）分。多元分层回归分析显示，半年内缺课天数是患儿生活质量的负向预测因素；患病时长、独生子女与否、母亲无工作是家长生活质量的负向预测因素；患儿和家长医患沟通则为双方生活质量的正向预测因素。主客体互依模型结果显示：患儿和家长的过渡期准备及双方生活质量之间存在互依关系；家长的过渡期准备和家长生活质量之间存在主体效应（B=27.76，P=0.000），患儿及家长均存在客体效应（患儿：B=-14.91，P=0.007；家长：B=14.35，P=0.000）；分维度分析中则存在不同程度的主客体效应。结论·慢性肾脏病患儿及其家长的过渡期准备与双方生活质量间存在互依关系；医护人员需关注双方过渡期间的亲子互动，将两者均纳入有针对性的过渡期准备计划中，提高双方的生活质量。

关键词: 生活质量, 过渡期准备, 慢性肾脏病, 儿童, 家长, 主-客体互依模型

Abstract:

Objective·To investigate the interdependence between chronic kidney disease children's transition readiness assessment of children and their parents and the quality of life of both parties by using an Actor-Partner Interdependence Model.

Methods·A convenience sample of 177 pairs of children with CKD aged 12?18 years who were hospitalized in the Nephrology Department of Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine and Children′s Hospital of Shanghai, Shanghai Jiao Tong University from October 2018 to April 2021, and their parents were selected for the general information questionnaire and self-care and transition readiness and quality of life questionnaire, and a model was constructed by using AMOS 24.0 to analyze the correlations.

Results·The assessment of transition readiness of 177 children with CKD and their parents was unsatisfactory, with item average score of 3.39±0.62 for the children and 3.31±0.63 for the parents; the item average score of quality of life for the children and parents were 75.35±15.28 and 70.27±18.56, respectively. Multiple stratified regression analysis showed that the number of school days missed within six months was a negative predictor of the child′s quality of life; duration of illness, only child or not in a family, and mother unemployment were negative predictors of the parent′s quality of life, while doctor-patient communication between the child and the parent was a positive predictor for both parties. The results of the actor-partner interdependence model showed interdependence between child and parent assessment of the child′s transition readiness and quality of life of both parties, with an actor effect between parent transition readiness and parent quality of life (B=27.76, P=0.000) and a partner effect for both child and parent (child: B=-14.91, P=0.007; parent: B=14.35, P=0.000), and in the subdimensional analysis, there were actor-partner effects of varying degrees.

Conclusion·There is a reciprocal relationship between child′s transition readiness by the child with CKD and his or her parents and the quality of life of both parties, and health care providers need to focus on parent-child interaction during the child-parent transition and include both the child and parents in the development of a targeted transition readiness plan to improve the quality of life of both parties.

Key words: quality of life, transition readiness, chronic kidney disease, child, parent, Actor-Partner Interdependence Model

中图分类号:

R473

周丝丝, 巩格言, 马佳莉, 高雯颖, 张莹. 慢性肾脏病患儿-家长过渡期准备与双方生活质量的互依关系分析[J]. 上海交通大学学报(医学版), 2021, 41(12): 1588-1595.

Si-si ZHOU, Ge-yan GONG, Jia-li MA, Wen-ying GAO, Ying ZHANG. Analysis of the interdependence between chronic kidney disease child-parent transition readiness and the quality of life of both parties[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(12): 1588-1595.

图/表 8

参考文献 15

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Item	M （Q₁， Q₃）	QoL of children		QoL of parents
Item	M （Q₁， Q₃）	r value	P value	r value	P value
Child′s age/year	13 （12， 14）	0.020	0.787	0.094	0.215
Father′s age/year	41 （39， 45）	-0.005	0.945	-0.031	0.680
Mother′s age/year	39 （38， 44）	0.018	0.809	-0.008	0.914
Disease duration/month	12.00 （1.75， 48.00）	-0.257	0.001	-0.289	0.000
Absence from school during half a year/d	10 （0， 60）	-0.486	0.000	-0.128	0.089
Kind of oral medicines used/n	3 （1， 5）	-0.302	0.000	-0.147	0.051

Item	M （Q₁， Q₃）	QoL of children		QoL of parents
Item	M （Q₁， Q₃）	r value	P value	r value	P value
Child′s age/year	13 （12， 14）	0.020	0.787	0.094	0.215
Father′s age/year	41 （39， 45）	-0.005	0.945	-0.031	0.680
Mother′s age/year	39 （38， 44）	0.018	0.809	-0.008	0.914
Disease duration/month	12.00 （1.75， 48.00）	-0.257	0.001	-0.289	0.000
Absence from school during half a year/d	10 （0， 60）	-0.486	0.000	-0.128	0.089
Kind of oral medicines used/n	3 （1， 5）	-0.302	0.000	-0.147	0.051

Item	n（%）	QoL of children			QoL of parents
Item	n（%）	x±s	F/t value	P value	x±s	F/t value	P value
Gender			0.367	0.714		-1.002	0.318
Boy	112 （63.3）	75.60±15.82			69.16±18.70
Girl	65 （36.7）	74.72±14.58			72.06±18.34
Primary caregiver			0.747	0.525		1.954	0.123
Father	41 （23.2）	77.31±13.30			74.33±17.70
Mother	113 （63.8）	74.74±16.07			67.82±19.13
Grandparent	20 （11.3）	75.65±15.15			75.81±16.36
Other	3 （1.7）	64.85±15.84			67.50±6.96
Number of children in a family			2.316	0.022		2.659	0.009
One	75 （42.4）	78.35±14.40			74.48±17.86
More than one	102 （57.6）	73.01±15.68			67.10±18.54
Geographical location			－3.089	0.002		-1.861	0.064
Rural area	85 （48.0）	71.65±15.19			67.54±18.76
Urban area	92 （52.0）	78.62±14.78			72.71±18.14
Family income			3.766	0.012		1.163	0.325
<4 000 yuan	38 （21.5）	73.08±14.75			66.32±19.82
4 001‒8 000 yuan	72 （40.7）	72.58±14.81			69.80±16.50
8 001‒12 000 yuan	36 （20.3）	76.45±17.21			74.17±19.56
＞12 000 yuan	31 （17.5）	82.85±12.73			71.45±20.19
Father′s education level			3.311	0.021		1.102	0.350
Less than junior school	25 （14.1）	75.65±15.10			67.80±22.41
Junior school	70 （39.5）	71.84±15.14			67.91±14.83
High school or technical secondary school	35 （19.8）	80.34±15.86			73.33±18.77
College degree or above	47 （26.6）	78.01±14.23			72.66±21.03
Mother′s education level			2.756	0.044		1.850	0.140
Less than junior school	38 （21.5）	72.54±14.21			69.01±18.68
Junior school	62 （35.0）	72.37±14.97			66.65±17.07
High school or technical secondary school	31 （17.5）	78.05±17.60			72.27±15.47
College degree or above	46 （26.0）	79.56±14.20			74.23±18.57
Father′s occupation			0.863	0.424		1.344	0.263
Blue-collar worker	96 （54.2）	76.66±14.81			72.18±18.29
White-collar worker	74 （41.8）	73.64±15.95			67.53±19.07
Unemployment	7 （4.0）	73.45±16.18			71.96±15.43
Mother′s occupation			6.097	0.003		8.203	0.000
Blue-collar worker	71 （40.1）	79.54±14.30			76.43±16.75
White-collar worker	57 （32.2）	74.51±14.20			68.40±19.08
Unemployment	49 （27.7）	69.96±16.50			63.37±17.93

Item	n（%）	QoL of children			QoL of parents
Item	n（%）	x±s	F/t value	P value	x±s	F/t value	P value
Gender			0.367	0.714		-1.002	0.318
Boy	112 （63.3）	75.60±15.82			69.16±18.70
Girl	65 （36.7）	74.72±14.58			72.06±18.34
Primary caregiver			0.747	0.525		1.954	0.123
Father	41 （23.2）	77.31±13.30			74.33±17.70
Mother	113 （63.8）	74.74±16.07			67.82±19.13
Grandparent	20 （11.3）	75.65±15.15			75.81±16.36
Other	3 （1.7）	64.85±15.84			67.50±6.96
Number of children in a family			2.316	0.022		2.659	0.009
One	75 （42.4）	78.35±14.40			74.48±17.86
More than one	102 （57.6）	73.01±15.68			67.10±18.54
Geographical location			－3.089	0.002		-1.861	0.064
Rural area	85 （48.0）	71.65±15.19			67.54±18.76
Urban area	92 （52.0）	78.62±14.78			72.71±18.14
Family income			3.766	0.012		1.163	0.325
<4 000 yuan	38 （21.5）	73.08±14.75			66.32±19.82
4 001‒8 000 yuan	72 （40.7）	72.58±14.81			69.80±16.50
8 001‒12 000 yuan	36 （20.3）	76.45±17.21			74.17±19.56
＞12 000 yuan	31 （17.5）	82.85±12.73			71.45±20.19
Father′s education level			3.311	0.021		1.102	0.350
Less than junior school	25 （14.1）	75.65±15.10			67.80±22.41
Junior school	70 （39.5）	71.84±15.14			67.91±14.83
High school or technical secondary school	35 （19.8）	80.34±15.86			73.33±18.77
College degree or above	47 （26.6）	78.01±14.23			72.66±21.03
Mother′s education level			2.756	0.044		1.850	0.140
Less than junior school	38 （21.5）	72.54±14.21			69.01±18.68
Junior school	62 （35.0）	72.37±14.97			66.65±17.07
High school or technical secondary school	31 （17.5）	78.05±17.60			72.27±15.47
College degree or above	46 （26.0）	79.56±14.20			74.23±18.57
Father′s occupation			0.863	0.424		1.344	0.263
Blue-collar worker	96 （54.2）	76.66±14.81			72.18±18.29
White-collar worker	74 （41.8）	73.64±15.95			67.53±19.07
Unemployment	7 （4.0）	73.45±16.18			71.96±15.43
Mother′s occupation			6.097	0.003		8.203	0.000
Blue-collar worker	71 （40.1）	79.54±14.30			76.43±16.75
White-collar worker	57 （32.2）	74.51±14.20			68.40±19.08
Unemployment	49 （27.7）	69.96±16.50			63.37±17.93

Independent variable	Assignment method
Number of children in a family	One=0； More than one=1
Geographical location	Rural area=0； Urban area=1
Family income	< 4 000 yuan=1； 4 001－8 000 yuan=2； 8 001－12 000 yuan=3；＞12 000 yuan=4
Father′s education level	Less than junior school= （0， 0， 0）； Junior school= （1， 0， 0）； High school or technical secondary school = （0， 1， 0）； College degree or above= （0， 0， 1）
Mother′s education level	Less than junior school= （0， 0， 0）； Junior school= （1， 0， 0）； High school or technical secondary school = （0， 1， 0）； College degree or above= （0， 0， 1）
Mother′s occupation	Blue-collar worker= （1， 0）； White-collar worker= （0， 0）； Unemployment= （0， 1）