基于COM-B模型的消化道肿瘤术后患者口服营养补充依从性研究

doi:10.3969/j.issn.1674-8115.2024.10.001

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (10): 1213-1220.doi: 10.3969/j.issn.1674-8115.2024.10.001

• 临床护理专题 •

基于COM-B模型的消化道肿瘤术后患者口服营养补充依从性研究

苏莉青¹(), 张洁², 窦雯玥², 李梦雪¹, 张雨萌¹, 常健¹^,²()

^1.上海交通大学护理学院，上海 200025
^2.上海交通大学医学院附属第一人民医院护理部，上海 201620

收稿日期:2024-03-01 接受日期:2024-05-20 出版日期:2024-10-28 发布日期:2024-10-28
通讯作者: 常健 E-mail:sliqing0219@sjtu.edu.cn;changjiancn@sjtu.edu.cn
作者简介:苏莉青（1998—），女，硕士生；电子信箱：sliqing0219@sjtu.edu.cn。
基金资助:
教育部高等学校科学研究发展中心项目(2023HT065);上海交通大学医学院护理学科建设项目(SJTUHLXK2021)

Compliance of oral nutritional supplements in postoperative patients with digestive tract cancer:an analysis based on COM-B model

SU Liqing¹(), ZHANG Jie², DOU Wenyue², LI Mengxue¹, ZHANG Yumeng¹, CHANG Jian¹^,²()

^1.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
^2.Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

Received:2024-03-01 Accepted:2024-05-20 Online:2024-10-28 Published:2024-10-28
Contact: CHANG Jian E-mail:sliqing0219@sjtu.edu.cn;changjiancn@sjtu.edu.cn
Supported by:
Program of Center for Scientific Research and Development in Higher Education Institutes, Ministry of Education, P.R. China(2023HT065);Nursing Development Program of Shanghai Jiao Tong University School of Medicine(SJTUHLXK2021)

摘要/Abstract

摘要：

目的·基于COM-B模型探究消化道肿瘤术后患者口服营养补充剂依从性影响因素，探讨服药信念与自我效能在影响路径中的中介作用。方法·采用便利抽样方法，对术后1个月的300例消化道肿瘤术后患者，采用一般资料调查表、Morisky服药依从性问卷、消化系统肿瘤病人营养知识-态度-行为问卷、多维度社会感知量表、服药相关信念量表、一般自我效能感量表进行调查，采用中介效应模型分析口服营养补充剂依从性的影响因素。结果·300例消化道肿瘤术后患者口服营养补充剂依从性得分为（1.61±1.38）分，处于较低水平。口服营养补充剂依从性与营养知识、社会支持、服药信念、自我效能之间呈正相关（r分别为0.391、0.401、0.438、0.410，均P<0.01）。服药信念在营养知识与口服营养补充剂依从性之间具有部分中介作用（效应值为0.097，占总效应的18.00%）；自我效能在营养知识与口服营养补充剂依从性之间具有部分中介作用（效应值为0.044，占总效应的8.16%）；自我效能在社会支持与口服营养补充剂依从性之间具有部分中介作用（效应值为0.044，占总效应的16.67%）。结论·消化道肿瘤患者术后口服营养补充剂依从性处于较低水平；护理人员在进行个性化护理干预时可以通过增加患者营养知识储备，提高社会支持度，同时减轻患者对口服营养的顾虑，提高患者的自我效能，以促进患者口服营养补充依从行为。

关键词: 消化道肿瘤, 肠内营养, 依从性, 中介作用

Abstract:

Objective ·To explore the influencing factors of oral nutritional supplement compliance in postoperative patients with digestive tract cancer based on COM-B model, and to analyze the mediating role of medication belief and self-efficacy in oral nutritional supplement. Methods ·A total of 300 postoperative gastrointestinal cancer patients were selected by convenience sampling method. The General Information Questionnaire, Morisky Medication Adherence Scale, Digestive Cancer Patients Nutrition Knowledge, Attitude and Practice Questionnaire, Multidimensional Scale of Perceived Social Support, Beliefs about Medicines Questionnaire and General Self-Efficacy Scale were used. A mediating effect model was used to analyze the influencing factors of compliance with oral nutritional supplements. Results ·The score of Morisky Medication Adherence scale was 1.61±1.38, which was at a low level. Oral nutritional supplement compliance was significantly positively correlated with nutrition knowledge, social support, medication belief and self-efficacy (r=0.391, 0.401, 0.438, 0.410, all P<0.01). Medication belief had a partial mediating effect between nutrition knowledge and adherence to oral nutritional supplements (effect size =0.097, accounting for 18.00% of the total effect). Self-efficacy had a partial mediating effect between nutrition knowledge and oral nutritional supplement compliance (effect size =0.044, accounting for 8.16% of the total effect). Self-efficacy had a partial mediating effect between social support and oral nutritional supplement compliance (effect size =0.044, accounting for 16.67% of the total effect). Conclusion ·The compliance of oral nutritional supplements in postoperative patients with gastrointestinal cancer is at a low level. The individualized nursing intervention can increase the nutritional knowledge of patients, improve the social support, reduce the concerns of patients about oral nutrition, and improve the self-efficacy of patients, so as to promote the compliance of patients with oral nutritional supplements.

Key words: digestive tract cancer, enteral nutrition, compliance, mediating effect

中图分类号:

R473.73

苏莉青, 张洁, 窦雯玥, 李梦雪, 张雨萌, 常健. 基于COM-B模型的消化道肿瘤术后患者口服营养补充依从性研究[J]. 上海交通大学学报（医学版）, 2024, 44(10): 1213-1220.

SU Liqing, ZHANG Jie, DOU Wenyue, LI Mengxue, ZHANG Yumeng, CHANG Jian. Compliance of oral nutritional supplements in postoperative patients with digestive tract cancer:an analysis based on COM-B model[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1213-1220.

图/表 4

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Item		MMAS score	Number/n (%)	t/F value	P value
Age	<65 years	1.82±1.39	154(51.3)	2.755	0.006
Age	≥65 years	1.38±1.34	146(48.7)	2.755	0.006
Gender	Male	1.66±1.38	176(58.7)	0.769	0.443
Gender	Female	1.54±1.38	124(41.3)	0.769	0.443
BMI	<24 kg/m²	1.54±1.44	161(53.7)	-0.986	0.325
BMI	≥24 kg/m²	1.69±1.31	139(46.3)	-0.986	0.325
Marital status	Single	1.03±0.89	30(10.0)	2.823	0.025
	Married	1.70±1.41	260(86.7)
	Divorced	1.40±1.34	5(1.7)
	Widowed	0.60±0.89	5(1.7)
Living arrangement	Single	2.27±1.10	11(3.7)	1.109	0.353
	With spouse	1.48±1.40	201 (67.0)
	With family	1.81±1.31	86 (28.7)
	With others	2.50±2.12	2 (0.7)
Education background	Not educated	1.32±1.06	19 (6.3)	3.108	0.016
	Primary school	1.47±1.38	96 (32.0)
	Middle school	1.56±1.28	97 (32.3)
	High school	1.62±1.42	55 (18.3)
	College/University	2.36±1.56	33 (11.0)
Monthly income	<2 000 yuan	1.52±1.30	93 (31.0)	3.924	0.004
	2 000‒2 999 yuan	1.45±1.31	87 (29.0)
	3 000‒3 999 yuan	1.56±1.33	66 (22.0)
	4 000‒5 000 yuan	1.81±1.55	33 (11.0)
	>5 000 yuan	2.57±1.60	21 (7.0)
Employment status	Unemployed	1.57±1.32	37 (12.3)	2.287	0.060
	Employed	2.12±1.38	59 (19.7)
	Retired	1.48±1.36	204 (68.0)
Medical payment	Publicly funded medical insurance	1.46±1.33	39 (13.0)	0.269	0.898
	Employee health insurance	2.02±1.42	82 (27.3)
	Urban medical insurance	1.39±1.23	69 (23.0)
	New rural cooperative medical insurance	1.45±1.41	97 (32.3)
	Self-paying	1.85±1.34	13 (4.3)
Adverse reaction	Diarrhea	1.69±1.42	59 (19.7)	2.523	0.041
	Abdominal distension	1.22±1.11	74 (24.7)
	Nausea	0.68±0.84	22 (7.3)
	Vomiting	1.57±1.40	7 (7.0)
	None	1.94±1.45	138 (46.0)

Item		MMAS score	Number/n (%)	t/F value	P value
Age	<65 years	1.82±1.39	154(51.3)	2.755	0.006
Age	≥65 years	1.38±1.34	146(48.7)	2.755	0.006
Gender	Male	1.66±1.38	176(58.7)	0.769	0.443
Gender	Female	1.54±1.38	124(41.3)	0.769	0.443
BMI	<24 kg/m²	1.54±1.44	161(53.7)	-0.986	0.325
BMI	≥24 kg/m²	1.69±1.31	139(46.3)	-0.986	0.325
Marital status	Single	1.03±0.89	30(10.0)	2.823	0.025
	Married	1.70±1.41	260(86.7)
	Divorced	1.40±1.34	5(1.7)
	Widowed	0.60±0.89	5(1.7)
Living arrangement	Single	2.27±1.10	11(3.7)	1.109	0.353
	With spouse	1.48±1.40	201 (67.0)
	With family	1.81±1.31	86 (28.7)
	With others	2.50±2.12	2 (0.7)
Education background	Not educated	1.32±1.06	19 (6.3)	3.108	0.016
	Primary school	1.47±1.38	96 (32.0)
	Middle school	1.56±1.28	97 (32.3)
	High school	1.62±1.42	55 (18.3)
	College/University	2.36±1.56	33 (11.0)
Monthly income	<2 000 yuan	1.52±1.30	93 (31.0)	3.924	0.004
	2 000‒2 999 yuan	1.45±1.31	87 (29.0)
	3 000‒3 999 yuan	1.56±1.33	66 (22.0)
	4 000‒5 000 yuan	1.81±1.55	33 (11.0)
	>5 000 yuan	2.57±1.60	21 (7.0)
Employment status	Unemployed	1.57±1.32	37 (12.3)	2.287	0.060
	Employed	2.12±1.38	59 (19.7)
	Retired	1.48±1.36	204 (68.0)
Medical payment	Publicly funded medical insurance	1.46±1.33	39 (13.0)	0.269	0.898
	Employee health insurance	2.02±1.42	82 (27.3)
	Urban medical insurance	1.39±1.23	69 (23.0)
	New rural cooperative medical insurance	1.45±1.41	97 (32.3)
	Self-paying	1.85±1.34	13 (4.3)
Adverse reaction	Diarrhea	1.69±1.42	59 (19.7)	2.523	0.041
	Abdominal distension	1.22±1.11	74 (24.7)
	Nausea	0.68±0.84	22 (7.3)
	Vomiting	1.57±1.40	7 (7.0)
	None	1.94±1.45	138 (46.0)

Item	DCNKAPQ	MSPSS	BMQ	GSES	MMAS
DCNKAPQ	1.000	0.274 ^①	0.275 ^①	0.204 ^①	0.391 ^①
MSPSS	0.274 ^①	1.000	0.176 ^①	0.322 ^①	0.401 ^①
BMQ	0.275 ^①	0.176 ^①	1.000	0.231 ^①	0.438 ^①
GSES	0.204 ^①	0.322 ^①	0.231 ^①	1.000	0.410 ^①
MMAS	0.391 ^①	0.401 ^①	0.438 ^①	0.410 ^①	1.000

Item	DCNKAPQ	MSPSS	BMQ	GSES	MMAS
DCNKAPQ	1.000	0.274 ^①	0.275 ^①	0.204 ^①	0.391 ^①
MSPSS	0.274 ^①	1.000	0.176 ^①	0.322 ^①	0.401 ^①
BMQ	0.275 ^①	0.176 ^①	1.000	0.231 ^①	0.438 ^①
GSES	0.204 ^①	0.322 ^①	0.231 ^①	1.000	0.410 ^①
MMAS	0.391 ^①	0.401 ^①	0.438 ^①	0.410 ^①	1.000

Dependent variable	Pathway	Effect	S.E.	95%CI	P value	Proportion/%
Nutritional knowledge	Total effect	0.539	0.136	0.302‒0.843	0.000	100.00
	Direct effect(Nutritional knowledge→ Compliance of ONS)	0.398	0.168	0.103‒0.769	0.008	73.84
	Mediating effect
	Nutritional knowledge →Self-efficacy	0.247	0.106	0.034‒0.453	0.027	‒
	Nutritional knowledge →Self-efficacy →Compliance of ONS	0.044	0.006	0.001‒0.019	0.019	8.16
	Nutritional knowledge →Medication belief	0.452	0.076	0.292‒0.592	0.001	‒
	Nutritional knowledge →Medication belief →Compliance of ONS	0.097	0.013	0.003‒0.032	0.017	18.00
	Total mediating effect	0.141	0.052	0.053‒0.257	0.006	26.16
Social support	Total effect	0.264	0.106	0.039‒0.442	0.028	100.00
	Direct effect (Social support →Compliance of ONS)	0.220	0.102	0.002‒0.392	0.049	83.33
	Mediating effect
	Social Support →Self-efficacy	0.247	0.086	0.063‒0.397	0.015	‒
	Social support →Self-efficacy →Compliance of ONS	0.044	0.026	0.006‒0.112	0.022	16.67
	Total mediating effect	0.044	0.026	0.006‒0.112	0.022	16.67
Self-efficacy	Direct effect (Self-efficacy →Compliance of ONS)	0.180	0.180	0.022‒0.320	0.026	100.00
Medication belief	Direct effect (Medication belief →Compliance of ONS)	0.215	0.215	0.020‒0.372	0.025	100.00

基于COM-B模型的消化道肿瘤术后患者口服营养补充依从性研究

Compliance of oral nutritional supplements in postoperative patients with digestive tract cancer:an analysis based on COM-B model

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