慢阻肺病肺康复患者自我效能在自我感受负担与远程康复使用意愿间的中介效应

doi:10.19983/j.issn.2096-8493.20250047

摘要/Abstract

摘要：

目的:研究慢性阻塞性肺疾病(简称“慢阻肺病”;chronic obstructive pulmonary disease,COPD)肺康复患者自我效能、自我感受负担、远程康复使用意愿之间的关系,探讨慢阻肺病肺康复患者自我效能在自我感受负担与远程康复使用意愿间是否存在中介效应。方法:本研究为前瞻性研究,采用方便抽样法,选取天津医科大学总医院呼吸与危重症医学科2024年6—11月收治的慢阻肺病患者作为研究对象,最终纳入108例。采用一般资料调查表、自我感受负担量表、慢阻肺病自我效能量表、慢阻肺病患者远程康复使用意愿量表进行调查,构建并检验中介模型。结果:慢阻肺病肺康复患者自我效能总分为(89.96±15.54)分、自我感受负担总分为(28.36±5.30)分、远程康复使用意愿总分为(76.84±23.09)分。相关性结果显示,慢阻肺病肺康复患者自我效能总分与自我感受负担总分呈明显负相关(r=-0.834,P<0.05);慢阻肺病肺康复患者远程康复使用意愿总分与自我感受负担总分呈明显负相关(r=-0.713,P<0.05);慢阻肺病肺康复患者自我效能与远程康复使用意愿呈明显正相关(r=0.792,P<0.05)。结构方程模型显示,慢阻肺病肺康复患者自我效能在自我感受负担与远程康复使用意愿间存在部分中介效应,中介效应占总效应的28.17%。结论:慢阻肺病肺康复患者心理负担能直接提升远程康复参与度,同时增强自我效能可间接促进康复意愿。

关键词: 肺疾病,慢性阻塞性, 康复, 问卷调查

Abstract:

Objective: To examine the relationship between self-efficacy, self-perceived burden, and willingness to use telerehabilitation among pulmonary rehabilitation patients with chronic obstructive pulmonary disease (COPD), and to explore whether there is a mediating effect of self-efficacy between self-perceived burden and willingness to use telerehabilitation among pulmonary rehabilitation patients with COPD. Methods: This prospective study enrolled 108 patients with COPD who were admitted to the Department of Respiratory and Critical Care Medicine at Tianjin Medical University General Hospital between June and November 2024. Participants were selected using a convenience sampling approach. Data were collected using four validated instruments: a general information questionnaire, the Self-Perceived Burden Scale, the COPD Self-Efficacy Scale, and the Telerehabilitation Willingness Scale for COPD patients. A mediation model was subsequently constructed and tested to evaluate the indirect effects of self-efficacy. Results: The mean total score for self-efficacy among patients with COPD undergoing pulmonary rehabilitation was 89.96±15.54, while the mean scores for self-perceived burden and willingness to use telerehabilitation were 28.36±5.30 and 76.84±23.09, respectively. Pearson correlation analyses revealed that self-efficacy was strongly negatively associated with self-perceived burden (r=-0.834, P<0.05), whereas willingness to engage in telerehabilitation was also negatively correlated with self-perceived burden (r=-0.713, P<0.05). In contrast, self-efficacy was positively associated with willingness to use telerehabilitation (r=0.792, P<0.05). Structural equation modeling indicated that self-efficacy partially mediated the relationship between self-perceived burden and willingness to use telerehabilitation, accounting for 28.17% of the total effect. Conclusion: Among patients with COPD undergoing pulmonary rehabilitation, self-perceived psychological burden was found to directly influence their willingness to participate in telerehabilitation. Moreover, enhancing self-efficacy exerted an indirect facilitating effect on this willingness, underscoring its mediating role in the rehabilitation decision-making process.

Key words: Pulmonary disease, chronic obstructive, Rehabilitation, Questionnaires

中图分类号:

R563

赵盼盼, 李娜, 王砚. 慢阻肺病肺康复患者自我效能在自我感受负担与远程康复使用意愿间的中介效应[J]. 结核与肺部疾病杂志, 2025, 6(3): 269-276. doi: 10.19983/j.issn.2096-8493.20250047

Zhao Panpan, Li Na, Wang Yan. The mediating effect of self-efficacy between self-perceived burden and willingness to use remote rehabilitation in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(3): 269-276. doi: 10.19983/j.issn.2096-8493.20250047

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参考文献 23

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因素	例数(构成比,%)	远程康复使用意愿得分	统计检验值	P值
年龄组(岁)			t=30.992	<0.001
≤60	39(36.11)	91.38±18.26
>60	69(63.89)	68.62±21.51
性别			t=0.614	0.435
男性	76(70.37)	75.71±22.92
女性	32(29.63)	79.53±23.64
文化程度			t=7.560	<0.001
初中及以下	68(62.96)	72.29±13.54
高中及以上	40(37.04)	84.57±20.33
婚姻状况			t=0.587	0.445
已婚	81(75.00)	77.82±23.57
离异或丧偶	27(25.00)	73.89±21.73
个人月收入(元)			t=12.768	<0.001
<5000	64(59.26)	70.59±23.07
≥5000	44(40.74)	85.93±20.10
吸烟情况			t=0.065	0.800
是	61(56.48)	76.34±22.22
否	47(43.52)	77.48±24.39
病程(年)			F=5.482	0.005
<5	49(45.37)	45.42±15.69
5~10	37(34.26)	46.66±12.61
>10	22(20.37)	55.66±9.76
肺功能分级			F=25.814	<0.001
2级	16(14.81)	103.18±16.70
3级	64(59.26)	77.50±18.74
4级	28(25.93)	60.28±21.04

项目	条目数(条)	得分	标准化得分	排序
自我感受负担总分	10	28.36±5.30	2.84±0.53	-
身体负担	2	9.31±0.86	4.65±0.43	1
情感负担	6	11.16±4.35	1.86±0.73	3
经济负担	2	7.89±0.98	3.95±0.848	2
自我效能总分	31	89.96±15.54	2.90±0.50	-
负面影响	11	34.02±6.24	3.09±0.57	1
情绪波动	7	19.53±3.78	2.79±0.54	4
体力活动	5	14.44±2.59	2.89±0.52	2
环境与温度	6	16.23±3.55	2.71±0.59	5
安全行为	2	5.73±1.61	2.87±0.81	3
远程康复使用意愿总分	26	76.84±23.09	2.96±0.89	-
绩效期望	5	18.41±5.62	3.68±1.12	1
努力期望	3	8.47±3.14	2.82±1.05	6
社会影响	3	8.38±2.93	2.79±0.98	7
感知严重性	3	8.59±3.32	2.86±1.11	5
感知易感性	4	12.48±4.10	3.12±1.03	2
自我效能	4	11.85±4.17	2.96±1.04	3
使用意愿	3	8.63±3.14	2.88±1.05	4

项目	自我感受负担总分	身体负担	情感负担	经济负担
自我效能总分	-0.834^a	-0.828^a	-0.717^a	-0.596^a
负面影响	-0.750^a	-0.588^b	-0.707^a	-0.395^b
情绪波动	-0.732^a	-0.873^a	-0.575^b	-0.636^a
体力活动	-0.665^a	-0.724^a	-0.542^b	-0.547^a
环境与温度	-0.726^a	-0.770^a	-0.609^a	-0.541^b
安全行为	-0.752^a	-0.799^a	-0.611^a	-0.651^a

项目	自我感受负担总分	身体负担	情感负担	经济负担
远程康复使用意愿总分	-0.713^a	-0.742^a	-0.678^a	-0.792^a
绩效期望	-0.524^a	-0.622^a	-0.491^a	-0.619^b
努力期望	-0.616^a	-0.601^a	-0.617^a	-0.694^a
社会影响	-0.665^a	-0.675^a	-0.640^a	-0.692^a
感知严重性	-0.627^a	-0.665^a	-0.607^a	-0.701^a
感知易感性	-0.626^a	-0.632^b	-0.618^a	-0.692^a
自我效能	-0.658^a	-0.636^a	-0.648^a	-0.709^a
使用意愿	-0.604^a	-0.630^a	-0.583^a	-0.675^a

项目	自我效能总分	负面影响	情绪波动	体力活动	环境与温度	安全行为
远程康复使用意愿总分	0.792^a	0.667^a	0.754^a	0.706^a	0.750^a	0.743^a
绩效期望	0.619^b	0.508^b	0.613^a	0.657^a	0.699^a	0.694^a
努力期望	0.694^a	0.655^a	0.614^a	0.691^a	0.728^a	0.628^a
社会影响	0.692^a	0.612^a	0.660^a	0.610^a	0.709^a	0.680^a
感知严重性	0.701^a	0.610^a	0.656^a	0.602^b	0.682^a	0.645^a
感知易感性	0.692^a	0.590^b	0.646^a	0.667^a	0.648^a	0.624^a
自我效能	0.709^a	0.588^a	0.690^a	0.626^a	0.695^a	0.652^a
使用意愿	0.675^a	0.572^b	0.649^a	0.685^a	0.644^a	0.660^a