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Article(id=1240738485280239647, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409045, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1725379200000, receivedDateStr=2024-09-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773744706696, onlineDateStr=2026-03-17, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773744706696, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773744706696, creator=13701087609, updateTime=1773744706696, updator=13701087609, issue=Issue{id=1240738480549065614, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773744705569, creator=13701087609, updateTime=1773744787657, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240738824918192654, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240738824922386959, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1630, endPage=1635, ext={EN=ArticleExt(id=1240738485561258032, articleId=1240738485280239647, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the correlation between self-efficacy, belief perception, and pain coping strategies in community-dwelling elderly patients with chronic pain, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between self-efficacy, belief perception, and pain coping strategies in community-dwelling elderly patients with chronic pain, providing a theoretical basis and guidance for targeted nursing interventions.

Methods

A stratified sampling method was used to select 363 community-dwelling elderly patients with chronic pain. The Chronic Pain Self-Efficacy Scale, Pain Beliefs and Perception Questionnaire, and Coping Strategies Questionnaire-Revised were employed for the survey. Pearson correlation analysis was conducted to analyze the correlations among variables, and multiple linear regression analysis was performed to identify factors influencing pain coping strategies.

Results

The self-efficacy score among the 363 patients was 73.70±8.92, the belief perception score was -4.69±13.67, and the pain coping strategies score was 73.96±8.60. Univariate analysis indicated statistically significant differences in coping strategy scores based on age, marital status, educational level, payment method for medical expenses, previous occupation, monthly income level, religious belief, physical exercise, duration of pain, number of comorbid chronic diseases, and primary caregiver (P<0.05). Correlation analysis showed a positive correlation between coping strategy scores and self-efficacy scores (r=0.517, P<0.01), and a negative correlation between coping strategy scores and belief perception scores (r=-0.443, P<0.01). Multiple linear regression analysis revealed that religious belief, educational level, belief perception scores, and self-efficacy scores were influencing factors for community-dwelling elderly patients with chronic pain.

Conclusion

Healthcare professionals should develop rational intervention strategies based on the study results to help patients enhance their self-efficacy, establish correct belief perceptions, and guide them in adopting proactive pain coping strategies, ultimately improving their quality of life.

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目的

探讨社区老年慢性疼痛患者自我效能、信念感知与疼痛应对策略的关系，为采取有针对性的护理措施提供理论依据和指导。

方法

采用分层抽样法选取363名社区老年慢性疼痛患者，使用慢性疼痛自我效能感量表、疼痛信念与感知问卷、应对策略问卷-修正版进行调查，采用Pearson相关分析分析变量间相关关系、多元线性回归分析疼痛应对策略的影响因素。

结果

363名患者的自我效能感得分为（73.70±8.92）分，信念感知得分为（-4.69±13.67）分，疼痛应对策略得分为（73.96±8.60）分。单因素分析显示，应对策略得分在不同年龄、婚姻状况、文化程度、医疗费用支付方式、既往职业、月收入水平、宗教信仰、体育锻炼情况、疼痛持续时间、合并其他慢性病数量、主要照顾者方面比较差异具有统计学意义（P<0.05）。相关分析显示，应对策略得分与自我效能感得分呈正相关（r=0.517，P<0.01）；应对策略得分与信念感知得分呈负相关（r=-0.443，P<0.01）。多元线性回归分析显示，宗教信仰、文化程度、信念感知得分、自我效能感得分是社区老年慢性疼痛患者的影响因素。

结论

医护人员应根据研究结果，制定合理化的干预手段，帮助患者提高自我效能感，树立正确的信念感知，为采取积极主动的疼痛应对策略提供指导，提升患者的生活质量。

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张小丽，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=H3Cwm63lYHn8KT6kp7szIQ==, magXml=mIhh4WRMu9KQfq0aGo144g==, pdfUrl=null, pdf=JHJ3l9SW14G1vANA561dtQ==, pdfFileSize=671701, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=VVlJTcpriVeOXfBIqD3Eaw==, mapNumber=null, authorCompany=null, fund=null, authors=

李明阳（1999—），男，硕士在读，研究方向：老年护理

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李明阳（1999—），男，硕士在读，研究方向：老年护理

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Pain Management Nursing, 2022, 23(4): 486-493., articleTitle=Self-Efficacy survey study of pain Self-Management in patients with cancer, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241081869568102789, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, xref=null, ext=[AuthorCompanyExt(id=1241081869576491399, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, companyId=1241081869568102789, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=North China University of Science and Technology, Tangshan, Hebei 063210, China), AuthorCompanyExt(id=1241081869584880008, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, companyId=1241081869568102789, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=华北理工大学，河北 唐山 063210)])], figs=[ArticleFig(id=1241081877017187055, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, language=EN, label=Table 1, caption=

Scores of patients’ self-efficacy, belief perception and pain coping strategies ［（$ \bar{x} \pm s$），n=363］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目条目数得分（分）条目均分（分）
疼痛自我效能总分2273.70±8.923.35±0.41
疼痛管理517.22±3.583.44±0.72
躯体功能929.68±6.573.30±0.73
症状应对826.80±5.633.35±0.70
信念感知总分16-4.69±13.67-0.29±0.85
疼痛很神秘4-0.72±4.12-0.18±1.03
会持续疼痛5-2.01±4.39-0.40±0.88
疼痛不可解除4-1.29±3.75-0.32±0.94
自责感3-0.66±3.07-0.22±1.02
疼痛应对策略总分2773.96±8.602.74±0.32
分散注意力516.72±4.273.34±0.85
厄运感611.10±6.841.85±1.14
忽视疼痛515.24±3.523.05±0.70
逃避疼痛412.35±4.083.09±1.02
勇敢面对414.17±4.783.54±1.20
祈祷34.38±4.161.46±1.39
), ArticleFig(id=1241081877231096572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, language=CN, label=表1, caption=

患者自我效能、信念感知及疼痛应对策略得分［（$ \bar{x} \pm s$），n=363］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目条目数得分（分）条目均分（分）
疼痛自我效能总分2273.70±8.923.35±0.41
疼痛管理517.22±3.583.44±0.72
躯体功能929.68±6.573.30±0.73
症状应对826.80±5.633.35±0.70
信念感知总分16-4.69±13.67-0.29±0.85
疼痛很神秘4-0.72±4.12-0.18±1.03
会持续疼痛5-2.01±4.39-0.40±0.88
疼痛不可解除4-1.29±3.75-0.32±0.94
自责感3-0.66±3.07-0.22±1.02
疼痛应对策略总分2773.96±8.602.74±0.32
分散注意力516.72±4.273.34±0.85
厄运感611.10±6.841.85±1.14
忽视疼痛515.24±3.523.05±0.70
逃避疼痛412.35±4.083.09±1.02
勇敢面对414.17±4.783.54±1.20
祈祷34.38±4.161.46±1.39
), ArticleFig(id=1241081877373702918, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, language=EN, label=Table 2, caption=

Univariate analysis of pain coping strategies in patients ［（$ \bar{x} \pm s$），n=363］

, figureFileSmall=null, figureFileBig=null, tableContent=
因素类别例数得分（分）t/F值P值
年龄（岁）60～7019172.52±8.444.7260.009
71～8015275.18±8.68
≥812075.90±8.20
性别男17373.56±8.45-0.5490.584
女19074.06±8.78
婚姻状况未婚1172.00±7.676.2270.002
已婚29773.20±8.59
离异/丧偶5577.53±8.09
文化程度小学及以下23475.85±8.2412.717<0.001
初中7371.90±8.16
高中或中专3568.97±7.50
大专1566.40±6.07
本科及以上665.00±9.98
医疗支付职工医保2870.68±7.639.696<0.001
居民医保13571.02±8.46
新农合医保17075.73±8.32
贫困救助677.50±7.87
全自费2478.79±6.86
既往职业公务员767.00±7.337.691<0.001
企/事业员工2871.25±7.34
农民19876.06±8.05
工人7972.08±8.83
教师3267.47±7.92
个体1373.85±8.66
无业676.67±8.07
月收入（元）<1 00011677.10±8.3817.197<0.001
1 000～3 00014274.17±8.09
3 001～5 0006071.30±7.60
>5 0004567.62±7.96
宗教信仰有2981.00±8.954.819<0.001
无33473.20±8.31
体育锻炼（次）从不11677.02±8.265.711<0.001
≥113774.61±7.64
≥511069.46±8.43
疼痛时间（年）<14370.88±7.6810.419<0.001
1～517272.41±8.76
6～1011475.30±7.81
>103479.74±8.25
慢性病数量（个）无8370.70±9.239.895<0.001
1～218073.76±7.98
3～59475.95±8.19
>5685.50±6.60
主要照顾者配偶27173.01±8.494.9720.007
子女6976.45±8.87
其他2375.52±7.87
), ArticleFig(id=1241081877524697872, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, language=CN, label=表2, caption=

患者疼痛应对策略的单因素分析［（$ \bar{x} \pm s$），n=363］

, figureFileSmall=null, figureFileBig=null, tableContent=
因素类别例数得分（分）t/F值P值
年龄（岁）60～7019172.52±8.444.7260.009
71～8015275.18±8.68
≥812075.90±8.20
性别男17373.56±8.45-0.5490.584
女19074.06±8.78
婚姻状况未婚1172.00±7.676.2270.002
已婚29773.20±8.59
离异/丧偶5577.53±8.09
文化程度小学及以下23475.85±8.2412.717<0.001
初中7371.90±8.16
高中或中专3568.97±7.50
大专1566.40±6.07
本科及以上665.00±9.98
医疗支付职工医保2870.68±7.639.696<0.001
居民医保13571.02±8.46
新农合医保17075.73±8.32
贫困救助677.50±7.87
全自费2478.79±6.86
既往职业公务员767.00±7.337.691<0.001
企/事业员工2871.25±7.34
农民19876.06±8.05
工人7972.08±8.83
教师3267.47±7.92
个体1373.85±8.66
无业676.67±8.07
月收入（元）<1 00011677.10±8.3817.197<0.001
1 000～3 00014274.17±8.09
3 001～5 0006071.30±7.60
>5 0004567.62±7.96
宗教信仰有2981.00±8.954.819<0.001
无33473.20±8.31
体育锻炼（次）从不11677.02±8.265.711<0.001
≥113774.61±7.64
≥511069.46±8.43
疼痛时间（年）<14370.88±7.6810.419<0.001
1～517272.41±8.76
6～1011475.30±7.81
>103479.74±8.25
慢性病数量（个）无8370.70±9.239.895<0.001
1～218073.76±7.98
3～59475.95±8.19
>5685.50±6.60
主要照顾者配偶27173.01±8.494.9720.007
子女6976.45±8.87
其他2375.52±7.87
), ArticleFig(id=1241081877763773210, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, language=EN, label=Table 3, caption=

Correlation analysis between self-efficacy, pain belief perception and coping strategies (r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量自我效能感总分信念感知总分
分散注意力0.401**-0.400**
厄运感-0.862**0.864**
忽视疼痛0.563**-0.551**
逃避疼痛-0.617**0.613**
勇敢面对0.827**-0.844**
祈祷-0.732**0.766**
应对策略总分0.517**-0.443**
), ArticleFig(id=1241081877877019425, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, language=CN, label=表3, caption=

自我效能感、信念感知与应对策略的相关性分析（r值）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量自我效能感总分信念感知总分
分散注意力0.401**-0.400**
厄运感-0.862**0.864**
忽视疼痛0.563**-0.551**
逃避疼痛-0.617**0.613**
勇敢面对0.827**-0.844**
祈祷-0.732**0.766**
应对策略总分0.517**-0.443**
), ArticleFig(id=1241081878007042854, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, language=EN, label=Table 4, caption=

Independent variable assignments

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量赋值方式
年龄（岁）60～70=1,71～80=2，≥81=3
婚姻状况未婚=1，已婚=2，离异/丧偶=3
文化程度小学及以下=1，初中=2，高中或中专=3，
大专=4，本科及以上=5
医疗支付职工医保=1，居民医保=2，新农合医疗=3，
贫困救助=4，全自费=5
既往职业公务员=1，企/事业单位员工=2，农民=3，
工人=4，教师=5，个体=6，无业=7
月收入（元）<1 000=1,1 000～3 000=2,3 001～5 000=3，
>5 000=4
宗教信仰有=1，无=2
体育锻炼从不=1，≥1次=2，≥5次=3
疼痛时间（年）<1=1,1～5=2，6～10=3,>10=4
慢性病数量（个）无=1,1～2=2,3～5=3,>5=4
主要照顾者配偶=1，子女=2，其他=3
自我效能感（分）原值
信念感知（分）原值
), ArticleFig(id=1241081878422278973, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485280239647, language=CN, label=表4, caption=

自变量赋值方式

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量赋值方式
年龄（岁）60～70=1,71～80=2，≥81=3
婚姻状况未婚=1，已婚=2，离异/丧偶=3
文化程度小学及以下=1，初中=2，高中或中专=3，
大专=4，本科及以上=5
医疗支付职工医保=1，居民医保=2，新农合医疗=3，
贫困救助=4，全自费=5
既往职业公务员=1，企/事业单位员工=2，农民=3，
工人=4，教师=5，个体=6，无业=7
月收入（元）<1 000=1,1 000～3 000=2,3 001～5 000=3，
>5 000=4
宗教信仰有=1，无=2
体育锻炼从不=1，≥1次=2，≥5次=3
疼痛时间（年）<1=1,1～5=2，6～10=3,>10=4
慢性病数量（个）无=1,1～2=2,3～5=3,>5=4
主要照顾者配偶=1，子女=2，其他=3
自我效能感（分）原值
信念感知（分）原值
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Regression analysis of the influencing factors of pain coping strategies in patients with chronic pain

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自变量β标准误标准化βt值P值
（常量）63.6964.337—14.686<0.001
信念感知0.2490.0370.3956.660<0.001
自我效能0.2910.0440.3256.664<0.001
文化程度-2.0320.522-0.222-3.893<0.001
宗教信仰-3.8321.476-0.121-2.5970.001
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慢性疼痛患者疼痛应对策略影响因素的回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量β标准误标准化βt值P值
（常量）63.6964.337—14.686<0.001
信念感知0.2490.0370.3956.660<0.001
自我效能0.2910.0440.3256.664<0.001
文化程度-2.0320.522-0.222-3.893<0.001
宗教信仰-3.8321.476-0.121-2.5970.001
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社区老年慢性疼痛患者自我效能、信念感知与疼痛应对策略的相关性分析
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李明阳 , 张小丽 , 冯浩芸 , 朱行通 , 吕磊 , 贾国奥 , 杨立国
现代预防医学 | 基层卫生服务 2025,52(9): 1630-1635
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现代预防医学 | 基层卫生服务 2025, 52(9): 1630-1635
社区老年慢性疼痛患者自我效能、信念感知与疼痛应对策略的相关性分析
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李明阳, 张小丽 , 冯浩芸, 朱行通, 吕磊, 贾国奥, 杨立国
作者信息
  • 华北理工大学，河北 唐山 063210

    • 李明阳（1999—），男，硕士在读，研究方向：老年护理

通讯作者:

张小丽，E-mail:
Analysis of the correlation between self-efficacy, belief perception, and pain coping strategies in community-dwelling elderly patients with chronic pain
Ming-yang LI, Xiao-li ZHANG , Hao-yun FENG, Xing-tong ZHU, Lei LV, Guo-ao JIA, Li-guo YANG
Affiliations
  • North China University of Science and Technology, Tangshan, Hebei 063210, China
出版时间: 2025-05-10 doi: 10.20043/j.cnki.MPM.202409045
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摘要
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目的

探讨社区老年慢性疼痛患者自我效能、信念感知与疼痛应对策略的关系，为采取有针对性的护理措施提供理论依据和指导。

方法

采用分层抽样法选取363名社区老年慢性疼痛患者，使用慢性疼痛自我效能感量表、疼痛信念与感知问卷、应对策略问卷-修正版进行调查，采用Pearson相关分析分析变量间相关关系、多元线性回归分析疼痛应对策略的影响因素。

结果

363名患者的自我效能感得分为（73.70±8.92）分，信念感知得分为（-4.69±13.67）分，疼痛应对策略得分为（73.96±8.60）分。单因素分析显示，应对策略得分在不同年龄、婚姻状况、文化程度、医疗费用支付方式、既往职业、月收入水平、宗教信仰、体育锻炼情况、疼痛持续时间、合并其他慢性病数量、主要照顾者方面比较差异具有统计学意义（P<0.05）。相关分析显示，应对策略得分与自我效能感得分呈正相关（r=0.517，P<0.01）；应对策略得分与信念感知得分呈负相关（r=-0.443，P<0.01）。多元线性回归分析显示，宗教信仰、文化程度、信念感知得分、自我效能感得分是社区老年慢性疼痛患者的影响因素。

结论

医护人员应根据研究结果，制定合理化的干预手段，帮助患者提高自我效能感，树立正确的信念感知，为采取积极主动的疼痛应对策略提供指导，提升患者的生活质量。

慢性疼痛  /  自我效能感  /  信念感知  /  应对策略  /  影响因素
Objective

To explore the relationship between self-efficacy, belief perception, and pain coping strategies in community-dwelling elderly patients with chronic pain, providing a theoretical basis and guidance for targeted nursing interventions.

Methods

A stratified sampling method was used to select 363 community-dwelling elderly patients with chronic pain. The Chronic Pain Self-Efficacy Scale, Pain Beliefs and Perception Questionnaire, and Coping Strategies Questionnaire-Revised were employed for the survey. Pearson correlation analysis was conducted to analyze the correlations among variables, and multiple linear regression analysis was performed to identify factors influencing pain coping strategies.

Results

The self-efficacy score among the 363 patients was 73.70±8.92, the belief perception score was -4.69±13.67, and the pain coping strategies score was 73.96±8.60. Univariate analysis indicated statistically significant differences in coping strategy scores based on age, marital status, educational level, payment method for medical expenses, previous occupation, monthly income level, religious belief, physical exercise, duration of pain, number of comorbid chronic diseases, and primary caregiver (P<0.05). Correlation analysis showed a positive correlation between coping strategy scores and self-efficacy scores (r=0.517, P<0.01), and a negative correlation between coping strategy scores and belief perception scores (r=-0.443, P<0.01). Multiple linear regression analysis revealed that religious belief, educational level, belief perception scores, and self-efficacy scores were influencing factors for community-dwelling elderly patients with chronic pain.

Conclusion

Healthcare professionals should develop rational intervention strategies based on the study results to help patients enhance their self-efficacy, establish correct belief perceptions, and guide them in adopting proactive pain coping strategies, ultimately improving their quality of life.

Chronic pain  /  Self-efficacy  /  Belief perception  /  Coping strategies  /  Influencing factors
李明阳, 张小丽, 冯浩芸, 朱行通, 吕磊, 贾国奥, 杨立国. 社区老年慢性疼痛患者自我效能、信念感知与疼痛应对策略的相关性分析. 现代预防医学, 2025 , 52 (9) : 1630 -1635 . DOI: 10.20043/j.cnki.MPM.202409045
Ming-yang LI, Xiao-li ZHANG, Hao-yun FENG, Xing-tong ZHU, Lei LV, Guo-ao JIA, Li-guo YANG. Analysis of the correlation between self-efficacy, belief perception, and pain coping strategies in community-dwelling elderly patients with chronic pain[J]. Modern Preventive Medicine, 2025 , 52 (9) : 1630 -1635 . DOI: 10.20043/j.cnki.MPM.202409045
正文
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国际疼痛协会（International Association for the Study of Pain，IASP）定义慢性疼痛为持续或反复发作超过3个月的疼痛[1]。调查显示，我国慢性疼痛患者人数已经超过3亿人[2]，老年人群中慢性疼痛的发生率高达35.7%[3]，严重影响了老年人的生活质量。社区老年慢性疼痛患者由于疼痛上报率低，主动就医行为差，导致疼痛情况更为复杂，进一步放大了疼痛的危害。自我效能感可以用来解释个体所采取行为和措施[4]。信念感知可以反映对待疼痛的不同态度和举动[5]。应对策略是常见的描述慢性疼痛相关结局的指标，了解患者的疼痛应对策略对疼痛的治疗及管理有重要意义。以往研究中关于社区老年慢性疼痛患者自我效能感与信念感知及应对策略的关系研究鲜有报道，缺乏对三者关系的系统性的相关分析。鉴于此，本研究针对社区老年慢性疼痛患者，分析其自我效能、信念感知与疼痛应对策略的关系，探讨影响应对策略选择影响的因素，为采取积极有效的应对策略提供理论依据。
1　对象与方法
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1.1　研究对象
本研究采用分层抽样法，将临沂市下属区县按经济发展水平划分为高、中、低三组。首先，从每组中随机抽取一个区县，共抽取三个区县。随后，在每个抽中的区县中随机抽取三家社区。最后，从每家社区中采用简单随机抽样法抽取40～50例患者作为研究对象。纳入标准：年龄≥60岁；疼痛持续或间歇超过3个月以上：自愿参与本次调查。排除标准：患有某些严重的器质性病变；患有认知障碍及精神疾患者。按量性研究样本量粗略估计方法，选取自变量的5~10倍进行计算[6]。调查中共包含25个自变量，考虑10%的无应答率，需纳入的样本量为138～275例，实际纳入样本363例。本研究通过华北理工大学医学伦理委员会审查（2023147)。
1.2　研究工具
1.2.1　一般资料调查问卷
主要包括年龄、性别、婚姻状况、月收入等12项内容。
1.2.2　慢性疼痛自我效能感量表
由Anderson[7]研制，包括疼痛管理自我效能感量表等三个分量表组成。量表总分越高，自我效能越高。Cronbach α系数为0.87～0.90。
1.2.3　疼痛信念与感知问卷
采用贺婷等[8]进行汉化的版本。量表共含有四个维度总计16个条目。得分越高代表患者负面情绪越强。Cronbach α系数为0.73～0.88。
1.2.4　应对策略问卷-修正版
由Riley[9]等在原来的问卷修正而来，国内学者进行翻译。分为分散注意力等六个维度共27个条目。得分越高，表明该条策略使用频率越高。Cronbach α系数为0.788～0.941。
1.3　资料收集方法
调查前，对所有人员进行培训。调查中，向患者做好解释说明，确保患者独立填写问卷，填写完后现场回收，确保结果准确。共计发放问卷385份，回收363份，有效回收率为96.2%。
1.4　统计学方法
定性资料使用频数和百分比描述。定量资料中符合正态分布采用（$ \bar{x} \pm s$）表示，不符合正态分布的采用［M（P25，P75）］表示。单因素分析用t检验或方差分析，不符合正态分布采用秩和检验。采用Pearson相关分析，探讨自我效能感、信念感知、应对策略的关系。多因素采用多元线性回归分析。检验水准α=0.05。
2　结果
收起
2.1　社区老年慢性疼痛患者自我效能感、信念感知与疼痛应对策略得分情况
363例社区老年慢性疼痛患者的自我效能总得分为（73.70±8.92）分；信念感知总得分为（-4.69±13.67）分；疼痛应对策略总得分为（73.96±8.60）分，其中勇敢面对维度均分最高为（3.54±1.20）分，祈祷维度均分最低为（1.46±1.39）分。见表1。
2.2　社区老年慢性疼痛患者疼痛应对策略的单因素分析
不同年龄、婚姻状况、文化程度、医疗费用支付方式、既往职业、月收入水平、宗教信仰、体育锻炼情况、疼痛持续时间、合并慢性病数量及主要照顾者的社区老年慢性疼痛患者疼痛应对策略得分有差异。见表2。
2.3　社区老年慢性疼痛患者自我效能感、信念感知及疼痛应对策略的相关性分析
社区老年慢性疼痛患者的应对策略总分与自我效能感得分呈正相关（r=0.517），其中分散注意力、忽视疼痛、勇敢面对维度与自我效能感呈正相关；厄运感、逃避疼痛、祈祷维度与自我效能感呈负相关。应对策略得分与信念感知得分呈负相关（r=-0.443），其中厄运感、逃避疼痛、祈祷与信念感知呈正相关；分散注意力、忽视疼痛、勇敢面对与信念感知呈负相关。见表3。
2.4　社区老年慢性疼痛患者疼痛应对策略的多因素分析
以疼痛应对策略为因变量，单因素分析中有统计学意义的变量、自我效能感得分、信念感知得分为自变量，进行多元线性回归分析，赋值方式见表4。结果显示，信念感知、宗教信仰、文化程度是社区老年慢性疼痛患者疼痛应对策略的影响因素，共解释了疼痛应对策略的30%。VIF=1.118～1.821（VIF<5），变量间不存在多重共线性，不会影响回归结果的准确性。见表5。
3　讨论
收起
3.1　社区老年慢性疼痛患者疼痛应对策略得分情况
本研究显示，社区老年慢性疼痛患者应对策略总分为（73.96±8.60）分，高于刘芩慈[10]对老年腰椎间盘突出症患者的研究，可能与研究对象及疼痛种类差异有关。勇敢面对维度均分最高，表明该策略使用最频繁。总体来看，社区老年慢性疼痛患者的应对策略较为积极乐观，而国外患者更倾向于选择被动消极的策略，这可能与国内外文化差异有关。一项关于芭蕾舞演员疼痛的研究[11]指出，患者认为疼痛是自然的，需学会与之共存并被动适应。
3.2　社区老年慢性疼痛患者自我效能与应对策略的相关性
本研究显示，自我效能与应对策略得分呈正相关，与相关研究一致[12]。自我效能感高的患者更倾向于选择积极、具体的应对策略，有助于增强战胜疼痛的信心；而效能感低的患者则多采取消极、被动的措施。医护人员应通过提升患者自我效能感，缓解慢性疼痛危害，减少致残率并改善生活质量，同时及时评估和引导患者的应对策略，增强其自我效能感。
3.3　社区老年慢性疼痛患者信念感知与应对策略的相关性
本研究显示，慢性疼痛患者的应对策略得分与信念感知得分呈负相关，与相关研究一致[13]。信念感知高的患者更倾向于采取积极有效的应对策略，保持乐观态度；而信念感知低的患者则容易因疼痛产生消极情绪，畏惧并逃避，加剧慢性疼痛的危害。信念感知影响患者治疗依从性和自我管理能力，进而影响应对策略的效果[14]。医护人员应通过引导和训练，增强患者信念感知，帮助其正确认识疼痛，树立信心，采取积极应对策略，促进身心健康。
3.4　社区老年慢性疼痛患者疼痛应对策略的影响因素
3.4.1　信念感知
本研究显示，社区老年慢性疼痛患者信念感知越强，负性情绪越明显，采取的应对策略更加消极被动，与张永靖[15]的研究一致。信念感知各维度中，感到疼痛很神秘的得分越高，表明患者对疼痛了解不足，易将疼痛归咎于自身，从而引发焦虑、抑郁等负性情绪。信念感知影响应对策略的类型，决定患者能否采取健康促进行为[16]，且其对疼痛的内心感受和描述的影响，有时比疼痛本身的生理体验更能左右应对策略的选择[17]。
3.4.2　宗教信仰
本研究显示，宗教信仰是疼痛应对策略的影响因素，与相关研究一致[18]。宗教信仰作为一种内心意识，表现为对特定事物的坚定信念，可为患者提供精神支持，影响疼痛结局[19]。有宗教信仰的慢性疼痛患者常通过祈祷等方式应对疼痛，如基督教徒通过祈祷和赎罪寻求缓解或增强信念[20]。国外研究[21]表明，宗教信仰可影响疼痛感知和控制，促使患者采取特定行为反应。在我国，宗教信仰者较少且宗教活动组织不完善，有宗教信仰的患者更倾向于使用祈祷和逃避策略，可能与内心情感及本土环境差异有关。
3.4.3　文化程度
研究显示，文化程度影响疼痛应对策略的选择，与相关研究一致[22]。文化程度较高的患者倾向于采取积极主动的应对策略，因其受教育水平较高，内心更为丰富，面对疼痛更为积极；而文化程度较低的患者则容易夸大疾病危害，形成灾难化思维，采取逃避等消极策略[23]。文化程度还反映个体对疾病信息的接受能力，导致认知差异，进而影响应对策略的选择。
3.4.4　自我效能
研究表明，自我效能感影响疼痛应对策略的选择，与以往研究一致[24]。自我效能感高的个体倾向于选择积极主动的策略，而自我效能感低的个体则更可能采取消极被动的策略。自我效能感反映个体对克服疼痛的信心，影响其对应对策略的判断。国外研究[25]也指出，自我效能感可调节患者行为，包括疼痛应对策略的选择，其高低可解释患者采取积极或消极策略的原因。
综上所述，自我效能感、信念感知与疼痛应对策略相关，宗教信仰、文化程度、信念感知和自我效能感可影响社区老年慢性疼痛患者应对策略的选择。医护人员应重点关注不同文化背景及文化程度较低患者的内心情感变化及对疼痛的态度。由于本研究仅针对社区老年人，未来可扩展至农村老年人，探讨地域差异对疼痛应对策略的影响，进一步完善老年人慢性疼痛研究并制定针对性干预措施。
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doi: 10.20043/j.cnki.MPM.202409045
  • 接收时间：2024-09-04
  • 首发时间：2026-03-17
  • 出版时间：2025-05-10
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