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Article(id=1241023857121882606, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202409170, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1725897600000, receivedDateStr=2024-09-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812744645, onlineDateStr=2026-03-18, pubDate=1737734400000, pubDateStr=2025-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812744645, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812744645, creator=13701087609, updateTime=1773812744645, updator=13701087609, issue=Issue{id=1241023847537897695, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812742361, creator=13701087609, updateTime=1773812823817, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024189247845056, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024189247845057, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=292, endPage=296, ext={EN=ArticleExt(id=1241023858971570711, articleId=1241023857121882606, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Potential profile analysis of health literacy in chronically comorbid disabled elderly and comparison of differences in family care quality, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the potential categories of health literacy of the elderly with chronic disease comorbid disability and their relationship with family nursing quality.

Methods

713 comorbid disabled elderly in Urumqi, Xinjiang were investigated by general data, function of daily living index, health literacy scale for chronic disease patients and Family Care Quality Scale for disabled elderly (FCCI). Mplus 8.3 was used to make potential profile analysis of their health literacy, and SPSS 26.0 software was applied. To compare the quality of family care for the elderly with comorbidity and disability in different categories of health literacy.

Results

The health literacy of the elderly with concomitant disabilities can be divided into three categories:high health literacy - high willingness (35.5%), medium health literacy - good acceptance (47.7%), and low health literacy - low access to information (16.8%). There were significant differences in the total score of family care quality and the scores of each dimension among the 3 different health literacy groups (P<0.001). The total score of family care quality in the group with high health literacy and high willingness was the highest (47.47±0.128), and the total score of family care quality in the group with low health literacy and low information access was the lowest (40.28±0.315). The scores of family care quality in the group with high health literacy and high willingness were higher than those in the other two groups, including scores of disabled elderly (28.03±0.053), caregiver (11.02±0.054) and family members (8.42±0.062). The scores of family care quality in the group with low health literacy and low access to information were lower than those in the other two groups, including scores of disabled elderly (24.78±0.176), caregiver (8.97±0.116) and family members (6.53±0.101).

Conclusion

There are three potential categories of health literacy for the elderly with comorbid disabilities, and the quality of family care for the elderly with comorbid disabilities is different in different potential categories. It is suggested that targeted personalized intervention programs should be developed based on the groups with the same health literacy of the elderly with comorbid disabilities, so as to improve the quality of their family care.

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目的

探究慢性病共病失能老人健康素养潜在类别及其与家庭照护质量的关系。

方法

采用一般资料、日常生活功能指数量表、慢性病病人健康素养量表、失能老人家庭照护质量量表（FCCI）对新疆乌鲁木齐市713名共病失能老人进行调查，采用Mplus 8.3对其健康素养进行潜在剖面分析，并运用SPSS 26.0软件，比较不同类别健康素养共病失能老人的家庭照护质量差异。

结果

共病失能老人健康素养可分为3个类别：高等型健康素养－高意愿型（35.5%）、中等型健康素养－接受良好型（47.7%）、低等型健康素养－低信息获取型（16.8%）。共病失能老人3个不同健康素养类别组的家庭照护质量总分及各维度得分比较差异有统计学意义（P<0.001）。高等型健康素养－高意愿型类别组的家庭照护质量总分最高为（47.47±0.128）、低等型健康素养－低信息获取型类别组的家庭照护质量总分最低为（40.28±0.315）。高等型健康素养－高意愿型类别组的家庭照护质量各维度得分均高于其他2个类别，其中失能老人维度得分（28.03±0.053）、照护者维度得分（11.02±0.054）及家庭成员维度得分（8.42±0.062）；低等型健康素养－低信息获取型类别组的家庭照护质量各维度得分均低于其他2个类别，其中失能老人维度得分（24.78±0.176）、照护者维度得分（8.97±0.116）及家庭成员维度得分（6.53±0.101）。

结论

共病失能老人健康素养存在3种潜在类别，不同潜在类别的共病失能老人家庭照护质量存在差异，建议基于共病失能老人健康素养相同的群体，制定有针对性的个性化干预方案，以期提高共病失能老人健康素养，进而改善其家庭照护质量。

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蔡雯，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=Rq4TV0s336sQ0t8EYik4Kw==, magXml=9fwWbIwTd498hNCOjUOuNQ==, pdfUrl=null, pdf=DpVsYTBqhbFQpfp+92e/Ew==, pdfFileSize=583685, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=MhnbngFdd1z7952TcqRwnw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=ti9AaHvoms2in4bSa0YL5g==, mapNumber=null, authorCompany=null, fund=null, authors=

杨雪霞（1997—），女，在读硕士，研究方向：社区护理学

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杨雪霞（1997—），女，在读硕士，研究方向：社区护理学

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杨雪霞（1997—），女，在读硕士，研究方向：社区护理学

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(In Chinese), articleTitle=Research on health literacy of the elderly under the background of population aging, refAbstract=null)], funds=[Fund(id=1241023868920459423, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, awardId=22BRK049, language=CN, fundingSource=新疆维吾尔自治区社会科学基金项目(22BRK049), fundOrder=null, country=null), Fund(id=1241023868991762600, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, awardId=LNYBPY-2023-18, language=CN, fundingSource=2023年老年长期照护教育部重点实验室开放基金(LNYBPY-2023-18), fundOrder=null, country=null), Fund(id=1241023869100814509, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, awardId=CXCY2024016, language=CN, fundingSource=新疆医科大学研究生科研创新项目(CXCY2024016), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241023860775121601, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, xref=1．, ext=[AuthorCompanyExt(id=1241023860783510209, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, companyId=1241023860775121601, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang 830011, China), AuthorCompanyExt(id=1241023860796093124, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, companyId=1241023860775121601, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1．新疆医科大学护理学院，新疆　乌鲁木齐　830011)]), AuthorCompany(id=1241023860905145041, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, xref=2．, ext=[AuthorCompanyExt(id=1241023860909339346, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, companyId=1241023860905145041, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2．同济大学附属妇产科医院)]), AuthorCompany(id=1241023861005808346, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, xref=3．, ext=[AuthorCompanyExt(id=1241023861039362784, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, companyId=1241023861005808346, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3．新疆维吾尔自治区中医医院)])], figs=[ArticleFig(id=1241023868094181482, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, language=EN, label=Fig.1, caption=Score distribution of potential categories of health literacy for elderly people with comorbidities and disabilities, figureFileSmall=lMprA238lIZqd2ZCPW1UgA==, figureFileBig=MhnbngFdd1z7952TcqRwnw==, tableContent=null), ArticleFig(id=1241023868211622000, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, language=CN, label=图1, caption=共病失能老人健康素养潜在类别条目得分分布, figureFileSmall=lMprA238lIZqd2ZCPW1UgA==, figureFileBig=MhnbngFdd1z7952TcqRwnw==, tableContent=null), ArticleFig(id=1241023868501028991, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, language=EN, label=Table 1, caption=

Health literacy potential profile model fitting indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntropyLMR(P)BLRT(P)类别概率
类别144 607.65844 826.99344 674.581
类别236 634.52536 968.09736 736.3040.972<0.001<0.0010.58/0.42
类别333 295.44133 743.25133 432.0760.982<0.001<0.0010.17/0.48/0.35
类别432 212.45532 774.50132 383.9450.9610.292<0.0010.33/0.16/0.23/0.28
), ArticleFig(id=1241023868580720777, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, language=CN, label=表1, caption=

健康素养潜在剖面模型拟合指标

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntropyLMR(P)BLRT(P)类别概率
类别144 607.65844 826.99344 674.581
类别236 634.52536 968.09736 736.3040.972<0.001<0.0010.58/0.42
类别333 295.44133 743.25133 432.0760.982<0.001<0.0010.17/0.48/0.35
类别432 212.45532 774.50132 383.9450.9610.292<0.0010.33/0.16/0.23/0.28
), ArticleFig(id=1241023868698161296, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, language=EN, label=Table 2, caption=

Comparison of the total score and dimensions of family care quality in different potential categories of health literacy (n=713,)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目C1（n=120）C2（n=340）C3（n=253）FP值
家庭照护质量得分40.28±0.31544.87±0.14547.47±0.128306.958<0.001
失能老人维度24.78±0.17627.05±0.07928.03±0.053228.008<0.001
照护者维度8.97±0.11610.26±0.06211.02±0.054149.312<0.001
家庭成员维度6.53±0.1017.56±0.0478.42±0.062165.664<0.001
), ArticleFig(id=1241023868803018905, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023857121882606, language=CN, label=表2, caption=

不同健康素养潜在类别组家庭照护质量总分及各维度的比较（n=713,）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目C1（n=120）C2（n=340）C3（n=253）FP值
家庭照护质量得分40.28±0.31544.87±0.14547.47±0.128306.958<0.001
失能老人维度24.78±0.17627.05±0.07928.03±0.053228.008<0.001
照护者维度8.97±0.11610.26±0.06211.02±0.054149.312<0.001
家庭成员维度6.53±0.1017.56±0.0478.42±0.062165.664<0.001
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慢性病共病失能老人健康素养的潜在剖面分析及家庭照护质量差异比较
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杨雪霞 1 , 马雪儿 2 , 邓嘉琪 3 , 何晓萱 1 , 李琴 1 , 贾茜茜 1 , 任树风 1 , 蔡雯 1
现代预防医学 | 基层卫生服务 2025,52(2): 292-296
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现代预防医学 | 基层卫生服务 2025, 52(2): 292-296
慢性病共病失能老人健康素养的潜在剖面分析及家庭照护质量差异比较
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杨雪霞1, 马雪儿2, 邓嘉琪3, 何晓萱1, 李琴1, 贾茜茜1, 任树风1, 蔡雯1
作者信息
  • 1．新疆医科大学护理学院，新疆　乌鲁木齐　830011
  • 2．同济大学附属妇产科医院
  • 3．新疆维吾尔自治区中医医院

    • 杨雪霞（1997—），女，在读硕士，研究方向：社区护理学

通讯作者:

蔡雯，E-mail：
Potential profile analysis of health literacy in chronically comorbid disabled elderly and comparison of differences in family care quality
Xue-xia YANG1, Xue-er MA2, Jia-qi Deng3, Xiao-xuan HE1, Qin LI1, Qian-qian JIA1, Shu-feng RENG1, Wen CAI1
Affiliations
  • School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang 830011, China
出版时间: 2025-01-25 doi: 10.20043/j.cnki.MPM.202409170
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摘要
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目的

探究慢性病共病失能老人健康素养潜在类别及其与家庭照护质量的关系。

方法

采用一般资料、日常生活功能指数量表、慢性病病人健康素养量表、失能老人家庭照护质量量表（FCCI）对新疆乌鲁木齐市713名共病失能老人进行调查，采用Mplus 8.3对其健康素养进行潜在剖面分析，并运用SPSS 26.0软件，比较不同类别健康素养共病失能老人的家庭照护质量差异。

结果

共病失能老人健康素养可分为3个类别：高等型健康素养－高意愿型（35.5%）、中等型健康素养－接受良好型（47.7%）、低等型健康素养－低信息获取型（16.8%）。共病失能老人3个不同健康素养类别组的家庭照护质量总分及各维度得分比较差异有统计学意义（P<0.001）。高等型健康素养－高意愿型类别组的家庭照护质量总分最高为（47.47±0.128）、低等型健康素养－低信息获取型类别组的家庭照护质量总分最低为（40.28±0.315）。高等型健康素养－高意愿型类别组的家庭照护质量各维度得分均高于其他2个类别，其中失能老人维度得分（28.03±0.053）、照护者维度得分（11.02±0.054）及家庭成员维度得分（8.42±0.062）；低等型健康素养－低信息获取型类别组的家庭照护质量各维度得分均低于其他2个类别，其中失能老人维度得分（24.78±0.176）、照护者维度得分（8.97±0.116）及家庭成员维度得分（6.53±0.101）。

结论

共病失能老人健康素养存在3种潜在类别，不同潜在类别的共病失能老人家庭照护质量存在差异，建议基于共病失能老人健康素养相同的群体，制定有针对性的个性化干预方案，以期提高共病失能老人健康素养，进而改善其家庭照护质量。

共病失能老人  /  健康素养  /  潜在剖面分析  /  家庭照护质量  /  影响因素
Objective

To explore the potential categories of health literacy of the elderly with chronic disease comorbid disability and their relationship with family nursing quality.

Methods

713 comorbid disabled elderly in Urumqi, Xinjiang were investigated by general data, function of daily living index, health literacy scale for chronic disease patients and Family Care Quality Scale for disabled elderly (FCCI). Mplus 8.3 was used to make potential profile analysis of their health literacy, and SPSS 26.0 software was applied. To compare the quality of family care for the elderly with comorbidity and disability in different categories of health literacy.

Results

The health literacy of the elderly with concomitant disabilities can be divided into three categories:high health literacy - high willingness (35.5%), medium health literacy - good acceptance (47.7%), and low health literacy - low access to information (16.8%). There were significant differences in the total score of family care quality and the scores of each dimension among the 3 different health literacy groups (P<0.001). The total score of family care quality in the group with high health literacy and high willingness was the highest (47.47±0.128), and the total score of family care quality in the group with low health literacy and low information access was the lowest (40.28±0.315). The scores of family care quality in the group with high health literacy and high willingness were higher than those in the other two groups, including scores of disabled elderly (28.03±0.053), caregiver (11.02±0.054) and family members (8.42±0.062). The scores of family care quality in the group with low health literacy and low access to information were lower than those in the other two groups, including scores of disabled elderly (24.78±0.176), caregiver (8.97±0.116) and family members (6.53±0.101).

Conclusion

There are three potential categories of health literacy for the elderly with comorbid disabilities, and the quality of family care for the elderly with comorbid disabilities is different in different potential categories. It is suggested that targeted personalized intervention programs should be developed based on the groups with the same health literacy of the elderly with comorbid disabilities, so as to improve the quality of their family care.

Comorbidity disabled elderly  /  Health literacy  /  Potential profile analysis  /  Quality of home care  /  Influencing factor
杨雪霞, 马雪儿, 邓嘉琪, 何晓萱, 李琴, 贾茜茜, 任树风, 蔡雯. 慢性病共病失能老人健康素养的潜在剖面分析及家庭照护质量差异比较. 现代预防医学, 2025 , 52 (2) : 292 -296 . DOI: 10.20043/j.cnki.MPM.202409170
Xue-xia YANG, Xue-er MA, Jia-qi Deng, Xiao-xuan HE, Qin LI, Qian-qian JIA, Shu-feng RENG, Wen CAI. Potential profile analysis of health literacy in chronically comorbid disabled elderly and comparison of differences in family care quality[J]. Modern Preventive Medicine, 2025 , 52 (2) : 292 -296 . DOI: 10.20043/j.cnki.MPM.202409170
正文
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随着预期寿命的增加，面临慢性疾病或失能的老年人数量也不可避免地增加[1]。而慢性病共病老年人失能状态不仅导致活动受限、社会参与障碍，而且还会产生焦虑、抑郁等负性情绪，严重威胁其身心健康的同时日常照顾需求使家庭照护面临挑战[2]。健康素养是个体获得健康相关信息，并理解及运用健康信息的能力[3]，其高低能够影响患者的健康结局[4]。失能老年人健康素养能直接影响其生活质量[5]，且较高的健康素养意味着他们能够更好地理解和管理自己的健康状况，从而影响其家庭照护质量。潜在剖面分析（latent profile analysis, LPA）[6]是以个体为中心，基于个体不同特征对其进行分类，可以进行群体异质性分析。本研究基于潜在剖面分析探究共病失能老人健康素养的不同类别及其家庭照护质量差异，以期为进一步提高共病失能老人健康素养及制定家庭照护精准化干预方案提供参考。
1　对象与方法
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1.1　研究对象
于2023年2月至2023年11月期间，采用随机抽样法抽取乌鲁木齐市3个区，在每个区内整群抽取1所社区卫生服务中心进行调研，抽取符合纳入排除标准的713名慢性病共病失能老人为研究对象。纳入标准包括：①年龄≥60岁；②失能，即日常生活活动能力（ADL）至少存在1项受损，Barthel指数（BI）评定表得分低于100分[7]；③同时存在≥2种慢性病（按照国际疾病分类第11版[8]规定的慢性病，包括高血压、糖尿病等）；④在当地居住3年以上的老年人。本研究经新疆医科大学伦理委员会的批准（审批号：XJYKDXR202230407001）。
1.2　研究工具
1.2.1　一般资料调查表
由自行编制，主要内容包括共病失能老人性别、年龄、文化程度、是否独居、婚姻状况、患慢性病共病数量等。
1.2.2　ADL评估工具
采用Barthel指数问卷(Barthel Index, BI)[9]：该量表共计10个条目，包括穿衣、进食、修饰、控制大小便、洗澡、如厕、转移、上下楼梯、平地行走。依据不同得分评定为完全自理、轻度失能、中度失能、重度失能，分数越高表明其日常生活自理能力越好。<40分为重度失能，40～59分为中度失能，60～99分为轻度失能，100分为完全自理。该量表的Cronbach α系数为0.92。
1.2.3　慢性病患者健康素养量表
由孙浩林等[10]汉化，包含交流互动能力、信息获取能力、经济支持意愿及改善健康意愿4个维度，共24个条目。量表以1～5计分，总得分为24～120分，得分越高提示其健康素养水平越好。该量表Cronbach α系数为0.970。
1.2.4　失能老人家庭照护质量量表（family caregiver consequences inventory，FCCI）[11]
由学者徐亚瑛教授编制，包含失能老年人、照护者、家庭三个维度，共21个条目，量表以1～3计分，总得分21～63分，分数越高提示家庭照护质量越好。本研究该量表Cronbach α为0.83。
1.3　统计学处理
本研究采用Mplus 8.3和SPSS 26.0软件进行数据统计分析。（1）以健康素养条目得分为外显变量运用Mplus 8.3进行潜在剖面分析。对共病失能老人的健康素养类型进行分类，拟合潜在类别数目为1～4的模型，并选择最佳拟合模型。模型拟合指标：①赤池信息标准（Akaike information criteria, AIC）、经过校正贝叶斯信息准则（adjusted BIC, aBIC）以及贝叶斯信息标准（Bayesian information criteria, BIC），值越小代表模型拟合度越好；②熵（Entropy）值为0~1，越接近1代表分类准确率越高[12]；③基于Bootstrap的似然比值（BLRT）、似然比检验（LMR）比较模型拟合差异。（2）用SPSS 26.0对数据进一步分析，比较不同健康素养潜在类别组的家庭照护质量总分及各维度的差异。
2　结果
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2.1　共病失能老人一般资料
本研究回收问卷750份问卷，实际有效问卷713份，其有效回收率为95.07%。713例共病失能老人年龄主要以75~79岁（35.1%）、≥80岁（39.1%）为主，其中男性334例（46.8%），女性379例（53.2%）；小学及以下409例（57.4%），初中例182（25.5%），高中及以上122例（17.1%）；有配偶490例（68.7%），无配偶223例（31.3%）；独居45例（6.3%）、非独居668例（93.7%）；患有2~3项慢性病370例（51.9%），4项及以上慢性病343例（48.1%）；失能程度主要以轻度失能562例（78.8%）为主。
2.2　共病失能老人健康素养的潜在类别
本研究以慢性病健康素养量表的24个条目为指标，将共病失能老人健康素养依次分成4类进行模型拟合估计，表1。当其分为3个潜在类别时，Entropy值（0.982）最接近1，AIC、BIC及aBIC数值较小，BLRT和LMR的P值均有统计学意义。基于此，选择模型3类别作为共病失能老人健康素养的最优分类。
依据模型3，根据各类别分布情况对C1、C2、C3 进行命名。其中C3类别各条目得分较高，在改善健康意愿各条目得分最高，命名为高等型健康素养－高意愿型，占总样本的35.5%；C1类别得分总体偏低，在信息获取能力各条目得分均最低，与其他两组相差较大，命名为低等型健康素养－低信息获取型，占总样本的16.8%；C2类别处于C3和C1类别之间，命名为中等型健康素养－接受良好型，占总样本的47.7%。见图1。
2.3　不同健康素养潜在类别组家庭照护质量比较
结果显示，不同健康素养潜在类别组的家庭照护质量总分及各维度得分比较，差异均有统计学意义(P<0.001)，见表2。
3　讨论
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3.1　共病失能老人健康素养的不同潜在类别
健康素养是决定个体健康的重要保护因素，健康素养水平越高对个体的健康促进行为越好[13-14]，进而提高其生活质量。通过潜在剖面分析，本研究将共病失能老人健康素养可分为高等型健康素养－高意愿型、中等型健康素养－接受良好型和低等型健康素养－低信息获取型3个类别。
C1低等型健康素养－低信息获取型占总样本的16.8%（120/713），该类别共病失能老人信息获取能力、交流互动能力较其他两类别整体偏低，与刘梦如等[15]研究相一致。可能由于共病失能导致老人行动不便，社会交往障碍，健康信息交流减少，获取健康信息的主动性也降低，影响失能老人健康素养水平[16]。鉴于此，社区及家庭照护者可针对共病失能老人的不同情况，应采取个性化的沟通方式，比如，视力不佳的共病失能老人，可以使用大字体或者语音辅助工具，增加其信息获取能力及交流互动能力。与此同时，社区可组织开展共病失能老年人交流互动活动，并进行针对性的社交技能培训。C2中等型健康素养－接受良好型占总样本的47.7%（340/713），此类别占比最大，这可能与共病失能老人电子健康素养较高，能借助现代技术支持获取需要的信息，也更能积极采取健康的生活方式有一定关系[17]。因此，家庭照护者需提供精神支持以及现代技术支持，帮助共病失能老人学习电子产品简单通信的使用，为其沟通交流、信息获取提供平台，从而提高其慢性病健康素养。C3高等型健康素养－高意愿型占总样本的35.5%（253/713），此类别共病失能老人的改善健康意愿处于高水平，对于健康知识的求知欲强。因此，社区医务人员应提供老年服务、康复指导等，为此类别人群提供获取健康知识的便捷途径，进一步增强其健康意识。
3.2　不同健康素养潜在类别的共病失能老人家庭照护质量存在差异
本研究结果显示，3个不同潜在类别组的家庭照护质量总分及各维度得分比较存在差异。在家庭照护质量总得分方面存在的差异，C3高等型健康素养－高意愿型共病失能老人家庭照护质量总得分为（47.47±0.128），C2中等型健康素养－接受良好型家庭照护质量总得分为（44.87±0.145），而C1低等型健康素养－低信息获取型共病失能老人家庭照护质量得分最低为（40.28±0.315）。由此可知，共病失能老人的健康素养对于家庭照护质量具有重要影响。学者研究发现健康素养与健康相关生活质量之间呈正相关[18-19]，与本研究结果相似。高等型健康素养－高意愿型共病失能老人能够更准确地理解医护人员的指导，能够采取积极的健康行为，提高了家庭照护的质量。
在家庭照护质量失能老人、照护者及家庭成员三个维度得分方面存在的差异，C3高等型健康素养－高意愿型共病失能老人家庭照护质量各维度得分最高，C2中等型健康素养－接受良好型在各维度得分居中，C1低等型健康素养－低信息获取型在各维度得分处于最低。
在共病失能老人自身维度，分析可能的原因是对于共病失能老人而言，健康素养的高低直接关系到他们对自身健康状况的认知和管理能力[20]。较高的健康素养有助于老人更好地理解医生的嘱咐、合理用药、控制饮食，并积极参与康复活动，从而提高生活质量。在共病失能老人照护者维度，可以从共病失能老人不同健康素养类别对照护效果、照护负担与压力以及照护满意度等方面进行分析。在照护效果方面，可能的原因是高健康素养类别组的共病失能老人能够更准确地描述自己的健康状况和需求，使家庭成员或照护者能够更有效地提供照护，从而提高照护效果。在照护负担与压力方面，当共病失能老人具备较高的健康素养时，他们能够更好地管理自己的健康状况，减少因疾病恶化或并发症而产生的照护需求，从而减轻家庭成员的照护负担。相反，C1低等型健康素养－低信息获取型类别组可能导致老人对疾病的认识不足，忽视自我管理[21]，增加照护者的压力和负担。在照护满意度方面，高健康素养的共病失能老人通常能够更好地理解照护者的付出和努力，从而提高对照护服务的满意度，同时良好的健康素养还有助于老人与照护者之间建立更紧密的信任和合作关系，共同应对疾病带来的挑战。因此，基于不同健康素养潜在类别组的共病失能老人，开展不同方案、多途径的疾病相关知识健康教育，应鼓励共病失能老人及家庭照护者注重自身健康素养的提升。
4　小结
收起
共病失能老人的健康素养存在一定的异质性，可分为高等型健康素养－高意愿型、中等型健康素养－接受良好型和低等型健康素养－低信息获取型，不同的健康素养类别的家庭照护质量存在差异，后期可根据不同类别所应对的问题，采取个性化的干预方案。
基金
收起
  • 新疆维吾尔自治区社会科学基金项目(22BRK049)
  • 2023年老年长期照护教育部重点实验室开放基金(LNYBPY-2023-18)
  • 新疆医科大学研究生科研创新项目(CXCY2024016)
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2025年第52卷第2期
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doi: 10.20043/j.cnki.MPM.202409170
  • 接收时间：2024-09-10
  • 首发时间：2026-03-18
  • 出版时间：2025-01-25
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  • 收稿日期：2024-09-10
基金
新疆维吾尔自治区社会科学基金项目(22BRK049)
2023年老年长期照护教育部重点实验室开放基金(LNYBPY-2023-18)
新疆医科大学研究生科研创新项目(CXCY2024016)
作者信息
    1．新疆医科大学护理学院，新疆　乌鲁木齐　830011
    2．同济大学附属妇产科医院
    3．新疆维吾尔自治区中医医院

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