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Article(id=1241034449060680093, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411504, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1732636800000, receivedDateStr=2024-11-27, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815269961, onlineDateStr=2026-03-18, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815269961, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815269961, creator=13701087609, updateTime=1773815269961, updator=13701087609, issue=Issue{id=1241034441380917539, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815268130, creator=13701087609, updateTime=1773815340947, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241034746873049765, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241034746873049766, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2021, endPage=2026, ext={EN=ArticleExt(id=1241034449597551051, articleId=1241034449060680093, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of health literacy on self-management among community patients with peptic ulcers: the chain mediating effects of social support and self-efficacy, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the potential pathways influencing self-management behaviors among community patients with peptic ulcers, providing a basis for interventions aimed at enhancing self-management in this population.

Methods

From March to August 2024, a stratified cluster sampling combined with convenience sampling was employed to randomly select 640 community patients with peptic ulcers from five administrative districts in Hengyang city for a questionnaire survey. Data analysis was conducted using SPSS 26.0 for t-tests, ANOVA, and partial correlation analysis, and a chain mediation model was constructed using Process 4.0 plugin model 6.

Results

Health literacy had a significant direct effect on self-management (b=0.322, 95%CI: 0.254-0.390); the mediating effects of social support and self-efficacy between health literacy and self-management were 0.067 (95%CI: 0.043-0.098) and 0.100 (95%CI: 0.069-0.135), respectively. The chain mediating effect of social support and self-efficacy was also significant (b=0.016, 95%CI: 0.008-0.025).

Conclusion

Enhancing the level of health literacy among community patients with peptic ulcers is beneficial for improving social support and increasing self-efficacy, thereby enhancing self-management levels.

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目的

探索社区消化性溃疡患者自我管理行为的潜在影响路径，为开展社区消化性溃疡患者自我管理的干预提供依据。

方法

于2024年3—8月，采取分层整群抽样和便利抽样的方法随机抽取衡阳市5个行政区的640名社区消化性溃疡患者进行问卷调查。数据分析采用SPSS 26.0进行t检验、方差分析和偏相关分析，采用Process 4.0插件模型6构建链式中介模型

结果

健康素养对自我管理的直接效应显著（β=0.322,95%CI:0.254～0.390）；社会支持和自我效能在健康素养与自我管理之间的中介效应分别为0.067（95%CI：0.043～0.098）和0.100（95%CI：0.069～0.135）；社会支持-自我效能链式中介效应显著（β=0.016,95%CI：0.008～0.025）。

结论

提高社区消化性溃疡患者的健康素养水平，有利于改善社会支持水平和提升自我效能感，从而提高自我管理水平。

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曾颖，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=9a5M29Pd4wK/ZUh/ixuktA==, magXml=B5BeZ95CBjtZlznBna03iQ==, pdfUrl=null, pdf=c34KJMzrfRIVbcDSciLayg==, pdfFileSize=705627, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=y5t5DbvvtyJ9fL2ca34C1A==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=Y4RIAeZyxi2a4Zkv9gYrFw==, mapNumber=null, authorCompany=null, fund=null, authors=

黄丽丽（2000—），女，硕士在读，研究方向：健康与慢病管理学

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黄丽丽（2000—），女，硕士在读，研究方向：健康与慢病管理学

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黄丽丽（2000—），女，硕士在读，研究方向：健康与慢病管理学

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Psychological Review, 1977, 84(2): 191-215., articleTitle=Self-efficacy: toward a unifying theory of behavioral change, refAbstract=null), Reference(id=1241050846163693747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, doi=null, pmid=null, pmcid=null, year=2021, volume=9, issue=12, pageStart=1734, pageEnd=null, url=null, language=null, rfNumber=[31], rfOrder=42, authorNames=Lee EH, Lee YW, Chae D, journalName=Healthcare, refType=null, unstructuredReference=Lee EH, Lee YW, Chae D, et al. Pathways linking health literacy to self-management in People with type 2 diabetes[J]. Healthcare,2021, 9(12): 1734., articleTitle=Pathways linking health literacy to self-management in People with type 2 diabetes, refAbstract=null), Reference(id=1241050846335660221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, doi=null, pmid=null, pmcid=null, year=2024, volume=51, issue=1, pageStart=105, pageEnd=110, url=null, language=null, rfNumber=[32], rfOrder=43, authorNames=郑思榆, 钟思思, 陈江芸, journalName=现代预防医学, refType=null, unstructuredReference=郑思榆，钟思思，陈江芸，等.自我效能感与焦虑在社会支持与老年慢性病患者幸福感关系中的链式中介作用[J].现代预防医学，2024，51（1）：105-110., articleTitle=自我效能感与焦虑在社会支持与老年慢性病患者幸福感关系中的链式中介作用, refAbstract=null), Reference(id=1241050846520209602, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, doi=null, pmid=null, pmcid=null, year=2024, volume=51, issue=1, pageStart=105, pageEnd=110, url=null, language=null, rfNumber=[32], rfOrder=44, authorNames=Zheng SY, Zhong SS, Chen JY, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Zheng SY, Zhong SS, Chen JY, et al. The chain mediating role of self-efficacy and anxiety in the relationship between social support and well-being of elderly patients with chronic diseases[J]. Modern Preventive Medicine, 2024, 51(1): 105-110.(In Chinese), articleTitle=The chain mediating role of self-efficacy and anxiety in the relationship between social support and well-being of elderly patients with chronic diseases, refAbstract=null)], funds=[Fund(id=1241050836839756630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, awardId=S202310555251, language=CN, fundingSource=湖南省大学生创新训练计划(S202310555251), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241050826215584141, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, xref=null, ext=[AuthorCompanyExt(id=1241050826228167054, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, companyId=1241050826215584141, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Nanhua University School of Nursing, Hengyang, Hunan 421001, China), AuthorCompanyExt(id=1241050826232361359, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, companyId=1241050826215584141, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=南华大学护理学院，湖南 衡阳 421001)])], figs=[ArticleFig(id=1241050834037961439, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=EN, label=Figure 1, caption=Chain mediation model, figureFileSmall=SrDDXVbK1VRrPD8JxXmdOQ==, figureFileBig=72rwKjFNg/qfLhkh0Xl9sg==, tableContent=null), ArticleFig(id=1241050834230899439, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=CN, label=图1, caption=链式中介模型

注：*P<0.001；性别、学历、收入、居住情况和健康教育为控制变量。

, figureFileSmall=SrDDXVbK1VRrPD8JxXmdOQ==, figureFileBig=72rwKjFNg/qfLhkh0Xl9sg==, tableContent=null), ArticleFig(id=1241050834495140604, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=EN, label=Table 1, caption=

Comparison of scale scores among patients with peptic ulcer

, figureFileSmall=null, figureFileBig=null, tableContent=
特征人数（%）变量得分（分）
自我管理健康素养社会支持自我效能
总样本640（100）145.90±31.4082.28±17.2764.50±13.456.24±1.55
性别
男339（53.00）137.67±32.2179.70±17.3163.30±13.996.00±1.54
女301（47.00）155.17±27.7285.19±16.7865.85±12.706.51±1.52
t值-7.319***-4.067***-2.409*-4.193***
年龄（岁）
18～29204(31.87)155.19±21.3485.74±16.3866.35±12.246.47±1.38
30～39110(17.19)148.84±31.7983.45±16.5464.42±14.076.37±1.46
40～49179(27.97)141.05±40.0180.43±17.5363.88±14.496.09±1.72
50～59105(16.41)137.25±28.6579.07±17.6962.78±13.346.08±1.61
≥6042(6.56)135.38±23.0378.36±18.6262.62±12.515.87±1.53
F值9.417***4.214**1.7012.724*
户籍
城市436(68.12)148.19±30.9983.67±16.8465.04±13.216.27±1.57
农村204(31.88)141.01±31.7879.31±17.8563.34±13.906.19±1.50
t值2.708**2.996**1.4930.590
居住情况
与家人同住480（75.00）146.55±29.9082.26±17.5065.08±13.156.28±1.58
与朋友/同事同住79（12.34）152.34±31.3686.15±15.0565.67±13.766.41±1.40
独居54（8.44）129.15±41.2077.17±18.4358.22±13.935.49±1.43
其他27（4.22）149.04±25.0581.63±14.8463.22±14.216.55±1.13
F值6.557***2.940*4.579**5.095**
家庭人均月收入（元）
<2 00041（6.40）129.54±31.0578.71±19.8662.63±13.065.98±1.47
2 000～4 000276（43.13）137.45±33.0680.50±17.7162.85±13.176.09±1.56
4 000～6 000162（25.31）151.40±25.2983.36±16.1464.82±13.146.22±1.50
>6 000161（25.16）159.02±27.8985.17±16.5467.47±13.886.60±1.55
F值23.688***3.311*4.355**4.249**
学历
小学及以下74（11.56）133.91±30.2177.39±16.7962.46±13.796.15±1.50
初中128（20.00）131.95±34.1978.34±18.4661.33±13.035.63±1.68
高中或中专135（21.09）142.30±32.3380.27±16.9865.69±13.776.24±1.53
大学或大专266（41.56）156.03±26.2485.69±15.8765.87±13.346.56±1.40
硕士研究生及以上37（5.79）158.49±24.6588.51±18.6765.30±11.996.33±1.67
F值19.991***7.712***3.241*8.131***
家族史
无538（84.06）144.38±30.3081.90±17.0564.20±13.376.20±1.51
有102（15.94）153.91±35.7584.29±18.3766.06±13.816.50±1.74
t值-2.526*-1.284-1.252-1.641
P值0.0130.2000.2130.103
溃疡类型
胃溃疡191(29.84)154.50±26.1084.95±16.7865.84±13.476.43±1.45
十二指肠溃疡301(47.03)150.46±28.3483.60±16.8965.44±13.116.39±1.43
复合性溃疡148(23.13)125.53±34.7776.16±17.3360.84±13.535.69±1.77
F值47.535***12.927***7.323**12.603***
健康教育
是310（48.44）152.02±32.9383.97±16.8465.70±13.376.40±1.62
否330（51.56）140.15±28.7880.69±17.5463.37±13.446.10±1.46
t值4.840***2.412*2.201*2.432*
医保类型
城镇职工96(15.00)150.45±35.3986.02±17.5066.56±15.346.31±1.58
城乡居民482(75.30)144.99±30.7581.35±16.9264.23±13.046.23±1.54
其他62(9.70)145.92±29.7283.71±18.9663.35±13.366.25±1.58
F值1.2103.180*1.4520.117
), ArticleFig(id=1241050834696467206, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=CN, label=表1, caption=

消化性溃疡患者各量表得分比较

, figureFileSmall=null, figureFileBig=null, tableContent=
特征人数（%）变量得分（分）
自我管理健康素养社会支持自我效能
总样本640（100）145.90±31.4082.28±17.2764.50±13.456.24±1.55
性别
男339（53.00）137.67±32.2179.70±17.3163.30±13.996.00±1.54
女301（47.00）155.17±27.7285.19±16.7865.85±12.706.51±1.52
t值-7.319***-4.067***-2.409*-4.193***
年龄（岁）
18～29204(31.87)155.19±21.3485.74±16.3866.35±12.246.47±1.38
30～39110(17.19)148.84±31.7983.45±16.5464.42±14.076.37±1.46
40～49179(27.97)141.05±40.0180.43±17.5363.88±14.496.09±1.72
50～59105(16.41)137.25±28.6579.07±17.6962.78±13.346.08±1.61
≥6042(6.56)135.38±23.0378.36±18.6262.62±12.515.87±1.53
F值9.417***4.214**1.7012.724*
户籍
城市436(68.12)148.19±30.9983.67±16.8465.04±13.216.27±1.57
农村204(31.88)141.01±31.7879.31±17.8563.34±13.906.19±1.50
t值2.708**2.996**1.4930.590
居住情况
与家人同住480（75.00）146.55±29.9082.26±17.5065.08±13.156.28±1.58
与朋友/同事同住79（12.34）152.34±31.3686.15±15.0565.67±13.766.41±1.40
独居54（8.44）129.15±41.2077.17±18.4358.22±13.935.49±1.43
其他27（4.22）149.04±25.0581.63±14.8463.22±14.216.55±1.13
F值6.557***2.940*4.579**5.095**
家庭人均月收入（元）
<2 00041（6.40）129.54±31.0578.71±19.8662.63±13.065.98±1.47
2 000～4 000276（43.13）137.45±33.0680.50±17.7162.85±13.176.09±1.56
4 000～6 000162（25.31）151.40±25.2983.36±16.1464.82±13.146.22±1.50
>6 000161（25.16）159.02±27.8985.17±16.5467.47±13.886.60±1.55
F值23.688***3.311*4.355**4.249**
学历
小学及以下74（11.56）133.91±30.2177.39±16.7962.46±13.796.15±1.50
初中128（20.00）131.95±34.1978.34±18.4661.33±13.035.63±1.68
高中或中专135（21.09）142.30±32.3380.27±16.9865.69±13.776.24±1.53
大学或大专266（41.56）156.03±26.2485.69±15.8765.87±13.346.56±1.40
硕士研究生及以上37（5.79）158.49±24.6588.51±18.6765.30±11.996.33±1.67
F值19.991***7.712***3.241*8.131***
家族史
无538（84.06）144.38±30.3081.90±17.0564.20±13.376.20±1.51
有102（15.94）153.91±35.7584.29±18.3766.06±13.816.50±1.74
t值-2.526*-1.284-1.252-1.641
P值0.0130.2000.2130.103
溃疡类型
胃溃疡191(29.84)154.50±26.1084.95±16.7865.84±13.476.43±1.45
十二指肠溃疡301(47.03)150.46±28.3483.60±16.8965.44±13.116.39±1.43
复合性溃疡148(23.13)125.53±34.7776.16±17.3360.84±13.535.69±1.77
F值47.535***12.927***7.323**12.603***
健康教育
是310（48.44）152.02±32.9383.97±16.8465.70±13.376.40±1.62
否330（51.56）140.15±28.7880.69±17.5463.37±13.446.10±1.46
t值4.840***2.412*2.201*2.432*
医保类型
城镇职工96(15.00)150.45±35.3986.02±17.5066.56±15.346.31±1.58
城乡居民482(75.30)144.99±30.7581.35±16.9264.23±13.046.23±1.54
其他62(9.70)145.92±29.7283.71±18.9663.35±13.366.25±1.58
F值1.2103.180*1.4520.117
), ArticleFig(id=1241050835434664721, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=EN, label=Table 2, caption=

Correlation coefficient of main variables (r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量自我管理健康素养社会支持自我效能
自我管理1
健康素养0.455**1
社会支持0.400**0.215**1
自我效能0.456**0.385**0.285**1
), ArticleFig(id=1241050835937981212, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=CN, label=表2, caption=

主要变量的相关系数(r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量自我管理健康素养社会支持自我效能
自我管理1
健康素养0.455**1
社会支持0.400**0.215**1
自我效能0.456**0.385**0.285**1
), ArticleFig(id=1241050836076393252, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=EN, label=Table 3, caption=

Analysis of chain mediation model

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程整体拟合指数回归系数显著性
结果变量预测变量R值R2值F值β（95%CI）t值P值
自我管理健康素养0.5760.332105.1270.505(0.436～0.574)14.395<0.001
社会支持健康素养0.2770.76717.5920.245(0.170～0.320)6.428<0.001
自我效能健康素养0.4940.24451.3600.764(0.611～0.917)4.501<0.001
社会支持0.486(0.332～0.641)6.190<0.001
自我管理健康素养0.6900.476115.1690.322(0.254～0.390)9.335<0.001
社会支持0.277(0.211～0.342)8.299<0.001
自我效能0.131(0.099～0.163)8.015<0.001
), ArticleFig(id=1241050836189639470, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=CN, label=表3, caption=

链式中介模型分析

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程整体拟合指数回归系数显著性
结果变量预测变量R值R2值F值β（95%CI）t值P值
自我管理健康素养0.5760.332105.1270.505(0.436～0.574)14.395<0.001
社会支持健康素养0.2770.76717.5920.245(0.170～0.320)6.428<0.001
自我效能健康素养0.4940.24451.3600.764(0.611～0.917)4.501<0.001
社会支持0.486(0.332～0.641)6.190<0.001
自我管理健康素养0.6900.476115.1690.322(0.254～0.390)9.335<0.001
社会支持0.277(0.211～0.342)8.299<0.001
自我效能0.131(0.099～0.163)8.015<0.001
), ArticleFig(id=1241050836365800250, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=EN, label=Table 4, caption=

Test of chain mediating effect

, figureFileSmall=null, figureFileBig=null, tableContent=
效应路径β(95%CI)标准误效应（%）
总效应0.505(0.436～0.574)0.351100.00
直接效应0.322(0.254～0.390)0.34563.76
中介效应中介效应总量0.183(0.139～0.232)0.23736.24
路径10.067(0.043～0.098)0.01413.27
路径20.100(0.069～0.135)0.01719.80
路径30.016(0.008～0.025)0.0043.17
), ArticleFig(id=1241050836546155330, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034449060680093, language=CN, label=表4, caption=

链式中介路径分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应路径β(95%CI)标准误效应（%）
总效应0.505(0.436～0.574)0.351100.00
直接效应0.322(0.254～0.390)0.34563.76
中介效应中介效应总量0.183(0.139～0.232)0.23736.24
路径10.067(0.043～0.098)0.01413.27
路径20.100(0.069～0.135)0.01719.80
路径30.016(0.008～0.025)0.0043.17
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健康素养对社区消化性溃疡患者自我管理的影响——社会支持和自我效能的链式中介作用
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黄丽丽 , 孟心如 , 彭彤 , 丁彤彤 , 冯歌辉 , 曾颖
现代预防医学 | 基层卫生服务 2025,52(11): 2021-2026
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现代预防医学 | 基层卫生服务 2025, 52(11): 2021-2026
健康素养对社区消化性溃疡患者自我管理的影响——社会支持和自我效能的链式中介作用
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黄丽丽, 孟心如, 彭彤, 丁彤彤, 冯歌辉, 曾颖
作者信息
  • 南华大学护理学院，湖南 衡阳 421001

    • 黄丽丽（2000—），女，硕士在读，研究方向：健康与慢病管理学

通讯作者:

曾颖，E-mail:
The impact of health literacy on self-management among community patients with peptic ulcers: the chain mediating effects of social support and self-efficacy
Li-li HUANG, Xin-ru MENG, Tong PENG, Tong-tong DING, Ge-hui FENG, Ying ZENG
Affiliations
  • Nanhua University School of Nursing, Hengyang, Hunan 421001, China
出版时间: 2025-06-10 doi: 10.20043/j.cnki.MPM.202411504
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摘要
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目的

探索社区消化性溃疡患者自我管理行为的潜在影响路径，为开展社区消化性溃疡患者自我管理的干预提供依据。

方法

于2024年3—8月，采取分层整群抽样和便利抽样的方法随机抽取衡阳市5个行政区的640名社区消化性溃疡患者进行问卷调查。数据分析采用SPSS 26.0进行t检验、方差分析和偏相关分析，采用Process 4.0插件模型6构建链式中介模型

结果

健康素养对自我管理的直接效应显著（β=0.322,95%CI:0.254～0.390）；社会支持和自我效能在健康素养与自我管理之间的中介效应分别为0.067（95%CI：0.043～0.098）和0.100（95%CI：0.069～0.135）；社会支持-自我效能链式中介效应显著（β=0.016,95%CI：0.008～0.025）。

结论

提高社区消化性溃疡患者的健康素养水平，有利于改善社会支持水平和提升自我效能感，从而提高自我管理水平。

消化性溃疡  /  健康素养  /  社会支持  /  自我效能  /  自我管理
Objective

To explore the potential pathways influencing self-management behaviors among community patients with peptic ulcers, providing a basis for interventions aimed at enhancing self-management in this population.

Methods

From March to August 2024, a stratified cluster sampling combined with convenience sampling was employed to randomly select 640 community patients with peptic ulcers from five administrative districts in Hengyang city for a questionnaire survey. Data analysis was conducted using SPSS 26.0 for t-tests, ANOVA, and partial correlation analysis, and a chain mediation model was constructed using Process 4.0 plugin model 6.

Results

Health literacy had a significant direct effect on self-management (b=0.322, 95%CI: 0.254-0.390); the mediating effects of social support and self-efficacy between health literacy and self-management were 0.067 (95%CI: 0.043-0.098) and 0.100 (95%CI: 0.069-0.135), respectively. The chain mediating effect of social support and self-efficacy was also significant (b=0.016, 95%CI: 0.008-0.025).

Conclusion

Enhancing the level of health literacy among community patients with peptic ulcers is beneficial for improving social support and increasing self-efficacy, thereby enhancing self-management levels.

Peptic ulcer  /  Health literacy  /  Social support  /  Self-efficacy  /  Self-management
黄丽丽, 孟心如, 彭彤, 丁彤彤, 冯歌辉, 曾颖. 健康素养对社区消化性溃疡患者自我管理的影响——社会支持和自我效能的链式中介作用. 现代预防医学, 2025 , 52 (11) : 2021 -2026 . DOI: 10.20043/j.cnki.MPM.202411504
Li-li HUANG, Xin-ru MENG, Tong PENG, Tong-tong DING, Ge-hui FENG, Ying ZENG. The impact of health literacy on self-management among community patients with peptic ulcers: the chain mediating effects of social support and self-efficacy[J]. Modern Preventive Medicine, 2025 , 52 (11) : 2021 -2026 . DOI: 10.20043/j.cnki.MPM.202411504
正文
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消化性溃疡是常见的慢性消化系统疾病，虽短期内可临床愈合，但复发率高，并发症凶险、死亡率高。近年来我国消化性溃疡的疾病负担加重，给我国医疗系统带来沉重负担[1-2]。该病患者经住院或门诊治疗症状稳定后，通常回归社区进行长期健康管理。其自我管理行为与疾病复发密切相关[3]，然而社区消化性溃疡患者自我管理行为欠佳[4]。研究表明[5]，慢性病患者回归社区后，随着医疗监督减少与症状缓解，其自我管理水平呈下降趋势。因此，探讨社区消化性溃疡患者的自我管理影响因素及其潜在机制，对社区工作者制定针对性干预策略具有重要意义。
健康素养指个体获取、理解和处理健康相关信息的能力，被认为是自我管理的基础[6]。研究显示，健康素养显著影响消化性溃疡患者的自我管理行为[7]。自我效能指个体对自身实现预期目标的信心，可直接预测自我管理，并中介健康素养对慢性病自我管理的影响[8]。此外，社会支持被认为是有望解释健康素养与自我效能关系的因素，据报道，健康素养低的患者更少参与社会交往，以至失去一些社会支持，这会降低自我效能，且进一步影响患者的自我管理行为[9]。
既往研究多聚焦于住院或门诊等医疗场景中消化性溃疡患者健康素养与自我管理的直接关联，忽略了其中潜在机制的探索[7,10]。即在验证健康素养对社区消化性溃疡患者自我管理影响的具体路径方面并不充分，其研究结论在指导社区卫生工作中具有一定局限。鉴于此，本研究拟探讨健康素养对社区消化性溃疡患者自我管理的影响，并进一步验证社会支持与自我效能的链式中介作用，以期为社区场景下提高消化性溃疡患者的自我管理水平提供参考。
1　对象与方法
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1.1　对象
采用分层整群抽样，按衡阳市蒸湘区、石鼓区、珠晖区、雁峰区以及南岳区五个行政区域进行划分，从每个行政区随机抽取1个卫生服务中心，再采取便利抽样法，于2024年3—8月对社区消化性溃疡患者进行问卷调查。纳入标准：符合《消化性溃疡诊断与治疗规范》（2016）PU诊断标准；年龄≥18岁；社区居住时间≥6个月的常住居民；知情同意，自愿参加。排除标准：处于消化性溃疡急性住院或专科门诊治疗状态；无法有效沟通者；明确诊断为癌症，合并心肝肾等脏器功能不全。共发放问卷676份，其中无效问卷36份，有效率为94.67%。该调查通过了南华大学伦理委员会审批（2023NHHL003）。
1.2　调查工具
1.2.1　一般情况调查表
包括年龄、性别、教育程度、收入状况等。
1.2.2　慢性病病人健康素养量表（HeLMS）
该量表由孙浩林等[11]修订。量表包含四个维度，使用Likert 5级评分法计分，总分为24～120分。调查对象量表得分≥80%为具备健康素养，得分越高表示健康素养越高。本研究中量表的Cronbach α系数为0.964。
1.2.3　医疗社会支持量表（MOS-SSS）
由Sherbourne等[12]编制。量表包含四个维度，使用Likert 5级评分法，总分为19～95分，得分越高表示社会支持水平越高。本研究中量表的Cronbach α系数为0.950。
1.2.4　慢性病自我效能量表（CDSES）
该量表由Lorig[13]编制。量表包含两个维度，采用Likert 10级评分法，取量表均分为总分，总分为1～10分，得分<7分说明自我效能不足，得分≥7分说明自我效能水平高。本研究中量表的Cronbach α系数为0.898。
1.2.5　消化性溃疡自我管理问卷
该量表由仲秀玲[14]编制，包括四个维度，使用Likert 5级评分法，总分41～205分，得分越高表明自我管理行为越佳。本研究中量表的Cronbach α系数为0.987。
1.3　质量控制
调查前统一培训研究人员；调查中当场验收并核实问卷，阅读困难者由研究人员逐条朗诵并解释，同时记录被调查者的回答；问卷回收后采取双人录入并进行一致性校验。
1.4　统计分析
采用SPSS 26.0软件分析数据，经正态性检验，计量资料基本符合正态分布，故采用（）描述，计数资料使用频数和百分比描述；组间资料采用独立样本t检验或方差分析；相关分析采用偏相关分析；采用PROCESS 4.0中的模型6构建链式中介模型，经bootstrap法检验社会支持和自我效能在健康素养及自我管理间的链式中介效应。检验水准α=0.05。
2　结果
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2.1　基本情况
本研究有效调查人数为640人，其中男性339人（53.00%），女性301人（47.00%）。见表1。
2.2　共同方法偏差检验
采用Harman单因素检验法进行共同方法偏差检验。结果显示，特征根大于1的因子共13个，且第一个因子的解释率为40.51%，小于50%的临界标准[15]，说明不存在严重的共同方法偏差问题。
2.3　各量表得分比较
社区消化性溃疡患者健康素养得分为（82.28±17.27）分，健康素养的具备率为22.81%；自我管理行为得分为（145.90±31.40）分、社会支持得分为（64.50±13.45）分、自我效能得分为（6.24±1.55）分。患者的健康素养、社会支持、自我效能及自我管理得分在多数人口学变量及研究相关变量中均存在组间差异（P<0.05）。见表1。
2.4　相关性分析
将单因素分析有统计学意义的因素作为控制变量，偏相关分析结果表明，自我管理、健康素养、社会支持、自我效能两两之间均呈显著正相关（P<0.01）。见表2。
2.5　链式中介模型分析
本研究在控制性别、学历、收入、居住情况和健康教育的基础上，以健康素养为自变量，以自我管理为因变量，以社会支持、自我效能作为中介变量构建链式中介模型。结果显示，健康素养对自我管理的总效应显著(β=0.505,P<0.001)。健康素养能正向预测社会支持(β=0.245,P<0.001)及自我效能(β=0.764,P<0.001)；健康素养对自我管理的直接效应显著(β=0.322,P<0.001)。此外，社会支持不仅能正向预测自我管理(β=0.277,P<0.001)，还能正向预测自我效能(β=0.486,P<0.001)；自我效能可正向预测自我管理(β=0.131,P<0.001)。见表3、图1。
中介效应分析显示，健康素养对自我管理的总效应为0.505，社会支持和自我效能在健康素养对自我管理的影响中呈链式中介效应，总中介效应为0.183，占总效应的36.24%。中介效应通过三条路径作用。第一条中介路径为健康素养→社会支持→自我管理；第二条路径为健康素养→自我效能→自我管理；第三条路径为健康素养→社会支持→自我效能→自我管理。健康素养对自我管理的直接效应为0.322，占总效应的63.76%。见表4。
3　讨论
收起
本研究结果显示，社区消化性溃疡患者健康素养总分为（82.28±17.27）分，具备率为22.81%，与田志强等[10]的研究结果相似，表明消化性溃疡患者健康素养普遍不足，需加强该人群的疾病相关知识教育。社会支持得分为（64.50±13.45）分，虽高于张曌等[16]的研究结果，但相较于量表理论中间值（57分）只处于中等偏上水平。这可能与亲友疾病管理知识欠缺导致有效支持不足有关。此外，患者自我效能较低，低于陈翠莲等[17]对中老年高血压患者自我效能的研究结果，可能因疾病反复及健康素养不足加重了患者的负性疾病感知[18]，进而抑制了其疾病管理的信心。自我管理得分为(145.90±31.4)分，与量表总分理论中间值123分相比，处于中等偏上水平。究其原因，消化性溃疡病程长且易反复，社区患者难以长期坚持自我管理，这提示需要加强对社区消化性溃疡患者的关注与干预。
研究发现健康素养可以直接正向影响社区消化性溃疡患者的自我管理水平，这与以往的研究结果一致[10,19]。高水平健康素养的患者获取、理解及处理健康信息的能力更强，能对影响自身健康的因素进行综合考虑，进而采取利于自身健康的自我管理行为。而健康素养不足的患者通常难以参与医疗决策、遵循医疗建议，缺乏自我管理相关的知识与技能[20]。因此，提高社区消化性溃疡患者的健康素养对提升其自我管理水平起着不可忽视的作用。
研究结果表明，社会支持在健康素养和自我管理之间起部分中介作用。这与以往研究结果一致[21]。研究表明，健康素养水平低的患者获取社会支持的意愿与能力不足[22-23]。一方面，患者在获取、理解和处理健康信息方面能力的不足，可直接导致医患沟通效能低下，从而难以有效获取医疗资源[22]。另一方面，健康素养不足的患者往往对自身的阅读与理解能力的欠缺感到羞耻[24]，这种羞耻感可能导致患者回避社交互动，甚至产生社交孤立，从而失去必要的社会支持[9,25]。且有研究显示高水平健康素养的患者更倾向于维持社交网络[26]，这意味着患者能更有效的获取自我管理所需的信息、情感和实际性支持[27]，从而选择进行自我管理。因此，对于健康素养不足的患者，首先，社区卫生工作者可开发通俗化健康教育资料，结合回授法等交互式宣教模式，降低患者的信息理解门槛，提高其沟通效能和健康素养[22]。其次，可通过开展同伴及家庭干预支持，协助患者重建社交网络，增强其社会支持的可及性[28]。此外，自我效能也在社区消化性溃疡患者的健康素养和自我管理之间起部分中介作用，这与以往研究结果一致[29]，根据社会认知理论[30]，自我效能主要来源之一是自己过往成功的直接经验。从这一角度来说，随着个体健康素养水平的提高，其自我管理的知识和技能也随之增强，从而有更多成功的经验来增强自我效能感，使其主动识别并应对自我管理过程中可能出现的潜在威胁，最终提高自我管理水平。
研究结果显示社会支持和自我效能在健康素养对自我管理的影响中起链式中介作用[31]。健康素养水平高的社区消化性溃疡患者，往往拥有更高的社会交往意愿与能力，可帮助他们建立更紧密的社会支持网络，进一步提高其战胜疾病的信心。研究显示[20,32]，从社会支持中获得的各种资源有助于促进患者的物质与情感稳定，缓解慢性病患者应对无效的精神压力，促进其自我管理的自信心，最终体现为较高的自我管理水平。由此可见，社区消化性溃疡患者需要进行多方位多角度的干预：以提高健康素养水平为着力点，搭建一个便捷的交流平台，以增加卫生系统、患者及家属之间交流沟通的机会和效果，提高患者的健康素养和社会支持，还应特别重视给予患者正向反馈，为患者树立疾病控制的信心，最终改善社区消化性溃疡患者自我管理水平，避免不良结果。本研究存在一定局限性。首先，本研究采用问卷调查的自我报告形式进行变量测量，可能存在主观偏倚。其次，横断面研究在因果推断上存在一定局限性，还需进行纵向多中心的研究，采用交叉滞后面板模型或多层自回归中介模型的设计，以进一步解释各变量间的因果关系和相关性程度。最后，本研究仅纳入了中国衡阳市样本，其样本代表性和推广性受到一定限制。
基金
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  • 湖南省大学生创新训练计划(S202310555251)
文献
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2025年第52卷第11期
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doi: 10.20043/j.cnki.MPM.202411504
  • 接收时间：2024-11-27
  • 首发时间：2026-03-18
  • 出版时间：2025-06-10
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