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Article(id=1324050937031045255, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202508376, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1755705600000, receivedDateStr=2025-08-21, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607943064, onlineDateStr=2026-11-02, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607943064, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607943064, creator=13701087609, updateTime=1793607943064, updator=13701087609, issue=Issue{id=1324050876230415089, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607928569, creator='13701087609', updateTime=1793670049253, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311429322507008, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311429322507009, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2054, endPage=2059, ext={EN=ArticleExt(id=1324050937261731976, articleId=1324050937031045255, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between emotional resilience and health-promoting behaviors in patients with chronic heart failure: the mediating role of health empowerment, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the mediating role of health empowerment in the relationship between emotional resilience and health-promoting behaviors in patients with chronic heart failure (CHF), and to provide a basis for developing targeted rehabilitation interventions.

Methods

A total of 235 CHF patients admitted to the Department of Emergency Medicine and the Department of Cardiology of Wuhan First Hospital from January 2022 to January 2025 were selected. According to the inclusion and exclusion criteria, 220 patients were finally included. They were surveyed using the General Information Questionnaire, the Emotional Resilience Scale, the Health Empowerment Scale for Elderly Patients with Chronic Diseases, and the Health-Promoting Lifestyle Profile (HPLP). Partial correlation analysis was performed using SPSS 26.0, and the mediating effect was tested using the macro program Process 4.2.

Results

All 220 CHF patients were included. The scores for emotional resilience, health empowerment, and health-promoting behaviors were 36.41±5.39, 91.89±9.32, and 110.21±7.62, respectively. Partial correlation analysis showed that emotional resilience was positively correlated with health empowerment (r=0.233, P<0.001) and health-promoting behaviors (r=0.399, P<0.001). Health empowerment was also positively correlated with health-promoting behaviors (r=0.439, P<0.001). The mediation analysis results indicated that emotional resilience had a significant positive effect on health empowerment (β=0.402, t=3.535, P<0.05) and on health-promoting behaviors (β=0.564, t=6.428, P<0.001). After adding health empowerment, emotional resilience still exerted a significant positive effect on health-promoting behaviors (β=0.444, t=5.323, P<0.001). Further verification using the Bootstrap method showed that the direct effect of emotional resilience on health-promoting behaviors accounted for 78.7% (95% CI: 0.280-0.608) of the total effect, while the indirect effect accounted for 21.3% (95% CI: 0.046-0.214).

Conclusion

Emotional resilience can directly affect health-promoting behaviors in CHF patients and can also indirectly affect them through health empowerment, so improving patients’ emotions and health empowerment may have a better effect on patients’ health-promoting behaviors.

, authors=Jing ZHANG1, Zhi-hao LIU2, Zhi-chao WANG1, Meng-li ZHU1, authorsList=Jing ZHANG, Zhi-hao LIU, Zhi-chao WANG, Meng-li ZHU, authorCompany=null, correspAuthors=Meng-li ZHU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324050938650046611, articleId=1324050937031045255, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=慢性心衰患者情绪弹性与健康促进行为关系——健康赋权的中介作用, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探究健康赋权在慢性心力衰竭（chronic heart falure，CHF）患者情绪弹性与健康促进行为关系中的中介作用，为制定针对性康复干预提供依据。

方法

选取2022年1月—2025年1月武汉市第一医院急诊医学科与心内科收治的235例CHF患者，根据纳入与排除标准最终纳入220例。使用一般资料调查表、情绪弹性问卷、老年慢性病患者健康赋权量表和健康促进生活方式量表进行调查，采用SPSS 26.0进行偏相关分析，并通过Process 4.2宏程序检验中介效应。

结果

共纳入220名CHF患者。情绪弹性得分（36.41±5.39）分、健康赋权（91.89±9.32）分、健康促进行为（110.21±7.62）分。偏相关性分析显示，情绪弹性与健康赋权（r=0.233，P<0.001）、健康促进行为（r=0.399，P<0.001）呈正相关，健康赋权与健康促进行为（r=0.439，P<0.001）亦呈正相关。中介分析结果显示，情绪弹性对健康赋权（β=0.402，t=3.535，P<0.05）、健康促进行为（β=0.564，t=6.428，P<0.001）具有显著正向影响，加入健康赋权后，情绪弹性对健康促进行为（β=0.444，t=5.323，P<0.001）同样具有显著正向影响。Bootstrap法进一步验证表明，情绪弹性对健康促进行为的直接效应占总效应的78.7%（95% CI：0.280～0.608），间接效应占21.3%（95% CI：0.046～0.214）。

结论

情绪弹性既能直接作用于CHF患者的健康促进行为，也能通过健康赋权间接发挥作用，因此改善患者情绪与健康赋权可能对患者健康促进行为有较好的效果。

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张婧（1985-），女，本科，护师，研究方向：急诊医学

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朱梦莉，E-mail：
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注：*为P<0.01，**为P<0.001；a表示情绪弹性对健康赋权的效应值；b表示健康赋权对健康促进行为的效应值；c表示情绪弹性对健康促进行为的总效应值；c’表示情绪弹性对健康促进行为的直接效应值。

, figureFileSmall=VIQ557ba3XKolvmiyGMRMQ==, figureFileBig=+2VlmAmAu7Z3JOjntJp0uA==, tableContent=null), ArticleFig(id=1324050943372832953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=EN, label=Table 1, caption=

General information on patients with chronic heart failure (n=220)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类人数构成比（%）
性别男12556.82
女9543.18
年龄（岁）18～608136.82
≥6013963.18
病程（年）<17835.45
1～510145.91
>54118.64
文化程度初中及以下10748.64
高中及以上11351.36
婚姻状况有配偶15972.27
无配偶6127.73
居住地农村3515.91
乡镇6630.00
城市11954.09
职业状态退休/无业15168.64
在职6931.36
家庭人均月收入（元）<3 0005123.18
3 000～5 0009844.55
>5 0007132.27
酗酒史是6931.36
否15168.64
吸烟史是8940.45
否13159.55
家族史是14766.82
否7333.18
运动频次（次/周）03315.00
1～311853.64
>36931.36
焦虑症状有7735.00
无14365.00
抑郁症状有3214.55
无18885.45
), ArticleFig(id=1324050943481884858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=CN, label=表1, caption=

CHF患者一般资料（n=220）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类人数构成比（%）
性别男12556.82
女9543.18
年龄（岁）18～608136.82
≥6013963.18
病程（年）<17835.45
1～510145.91
>54118.64
文化程度初中及以下10748.64
高中及以上11351.36
婚姻状况有配偶15972.27
无配偶6127.73
居住地农村3515.91
乡镇6630.00
城市11954.09
职业状态退休/无业15168.64
在职6931.36
家庭人均月收入（元）<3 0005123.18
3 000～5 0009844.55
>5 0007132.27
酗酒史是6931.36
否15168.64
吸烟史是8940.45
否13159.55
家族史是14766.82
否7333.18
运动频次（次/周）03315.00
1～311853.64
>36931.36
焦虑症状有7735.00
无14365.00
抑郁症状有3214.55
无18885.45
), ArticleFig(id=1324050943569965243, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=EN, label=Table 2, caption=

Emotional resilience, health empowerment, and health-promoting behavior scale scores in patients with chronic heart failure ［n=220，（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目条目数得分范围（分）维度得分（分）
情绪弹性1111～5536.41±5.39
积极情绪能力66～3017.19±3.28
情绪恢复力55～2518.73±4.11
健康赋权2626～13091.89±9.32
责任信念44～2014.80±2.25
获取支持66～3021.29±3.05
增长知识66～3021.33±3.16
参与治疗55～2517.21±2.18
重建自我55～2517.68±2.36
健康促进行为5252～208110.21±7.62
自我实现99～3618.68±2.28
健康责任感99～3622.08±2.71
躯体活动88～3219.55±2.86
营养99～3619.14±2.56
人际关系99～3614.92±1.35
压力调节88～3215.89±2.17
), ArticleFig(id=1324050943637074108, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=CN, label=表2, caption=

CHF患者情绪弹性、健康赋权、健康促进行为量表情况［n=220，（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目条目数得分范围（分）维度得分（分）
情绪弹性1111～5536.41±5.39
积极情绪能力66～3017.19±3.28
情绪恢复力55～2518.73±4.11
健康赋权2626～13091.89±9.32
责任信念44～2014.80±2.25
获取支持66～3021.29±3.05
增长知识66～3021.33±3.16
参与治疗55～2517.21±2.18
重建自我55～2517.68±2.36
健康促进行为5252～208110.21±7.62
自我实现99～3618.68±2.28
健康责任感99～3622.08±2.71
躯体活动88～3219.55±2.86
营养99～3619.14±2.56
人际关系99～3614.92±1.35
压力调节88～3215.89±2.17
), ArticleFig(id=1324050943708377277, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=EN, label=Table 3, caption=

Correlations between emotional resilience, health empowerment, and health-promoting behaviors in patients with chronic heart failure (n=220，r)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目情绪弹性健康赋权健康促进行为
情绪弹性1.000——
健康赋权0.233**1.000—
健康促进行为0.399**0.439**1.000
), ArticleFig(id=1324050943796457662, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=CN, label=表3, caption=

CHF患者情绪弹性、健康赋权、健康促进行为之间的相关性（n=220，r）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目情绪弹性健康赋权健康促进行为
情绪弹性1.000——
健康赋权0.233**1.000—
健康促进行为0.399**0.439**1.000
), ArticleFig(id=1324050943876149439, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=EN, label=Table 4, caption=

Results of regression analysis of emotional resilience and health empowerment on health-promoting behaviors in patients with chronic heart failure (n=220)

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程拟合指标系数显著性
结果变量预测变量RR2FβtP值
健康赋权0.2330.05412.499
情绪弹性0.4023.5350.001
健康促进行为0.3990.15949.077
情绪弹性0.5646.428<0.001
健康促进行为0.5340.28643.383
情绪弹性0.4445.323<0.001
健康赋权0.2996.194<0.001
), ArticleFig(id=1324050943955841216, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=CN, label=表4, caption=

情绪弹性和健康赋权对CHF患者健康促进行为的回归分析结果（n=220）

, figureFileSmall=null, figureFileBig=null, tableContent=
回归方程拟合指标系数显著性
结果变量预测变量RR2FβtP值
健康赋权0.2330.05412.499
情绪弹性0.4023.5350.001
健康促进行为0.3990.15949.077
情绪弹性0.5646.428<0.001
健康促进行为0.5340.28643.383
情绪弹性0.4445.323<0.001
健康赋权0.2996.194<0.001
), ArticleFig(id=1324050945197355201, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=EN, label=Table 5, caption=

Bootstrap method to test for mediating effects (n=220)

, figureFileSmall=null, figureFileBig=null, tableContent=
效应效应途径 效应值（95% CI）效应占比（%）
总效应0.0880.564（0.391～0.737）—
直接效应情绪弹性→健康促进行为0.0830.444（0.280～0.608）78.7
间接效应情绪弹性→健康赋权→健康促进行为0.0430.120（0.046～0.214）21.3
), ArticleFig(id=1324050945293824194, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050937031045255, language=CN, label=表5, caption=

Bootstrap法检验中介效应（n=220）

, figureFileSmall=null, figureFileBig=null, tableContent=
效应效应途径 效应值（95% CI）效应占比（%）
总效应0.0880.564（0.391～0.737）—
直接效应情绪弹性→健康促进行为0.0830.444（0.280～0.608）78.7
间接效应情绪弹性→健康赋权→健康促进行为0.0430.120（0.046～0.214）21.3
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慢性心衰患者情绪弹性与健康促进行为关系——健康赋权的中介作用
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张婧 1 , 刘志豪 2 , 王智超 1 , 朱梦莉 1
现代预防医学 | 健康与社会行为 2026,53(11): 2054-2059
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现代预防医学 |健康与社会行为 2026 , 53 (11) : 2054 -2059
慢性心衰患者情绪弹性与健康促进行为关系——健康赋权的中介作用
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张婧（1985-），女，本科，护师，研究方向：急诊医学

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张婧1, 刘志豪2, 王智超1, 朱梦莉1
作者信息
  • 1.武汉市第一医院 急诊医学科，湖北 武汉 430030
  • 2.武汉市第一医院 心血管内科
通讯作者:
朱梦莉，E-mail：
作者简介:

张婧（1985-），女，本科，护师，研究方向：急诊医学

Relationship between emotional resilience and health-promoting behaviors in patients with chronic heart failure: the mediating role of health empowerment
Jing ZHANG1, Zhi-hao LIU2, Zhi-chao WANG1, Meng-li ZHU1
Affiliations
  • Department of Emergency Medicine, Wuhan First Hospital, Wuhan, Hubei 430030, China
出版时间: 2026-06-10 doi: 10.20043/j.cnki.MPM.202508376
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摘要
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目的

探究健康赋权在慢性心力衰竭（chronic heart falure，CHF）患者情绪弹性与健康促进行为关系中的中介作用，为制定针对性康复干预提供依据。

方法

选取2022年1月—2025年1月武汉市第一医院急诊医学科与心内科收治的235例CHF患者，根据纳入与排除标准最终纳入220例。使用一般资料调查表、情绪弹性问卷、老年慢性病患者健康赋权量表和健康促进生活方式量表进行调查，采用SPSS 26.0进行偏相关分析，并通过Process 4.2宏程序检验中介效应。

结果

共纳入220名CHF患者。情绪弹性得分（36.41±5.39）分、健康赋权（91.89±9.32）分、健康促进行为（110.21±7.62）分。偏相关性分析显示，情绪弹性与健康赋权（r=0.233，P<0.001）、健康促进行为（r=0.399，P<0.001）呈正相关，健康赋权与健康促进行为（r=0.439，P<0.001）亦呈正相关。中介分析结果显示，情绪弹性对健康赋权（β=0.402，t=3.535，P<0.05）、健康促进行为（β=0.564，t=6.428，P<0.001）具有显著正向影响，加入健康赋权后，情绪弹性对健康促进行为（β=0.444，t=5.323，P<0.001）同样具有显著正向影响。Bootstrap法进一步验证表明，情绪弹性对健康促进行为的直接效应占总效应的78.7%（95% CI：0.280～0.608），间接效应占21.3%（95% CI：0.046～0.214）。

结论

情绪弹性既能直接作用于CHF患者的健康促进行为，也能通过健康赋权间接发挥作用，因此改善患者情绪与健康赋权可能对患者健康促进行为有较好的效果。

慢性心力衰竭  /  情绪弹性  /  健康促进行为  /  健康赋权  /  中介效应
Objective

To explore the mediating role of health empowerment in the relationship between emotional resilience and health-promoting behaviors in patients with chronic heart failure (CHF), and to provide a basis for developing targeted rehabilitation interventions.

Methods

A total of 235 CHF patients admitted to the Department of Emergency Medicine and the Department of Cardiology of Wuhan First Hospital from January 2022 to January 2025 were selected. According to the inclusion and exclusion criteria, 220 patients were finally included. They were surveyed using the General Information Questionnaire, the Emotional Resilience Scale, the Health Empowerment Scale for Elderly Patients with Chronic Diseases, and the Health-Promoting Lifestyle Profile (HPLP). Partial correlation analysis was performed using SPSS 26.0, and the mediating effect was tested using the macro program Process 4.2.

Results

All 220 CHF patients were included. The scores for emotional resilience, health empowerment, and health-promoting behaviors were 36.41±5.39, 91.89±9.32, and 110.21±7.62, respectively. Partial correlation analysis showed that emotional resilience was positively correlated with health empowerment (r=0.233, P<0.001) and health-promoting behaviors (r=0.399, P<0.001). Health empowerment was also positively correlated with health-promoting behaviors (r=0.439, P<0.001). The mediation analysis results indicated that emotional resilience had a significant positive effect on health empowerment (β=0.402, t=3.535, P<0.05) and on health-promoting behaviors (β=0.564, t=6.428, P<0.001). After adding health empowerment, emotional resilience still exerted a significant positive effect on health-promoting behaviors (β=0.444, t=5.323, P<0.001). Further verification using the Bootstrap method showed that the direct effect of emotional resilience on health-promoting behaviors accounted for 78.7% (95% CI: 0.280-0.608) of the total effect, while the indirect effect accounted for 21.3% (95% CI: 0.046-0.214).

Conclusion

Emotional resilience can directly affect health-promoting behaviors in CHF patients and can also indirectly affect them through health empowerment, so improving patients’ emotions and health empowerment may have a better effect on patients’ health-promoting behaviors.

Chronic heart failure  /  Emotional resilience  /  Health-promoting behaviors  /  Health empowerment  /  Mediating effect
张婧, 刘志豪, 王智超, 朱梦莉. 慢性心衰患者情绪弹性与健康促进行为关系——健康赋权的中介作用. 现代预防医学, 2026 , 53 (11) : 2054 -2059 . DOI: 10.20043/j.cnki.MPM.202508376
Jing ZHANG, Zhi-hao LIU, Zhi-chao WANG, Meng-li ZHU. Relationship between emotional resilience and health-promoting behaviors in patients with chronic heart failure: the mediating role of health empowerment[J]. Modern Preventive Medicine, 2026 , 53 (11) : 2054 -2059 . DOI: 10.20043/j.cnki.MPM.202508376
正文
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慢性心力衰竭（chronic heart failure, CHF）是全球心血管疾病主要致死病因之一，我国成人患病率达1.3%，患者5年生存率仅约50%[1]。传统药物治疗虽可降低病死率，但患者再入院率高，长期预后不佳[2]。且难以有效应对疾病带来的心理社会应激与行为问题。在“生物-心理-社会”医学模式下，健康促进行为是改善CHF预后的关键[3]。然而，当前临床评估多关注生理指标，对情绪弹性、健康赋权等心理社会维度识别不足。循证研究显示，负性情绪、低健康赋权与健康行为依从性差相关[4]。社会认知理论为理解上述关系提供了理论框架。该理论强调个体、行为与环境三者间的动态交互作用，其中自我效能感（个体对自己完成特定行为能力的信念）是行为改变的核心认知机制[5]。据此，情绪弹性可能通过提升健康赋权来促进健康行为，但三者关系在国内CHF人群中尚待检验。因此，本研究旨在探讨健康赋权在CHF患者情绪弹性与健康促进行为间的中介作用，为制定综合干预方案提供依据。
1　对象与方法
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1.1　研究对象
本研究于2022年1月—2025年1月在武汉市第一医院急诊科及心内科收治的CHF患者中进行，共发放235份调查问卷，剔除不符合标准问卷后，最终得到有效问卷220份。样本量计算公式为：N=4（μαS/δ）2，本研究α=0.05，μα=1.96，其中S取预调查中（n=30）健康促进行为得分的标准差（S=7.62），将容许误差δ设置在[0.25S，0.5S]之间，计算得出样本量n取值范围为62～246例，同时，根据中介效应分析对样本量的要求，通常建议大于200例[6]，本研究实际纳入220例，符合样本量要求。本次研究通过武汉市第一医院伦理委员会审批（伦理批号：WYLL202528），患者均签署知情同意书。
诊断标准：符合《慢性心力衰竭基层诊疗指南（2019）年》[7]中CHF的诊断标准。
纳入标准：（1）年龄≥18岁，性别不限；（2）美国纽约心脏疾病协会（New York Heart Association，NYHA）分级为Ⅱ～Ⅲ级[8]；（3）病程≥6个月；（4）患者意识清晰，能理解问卷内容；（5）临床资料及问卷信息完整。
排除标准：（1）妊娠期或哺乳期妇女；（2）合并严重器质性病变或功能障碍；（3）合并恶性肿瘤、自身免疫性疾病、代谢型疾病和血液系统疾病；（4）合并精神疾病或认知障碍；（5）合并先天性心脏病或房室传导阻滞等心律失常疾病；（6）心脏疾病病情不稳定，病情变化危及生命。
1.2　研究方法
1.2.1　控制变量
设计一般资料调查表，收集患者性别、年龄、病程、文化程度、婚姻状况、居住地、职业状态、家庭人均月收入、酗酒史、吸烟史、家族史、运动频次、焦虑症状、抑郁症状（通过患者自我报告是否经医生诊断或使用相关药物进行评估，并于病历信息核对）。
1.2.2　解释变量（情绪弹性）
使用情绪弹性问卷[9]评估患者情绪弹性，该问卷包括积极情绪能力和情绪恢复力二个维度，共11个条目，总分为11～55分，得分越高，表明个体的情绪弹性水平越高。该量表在本研究中的Cronbach α系数为0.770。
1.2.3　中介变量（健康赋权）
使用等姚秋怡等人[10]编制的老年人健康赋权量表评估患者健康赋权，尽管该量表最初针对老年人，但其内容（如责任信念、获取支持、参与治疗等）具有普适性。该量表包括责任信念、获取支持、增长知识、参与治疗和重建自我五个维度，共26个条目，每个条目采用Likert 5级评分1～5分，总分为26～130分，得分越高，表明个体的健康赋权水平越高。该量表在本研究中的Cronbach α系数为0.927
1.2.4　被解释变量（健康促进行为）
使用由Walker等修订、Lee等[11]汉化的健康促进生活方式量表（health promotion lifestyle profile, HPLP）评估患者健康促进行为。本研究预测试显示该量表在本样本中Cronbach α系数为0.918，信度良好。该量表包括六个维度，共52个条目，每个条目采用Likert 4 级评分，总分范围为52～208分，得分越高，表明个体的健康促进行为水平越高。
1.3　质量控制
本研究组建心血管专科护士与心理学研究人员构成的调查团队，所有成员均接受慢性心衰知识、沟通技巧、问卷指导与应急处理的统一培训。数据收集时，为患者提供氧气支持与大字问卷，对体力或读写受限者采用代填问卷方式，并分阶段完成以减轻负担。质量控制方面，实行现场双人核查，及时复核缺项与矛盾数据，并于24 h内完成电话复核。数据录入采用双人独立完成，对少量缺失值（≤5%）使用期望最大化法填补，关键变量缺失或缺失较多则予以剔除。所有纸质问卷均存放于科室密码文件柜，电子数据经加密后存储于医院内网，仅限课题负责人与统计员访问。
1.4　统计学分析
数据分析采用SPSS 26.0软件。计数资料以例和百分比表示，组间比较用χ2检验；满足正态分布且方差齐的计量资料以（均值±标准差）表示，采用t检验。采用Pearson偏相关分析情绪弹性、健康赋权、健康促进行为之间的关系。SPSS宏程序Process 4.2中模型4分析中介效应，bootstrap抽样5 000次。检验水准α=0.05。
2　结果
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2.1　CHF患者一般资料
共纳入220例CHF患者，其中男性125名（56.82%），年龄≥60岁139名（63.18%），病程1～5年101名（45.91%），文化程度高中及以上113名（51.36%），婚姻状况有配偶159名（72.27%），居住地为城市119例（54.09%），职业状态为退休/无业151名（68.64%），家庭人均月收入3 000～5 000元有98名（44.55%），151名无酗酒史（68.64%），131名无吸烟史（59.55%），147名有心衰或心血管疾病家族史（66.82%），运动频次1～3次/周118名（53.64%），143名无焦虑症状（65.00%），188名无抑郁症状（85.45%）。见表1。
2.2　CHF患者情绪弹性、健康赋权、健康促进行为量表情况
220例CHF患者的情绪弹性得分为（36.41±5.39）分，健康赋权得分（91.89±9.32）分，健康促进行为得分（110.21±7.62）分，具体各量表维度得分见表2。
2.3　CHF患者情绪弹性、健康赋权、健康促进行为的相关性分析
控制了性别、年龄、病程、文化程度等一般资料变量后，偏相关分析显示，CHF患者情绪弹性与健康赋权（r=0.233，P<0.001）、健康促进行为（r=0.399，P<0.001）量表呈正相关，健康赋权与健康促进行为（r=0.439，P<0.001）呈正相关。见表3。
2.4　CHF患者健康赋权的中介效应分析
以情绪弹性为自变量，健康赋权为中介变量，健康促进行为为因变量，利用Process 4.2模型4探究其关系，结果显示：情绪弹性对健康赋权（β=0.402，t=3.535，P<0.05）、健康促进行为（β=0.564，t=6.428，P<0.001）具有显著正向影响，加入中介变量后，情绪弹性对健康促进行为（β=0.444，t=5.323，P<0.001）也具有显著正向影响。见表4。
2.5　中介效应检验
Bootstrap法进一步检验得出，情绪弹性对健康促进行为的直接效应为0.444（95% CI：0.280～0.608），效应占比78.7%，间接效应为0.120（95% CI：0.046～0.214），效应占比21.3%，置信区间不包括0，说明健康赋权在情绪弹性和健康促进行为间有中介作用。见表5、图1。
3　讨论
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3.1　CHF患者情绪弹性、健康赋权与健康促进行为现况
本研究结果显示，220例CHF患者情绪弹性为（36.41±5.39）分、健康赋权（91.89±9.32）分、健康促进行为（110.21±7.62）分。其机制可能在于：首先，疾病负担抑制了情绪弹性，研究发现[12-13]，持续的心肌损伤和神经内分泌系统的过度激活，能够导致呼吸困难、疲劳等症状，这些持续应激源不断地消耗患者的心理资源，削弱了其积极情绪生成能力，从而引起了焦虑、恐惧等负性情绪的产生。同时，反复住院、活动耐力下降等亦会导致自我效能感削弱，社会功能受限则通过角色丧失和照护依赖造成自尊损伤，进一步降低了患者的情绪恢复能力[14]。其次，健康赋权资源分配不均反映了社会支持系统较为薄弱，本研究结果显示，68.64%患者为退休/无业状态，44.55%家庭月收入<5 000元，说明患者潜在的经济压力限制了其获取专业康复的资源，同时27.73%无配偶者缺乏照护支持，亦能够削弱疾病管理的能力，这与曹双燕等人[15]的研究结果相似。最后，客观阻碍造成了健康行为执行表现欠佳，如健康促进行为中“躯体活动”和“压力调节”维度得分偏低，可能与心衰患者因疲乏感形成的“症状恐惧-活动回避-功能退化”恶性循环密切相关[16]。
3.2　CHF患者情绪弹性、健康赋权与健康促进行为三者关系
本研究发现CHF患者情绪弹性与健康促进行为呈正相关（r=0.399），且情绪弹性越低者健康行为依从性越差，其机制可能在于低情绪弹性患者可能因呼吸困难等症状经历更强的应激反应，相关研究提示这可能与交感肾上腺髓质轴激活有关，升高的皮质醇水平可能抑制运动动机并参与“活动恐惧症”的形成[17-18]，这可能是本研究中68.64%患者周运动频次≤3次的现象出现得原因。同时情绪弹性与健康赋权呈正相关（r=0.233），情绪调节障碍削弱了患者“重建自我”的能力，并通过降低疾病管理信心，加剧了治疗参与度不足的情况[19]。健康赋权与健康促进行为亦存在强正相关（r=0.439），与钱玉霞等人[20]研究结果一致，提示低赋权状态限制了患者获取社会支持资源，使“责任信念”和“增长知识”能力受损，可能与其在‘营养’等健康行为维度上的表现不佳有关；而健康促进行为的持续恶化则能够通过加重心功能负担，进一步消耗情绪调节资源，从而形成恶性循环[21]。
3.3　健康赋权的中介效应
Bootstrap检验显示，健康赋权在情绪弹性与健康促进行为间存在显著中介效应（占比21.3%，95% CI:0.046～0.214），这表明健康赋权在情绪弹性与健康行为间发挥部分中介作用。（1）认知重构：健康赋权可能帮助患者将疾病管理视为自我主导的长期工程而非被动治疗，这种主体性认知有助于提升规律用药、合理运动等关键行为的执行意愿[15]。（2）资源整合：例如，医患共同决策机制为患者制定个体化运动方案等方式，能够将专业指导转化为可操作的日常行为，研究显示医患共同决策作为健康赋权的一种形式，可能与患者自我效能感的提升有关[22]，（3）压力代偿：赋权可能使个体通过正念冥想等适应性策略替代吸烟饮酒等消极应对方式，实现压力源的良性转化[23]。情绪弹性与健康赋权的协同作用可能尤为重要。低情绪弹性个体易因过度聚焦躯体不适而忽视营养管理等关键健康维度，而健康赋权提供的结构化支持（如家庭血压监测工具）可能有助于重塑其疾病感知模式，通过目标分解与阶段性反馈机制重建自我效能感，从而形成情绪、认知与行为的联动[24]。
3.4　实践意义与建议
基于本研究结果，我们提出以下针对临床实践和公共卫生的具体建议：首先，在临床层面，医护人员可整合情绪弹性评估，对低弹性患者早期实施心理干预，如正念训练或认知行为疗法，以增强其情绪调节能力。其次，医院可开展健康赋权教育项目，通过小组工作坊或数字健康工具，帮助患者提升自我管理技能，例如制定个性化运动计划和营养指南。最后，在公共卫生层面，建议政策制定者将心理社会支持纳入CHF管理指南，推广多学科团队模式，结合社区资源，为患者提供持续支持。这些措施有望改善CHF患者的健康行为，降低再入院率。
综上所述，本研究发现情绪弹性与CHF患者的健康促进行为相关，且健康赋权在此关系中发挥部分中介作用。然而，本研究存在若干局限性：一方面，横断面研究设计无法推断因果关系；另一方面，样本仅来自单中心，未区分NYHA II级与III级患者的机制差异，亦未纳入生物标志物与心理变量的交互效应。未来研究可采用纵向设计或干预性研究，结合移动健康技术，进一步验证变量间的因果路径并评估干预效果。
基金
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  • 湖北省自然科学基金(2025AFB374)
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2026年第53卷第11期
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doi: 10.20043/j.cnki.MPM.202508376
  • 接收时间：2025-08-21
  • 首发时间：2026-11-02
  • 出版时间：2026-06-10
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  • 收稿日期：2025-08-21
基金
湖北省自然科学基金(2025AFB374)
作者信息
    1.武汉市第一医院 急诊医学科，湖北 武汉 430030
    2.武汉市第一医院 心血管内科

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