基于自我超越理论的COM-B自我管理护理在CHF患者的应用分析

摘要/Abstract

摘要： 目的观察基于自我超越理论的能力、机会、动机-行为（COM-B）自我管理护理对慢性心力衰竭（CHF）患者中的应用。方法将120例CHF患者采用随机数字表法分为观察组、对照组各60例,对照组行常规干预策略,观察组实施基于自我超越理论的COM-B自我管理护理,比较两组患者干预前后健康信念量表、慢性病自我效能感量表（SECD6）、自我护理能力量表（ESCA）及8项Morisky服药依从性量表（MMAS-8）、服药信念量表（BMQ）评分。结果两组患者健康信念、SECD6、ESCA各维度评分及MMAS-8、BMQ必需性评分均较干预前提高（P<0.05）,且观察组高于对照组（P<0.05）;BMQ顾虑性评分均较干预前下降（P<0.05）,且观察组低于对照组（P<0.05）。结论基于自我超越理论的COM-B自我管理护理有助于提升CHF患者的健康信念、自我效能和自我护理能力,改善服药依从性及服药信念。

关键词: 慢性心力衰竭, 自我超越理论, 能力、机会、动机-行为模式, 健康信念, 自我效能, 服药依从性

Abstract: Objective To investigate the application of Capability, Opportunity, Motivation-Behavior (COM-B) self-management nursing based on the self-transcendence theory in patients with chronic heart failure (CHF). Methods A total of 120 patients with CHF were divided into observation group and control group using a random number table, with 60 patients in each group. The patients in the control group received conventional intervention strategies, while those in the observation group received COM-B self-management nursing based on the self-transcendence theory. The two groups were compared in terms of the scores of health belief scale, Self-efficacy for Managing Chronic Disease 6-Item Scale (SECD6), Exercise of Self-Care Agency Scale (ESCA), 8-Item Morisky Medication Adherence Scale (MMAS-8), and Beliefs about Medicines Questionnaire (BMQ) before and after intervention. Results After treatment, both groups had significant increases in the scores of health beliefs, each dimension of SECD6 and ESCA, MMAS-8, and BMQ necessity (P<0.05), and the observation group had significantly higher scores than the control group (P<0.05). Both groups had a reduction in BMQ concern score after intervention (P<0.05), and the observation group had a significantly lower score than the control group (P<0.05). Conclusion COM-B self-management nursing based on the self-transcendence theory can help to enhance the health belief, self-efficacy, and self-care ability of CHF patients and improve medication compliance and medication belief.

Key words: Chronic heart failure, Self-transcendence theory, Capability、Opportunity、Motivation-Behavior model, Health belief, Self-efficacy, Medication compliance

赖冬峥, 张国珍. 基于自我超越理论的COM-B自我管理护理在CHF患者的应用分析[J]. 心血管病防治知识, 2025, 15(4): 85-89.

LAI Dongzheng, ZHANG Guozhen. Application of Capability, Opportunity, Motivation-Behavior self-management nursing based on the self-transcendence theory in patients with chronic heart failure[J]. Prevention and Treatment of Cardiovascular Disease, 2025, 15(4): 85-89.

参考文献

[1] 苑强涛,姜鹏,何磊.比索洛尔不同用药剂量对老年慢性心力衰竭患者心肌重构和血管内皮功能及T淋巴细胞亚群的影响[J].感染、炎症、修复, 2022,23(4):217-220.
[2] 黄艳玲,顾则娟,孙国珍,等.慢性心力衰竭患者健康信息素养与自我管理行为及生活质量的相关性[J].实用临床医药杂志, 2022,26(10):105-119.
[3] Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions[J]. Implement Sci, 201123(6):42-44.
[4] 王蒙,张玲玲,王春华,等.提高慢性心力衰竭病人自我管理能力的循证实践[J].护理研究, 2022, 36(21):3822-3829.
[5] Heidenreich PA, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2022, 145(18):895-1032.
[6] 万丽红,张小培,潘俊豪,等.脑卒中患者健康信念简表的信效度检验[J].中华疾病控制杂志, 2017, 21(3):303-307.
[7] Jiang W, Zhang Y, Yan F, et al.Effectiveness of a nurse-led multidisciplinary self-management program for patients with coronary heart disease in communities: A randomized controlled trial[J]. Patient Educ Couns, 2020, 103(4):854-863.
[8] Du M, Kong H, Ran L, et al.Associations among health-promoting lifestyle, self-care agency and health-related quality of life in Bai older adults with hypertension in Yunnan China[J]. BMC Geriatr, 2022, 22(1):942-945.
[9] Iranpour A, Sarmadi V, Alian Mofrad A,et al.The Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8): can we trust it[J]? J Diabetes Metab Disord, 2022,21(1):835-840.
[10] 张振香,何福培,张春慧,等.慢性病共病患者服药依从性潜在类别及其影响因素分析[J].中国全科医学, 2022, 25(31):3904-3913.
[11] 姜佳池,李宛思,刘日,等.慢性心力衰竭患者自我管理能力在睡眠质量与感知压力间的中介效应[J].北华大学学报:自然科学版, 2023, 24(1):105-110.
[12] 邱小芩,黄彩献,傅桂芬,等.慢性心力衰竭患者院外健康管理程序的构建及应用[J].中华护理杂志, 2022, 57(4):401-407.

[1]	方文艳. 心身放松训练结合赋能教育对冠心病患者负性心理及自我效能的影响[J]. 心血管病防治知识, 2025, 15(5): 49-52.
[2]	武岭. 基于感恩拓延-建构理论为指导的双心护理对慢性心力衰竭患者自护能力的应用研究[J]. 心血管病防治知识, 2025, 15(5): 72-75.
[3]	张倩妮. 个体化营养支持结合间断负荷训练对老年慢性心力衰竭患者营养状态和心功能的影响[J]. 心血管病防治知识, 2025, 15(5): 76-79.
[4]	张静. 量化评估引导的流程式护理模式对老年急性心肌梗死后慢性心力衰竭患者的应用效果及对心功能影响[J]. 心血管病防治知识, 2025, 15(5): 83-87.
[5]	张长英. 家庭参与式自我效能护理在高血压性鼻出血患者中的应用研究[J]. 心血管病防治知识, 2025, 15(5): 111-114.
[6]	涂娴. 家属参与共享决策护理模式对精神分裂症合并高血压患者服药依从性及血压水平控制效果的影响[J]. 心血管病防治知识, 2025, 15(5): 115-118.
[7]	陈佳彬, 白凤鸣, 张红雨. 碱性磷酸酶联合心脏彩超指标对慢性心力衰竭患者的预后预测价值分析[J]. 心血管病防治知识, 2025, 15(4): 23-27.
[8]	魏梦杰. 生脉散合血府逐瘀汤加减联合沙库巴曲缬沙坦对气阴两虚型慢性心力衰竭的临床疗效[J]. 心血管病防治知识, 2025, 15(4): 36-39.
[9]	池木玲. 对老年高血压患者行“一病一品”护理措施的效果及对其血压控制、心理状态及自我效能感的影响研究[J]. 心血管病防治知识, 2025, 15(4): 70-72.
[10]	缪秋兰, 黄燕萍. 健康信念模式联合认知行为干预对冠心病合并高血压患者的综合管理效果[J]. 心血管病防治知识, 2025, 15(4): 116-119.
[11]	赵龙. 达格列净联合常规药物治疗慢性心力衰竭的临床疗效及安全性分析[J]. 心血管病防治知识, 2025, 15(3): 38-40.
[12]	姜丽丽, 郑爱喜. 慢性心力衰竭患者血清CysC、BNP表达水平及与疾病严重程度的相关性研究[J]. 心血管病防治知识, 2025, 15(3): 57-59.
[13]	陈巧敏. 主动脉内球囊反搏术后出现慢性心力衰竭急性加重患者实施团队分层护理的效果[J]. 心血管病防治知识, 2025, 15(3): 96-99.
[14]	刘菲菲, 杨美玲, 林守虹. 双主体三步法护理模式在颈动脉狭窄支架植入患者中的应用及服药依从性分析[J]. 心血管病防治知识, 2025, 15(3): 135-137.
[15]	周康. 益气复脉注射液联合重组人脑利钠肽在心房颤动伴慢性心力衰竭治疗中的临床效果观察[J]. 心血管病防治知识, 2025, 15(2): 38-41.