Family influences on self-management among functionally independent adults with diabetes or heart failure: do family members hinder as much as they help?
Family influences on self-management among functionally independent adults with diabetes or heart failure: do family members hinder as much as they help?
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DOI：
10.1177/1742395309354608
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发表时间：
2010-03
期刊：
影响因子：
1.3
通讯作者：
Piette JD
中科院分区：
文献类型：
--
作者：
Rosland AM;Heisler M;Choi HJ;Silveira MJ;Piette JD
在功能独立的糖尿病或心力衰竭患者中，我们检查了家庭成员的支持和家庭相关的自我护理障碍。然后，我们确定了与家庭支持和家庭障碍相关的患者特征，以及每种特征如何与自我管理依从性相关。对439例糖尿病或心力衰竭患者进行横断面调查（应答率为74%）。75%的受访者表示支持家庭参与自我护理，但25%的受访者表示经常遇到与家庭有关的自我护理障碍。与男子相比，妇女报告家庭支助较少（64%对77%），家庭对自我照顾的障碍较多（30%对21%）。78%的受访者表示，家庭成员会唠叨或批评他们的疾病护理。在多变量模型中，低健康素养，伴侣地位和较高的家庭功能与较高的家庭支持水平相关，而女性性别，年龄较大，教育程度较高，更多的抑郁症状与家庭自我护理障碍相关。家庭障碍与较低的疾病护理自我效能相关（p<0.01），障碍和家庭支持与患者的自我管理依从性相关（均p<0.05）。家庭成员高度参与这些高功能患者的自我护理。干预措施应帮助慢性病患者克服家庭自我护理的障碍，并帮助家庭使用积极有效的支持技术。
Among functionally independent patients with diabetes or heart failure, we examined family member support and family-related barriers to self-care. We then identified patient characteristics associated with family support and family barriers and how each was associated with self-management adherence. Cross-sectional survey of 439 patients with diabetes or heart failure (74% response rate). 75% of respondents reported supportive family involvement in self-care, however 25% reported frequent family-related barriers to self-care. Women reported family support less often (64% vs. 77%) and family barriers to self-care more often (30% vs. 21%) than men. 78% of respondents reported involved family members nagged or criticized them about illness care. In multivariate models, low health literacy, partnered status, and higher family function were associated with higher family support levels, while female gender, older age, higher education, and more depression symptoms were associated with family barriers to self-care. Family barriers were associated with lower disease care self-efficacy (p<.0.01), and both barriers and family support were associated with patients’ self-management adherence (both p<0.05). Family members are highly involved in the self-care of these higher-functioning patients. Interventions should help patients with chronic illness overcome family barriers to self-care and help families use positive and effective support techniques.