基于能力-机会-动机-行为模型的眼底病患者社会参与度异质性研究-东南大学学报医学版

基于能力-机会-动机-行为模型的眼底病患者社会参与度异质性研究

单位：江苏省人民医院宿迁医院眼科, 江苏宿迁 223800

分类号：R473.77

出版年·卷·期（页码）：2026·45·第二期（282-296）

摘要：

目的:基于能力-机会-动机-行为(COM-B)模型探索眼底病患者社会参与潜在类别的相关因素,为个体化干预决策提供参考。方法:便利抽样法选取2023年5月至2025年4月本院收治的眼底病患者为研究对象。基于COM-B模型(能力:视觉能力、心理弹性,机会:社会支持、家庭功能,动机:自我感受负担,行为:社会参与),采用一般资料调查表、中文版参与和自主性测评问卷(IPA)、心理弹性量表简版(CD-RISC-10)、社会支持评定量表(SSRS)、家庭关怀度指数量表(APGAR)、自我感受负担量表(SPBS)进行调查,并评估视觉能力。通过潜在剖面分析探索眼底病患者社会参与的潜在类别,多分类Logistic回归分析眼底病患者社会参与潜在类别的相关因素。结果:最终纳入305例眼底病患者。患者IPA总分(42.98±11.02)分,其中家庭角色(11.31±3.45)分,室内自主参与(9.98±3.46)分,室外自主参与(10.33±2.76)分,社会生活(11.35±2.86)分。305例眼底病患者社会参与表现为4种不同潜在类别:社会参与充分型(23.61%,72/305),中等社会参与型(37.70%,115/305),社会参与缺乏型(21.64%,66/305),室外-社会生活受限型(17.05%,52/305)。4个潜在类别的患者在年龄、职业状态、合并慢性病、视觉能力、心理弹性、社会支持、家庭关怀度、自我感受负担方面的比较,差异有统计学意义(均P<0.05)。多分类Logistic回归分析结果显示,职业状态、合并慢性病、视觉能力、心理弹性、社会支持、家庭关怀度、自我感受负担是眼底病患者社会参与潜在类别的相关因素(均P<0.05)。结论:眼底病患者社会参与度存在群体异质性,社会参与潜在类别不仅与职业状态、慢性病有关,而且与能力、机会、动机因素有关。临床医护人员可基于COM-B模型框架,针对不同潜在类别患者特征制定个体化干预策略,改善社会参与状况。

Objective: To explore the relevant factors of potential categories of social participation in patients with ocular fundus disease based on the capacity-opportunity-motivation-behavior(COM-B) model, and to provide references for individualized intervention decisions. Methods: A convenience sampling method was used to select patients with ocular fundus disease admitted to our hospital from May 2023 to April 2025 as the study subjects. Based on the COM-B model(capacity: visual ability, psychological resilience; opportunity: social support, family function; motivation: self-perceived burden; behavior: social participation), datas were collected using a general information questionnaire, the Chinese version of the Impact on Participation and Autonomy Questionnaire(IPA), the 10-item Connor-Davidson Resilience Scale(CD-RISC-10), the Social Support Rating Scale(SSRS), the Family Adaptation Partnership Growth Affection and Resolve Index(APGAR), and the Self-Perceived Burden Scale(SPBS), with visual ability also being assessed. The potential categories of social participation of patients with ocular fundus disease were explored through potential profile analysis, and the relevant factors of potential categories of social participation of patients with ocular fundus disease were analyzed by multi-class Logistic regression. Results: A total of 305 patients with ocular fundus disease were finally included. The total IPA score of the patients was(42.98±11.02) points, among which family role was(11.31±3.45) points, indoor autonomous participation was(9.98±3.46) points, outdoor autonomous participation was(10.33±2.76) points, and social life was(11.35±2.86) points. The social participation of 305 patients with ocular fundus disease was manifested in four different potential categories: adequate social participation type(23.61%, 72/305), moderate social participation type(37.70%, 115/305), insufficient social participation type(21.64%, 66/305), outdoor-social life restricted type(17.05%, 52/305). The comparisons among the four potential categories of patients in terms of age, occupational status, concurrent chronic diseases, visual ability, psychological resilience, social support, family care degree, and self-perceived burden showed statistically significant differences(all P<0.05). The results of multivariate Logistic regression analysis showed that occupational status, combined chronic diseases, visual ability, psychological resilience, social support, family care degree and self-perceived burden were the relevant factors of different potential categories of social participation in patients with ocular fundus disease(all P<0.05). Conclusion: There is significant heterogeneity in the social participation levels of patients with ocular fundus disease. Different types of social participation are not only related to occupational status and chronic diseases, but also to factors such as ability, opportunity and motivation. Clinical medical staff can formulate individualized intervention strategies based on the COM-B model framework for the characteristics of patients in different potential categories to improve the status of social participation.

参考文献：

[1] 中华医学会眼科学分会眼底病学组,中国医师协会眼科医师分会眼底病学组.我国主要眼底病慢病管理专家共识[J].中华眼底病杂志,2024,40(4):253-263.
[2] MENG Y,LIU Y,DUAN R,et al.Global,regional,and national epidemiology of vision impairment due to diabetic retinopathy among working-age population,1990-2021[J].J Diabetes,2025,17(7):e70121.
[3] ZHOU C,LI S,YE L,et al.Visual impairment and blindness caused by retinal diseases:a nationwide register-based study[J].J Glob Health,2023,13:04126.
[4] XIANG X,FREEDMAN V A,SHAH K,et al.Self-reported vision impairment and subjective well-being in older adults:a longitudinal mediation analysis[J].J Gerontol A Biol Sci Med Sci,2020,75(3):589-595.
[5] LEVASSEUR M,LUSSIER-THERRIEN M,BIRON M L,et al.Scoping study of definitions of social participation:update and co-construction of an interdisciplinary consensual definition[J].Age Ageing,2022,51(2):afab215.
[6] ABDI S,SPANN A,BORILOVIC J,et al.Understanding the care and support needs of older people:a scoping review and categorisation using the WHO international classification of functioning,disability and health framework(ICF)[J].BMC Geriatr,2019,19(1):195.
[7] TAKEMURA Y,INOUE K,SATO K,et al.Social participation and depressive symptoms among older adults[J].JAMA Netw Open,2025,8(9):e2530523.
[8] MICHIE S,VAN STRALEN M M,WEST R.The behaviour change wheel:a new method for characterising and designing behaviour change interventions[J].Implement Sci,2011,6(1):42.
[9] LIU D,GAO Y,SU X.Self-care ability and associated factors in community-dwelling older adults living with oral frailty using the COM-B model[J].J Oral Rehabil,2024,51(8):1530-1541.
[10] ZHANG M,GUO L,NAMASSEVAYAM G,et al.Factors associated with health behaviours among stroke survivors:a mixed-methods study using COM-B model[J].J Clin Nurs,2024,33(6):2138-2152.
[11] 刘源,骆方,刘红云.多阶段混合增长模型的影响因素:距离与形态[J].心理学报,2014,46(9):1400-1412.
[12] 刘晓华,周倩,成守珍.横断面研究护理论文评价要点解读(二)[J].现代临床护理,2019,18(7):78-83.
[13] 杨培增,范先群.眼科学[M].9版.北京:人民卫生出版社,2018:151-167.
[14] CARDOL M,DE HAAN R J,VAN DEN BOS G A,et al.The development of a handicap assessment questionnaire:the Impact on Participation and Autonomy(IPA)[J].Clin Rehabil,1999,13(5):411-419.
[15] 李红,崔明,周兰姝.中文版参与和自主性测评问卷的修订及信度、效度分析[J].中国康复医学杂志,2012,27(10):923-927,937.
[16] 王静,林可可,孙超,等.社会参与在老年2型糖尿病患者自我管理与社会隔离间的中介效应[J].中华全科医学,2024,22(9):1467-1470,1537.
[17] 韦磊,张百艺,罗玲平,等.社区老年慢性阻塞性肺疾病患者社会参与的潜在剖面分析[J].军事护理,2023,40(8):6-9.
[18] 原田甜,周俊阁,李国鑫,等.社区老年多重慢性病患者社会参与水平及影响因素分析[J].郑州大学学报(医学版),2024,59(4):475-479.
[19] 国家重点研发计划YFC项目组,中华医学会眼科学分会眼视光学组,中国医师协会眼科医师分会眼视光专业委员会.中国低视力康复临床指南(2021)[J].中华眼视光学与视觉科学杂志,2021,23(3):161-170.
[20] CONNOR K M,DAVIDSON J R T.Development of a new resilience scale:the Connor-Davidson Resilience Scale(CD-RISC)[J].Depress Anxiety,2003,18(2):76-82.
[21] CAMPBELL-SILLS L,STEIN M B.Psychometric analysis and refinement of the Connor-Davidson Resilience Scale(CD-RISC):validation of a 10-item measure of resilience[J].J Trauma Stress,2007,20(6):1019-1028.
[22] WANG L,SHI Z,ZHANG Y,et al.Psychometric properties of the 10-item Connor-Davidson Resilience Scale in Chinese earthquake victims[J].Psychiatry Clin Neurosci,2010,64(5):499-504.
[23] 肖水源.《社会支持评定量表》的理论基础与研究应用[J].临床精神医学杂志,1994(2):98-100.
[24] SMILKSTEIN G.The Family APGAR:a proposal for family function test and its use by physicians[J].J Fam Pract,1978,6(6):1231-1239.
[25] 吕繁,曾光,刘松暖,等.家庭关怀度指数问卷测量脑血管病病人家庭功能的信度和效度研究[J].中国公共卫生,1999(11):27-28.
[26] COUSINEAU N,MCDOWELL I,HOTZ S,et al.Measuring chronic Patients' feelings of being a burden to their caregivers:development and preliminary validation of a scale[J].Med Care,2003,41(1):110-118.
[27] 武燕燕,姜亚芳.癌症患者自我感受负担的调查与分析[J].护理管理杂志,2010,10(6):405-407.
[28] 尹奎,彭坚,张君.潜在剖面分析在组织行为领域中的应用[J].心理科学进展,2020,28(7):1056-1070.
[29] LUO D,YU S,WANG J,et al.Social participation of community-dwelling older adults in western China:a latent profile analysis[J].Front Public Health,2022,10:874204.
[30] XIE G,FOCACCI C N,LI J,et al.Association of social participation with progression and reversion of intrinsic capacity in older adults:based on multistate model[J].J Nutr Health Aging,2025,29(12):100719.
[31] ZHANG Y,SU D,CHEN Y,et al.Effect of socioeconomic status on the physical and mental health of the elderly:the mediating effect of social participation[J].BMC Public Health,2022,22(1):605.
[32] MARTINS A C.Using the International Classification of Functioning,Disability and Health(ICF) to address facilitators and barriers to participation at work[J].WORK A J Prev Assess Rehabil,2015,50(4):585-593.
[33] TOMIOKA K,KURUMATANI N,HOSOI H.Association between the frequency and autonomy of social participation and self-rated health[J].Geriatr Gerontol Int,2017,17(12):2537-2544.
[34] VAN DEN BROECKE M,DE JONG S,KIASUWA MBENGI R,et al.Development of ICF-based patient-reported outcome and experience measures to study social participation among people with chronic diseases:a mixed-methods protocol[J].BMJ Open,2024,14(12):e087798.
[35] ZHOU X,WU H.The impact of sensory impairments and eye diseases on cognitive function in elderly Chinese:The mediating effects of social participation[J].J Glob Health,2023,13:04068.
[36] 叶静,张戌凡.心理韧性视角下社会参与对老年人幸福感的影响研究——一个有调节的中介模型[J].中国卫生事业管理,2021,38(4):317-320.
[37] ÖZKAN E,NAL ÖZÜN Ö,GÖKTAŞ A,et al.Patient activation in adults with visual impairment:a study of related factors[J].BMC Public Health,2024,24(1):1599.
[38] 钟竹,刘思奇,付晶晶,等.重庆市主城区低视力老人社会参与类型及诉求的质性研究[J].护士进修杂志,2022,37(18):1709-1712.
[39] QIU X,LIANG J,LUO L,et al.Patterns of social participation among older adults with chronic multimorbidity in the community:a qualitative study[J].Int J Nurs Stud,2026,174:105279.
[40] 李珊,王冠一,杨小晓,等.家庭功能对糖尿病视网膜病变患者社会衰弱的影响:积极应对和健康素养的链式中介作用[J].中华现代护理杂志,2025,31(26):3585-3592.
[41] 王艳蕾,李晶莹,吕印香.糖尿病视网膜病变手术患者心理压力与自我感受负担的关系:心理弹性的中介效应[J].中国健康心理学杂志,2024,32(9):1377-1382.
[42] 阴文娟,武伟,何英娜,等.眼底病患者自我感受负担与生活质量的相关性分析[J].现代临床护理,2021,20(4):21-24.
[43] WANG G,DONG J,ZHU N,et al.Development and validation of a social alienation predictive model for older maintenance hemodialysis patients based on latent profile analysis—a cross-sectional study[J].BMC Geriatr,2024,24(1):495.
[44] WANG J,TANG H.Influence of feedforward control-based health education intervention on compliance,visual function and self-perceived burden among patients with diabetic retinopathy[J].Afr Health Sci,2023,23(3):328-335.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录