重庆地区白血病患儿家庭管理影响因素的结构方程模型分析
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摘要
目的探讨重庆地区儿童白血病家庭管理影响因素,为更好地开展家庭管理干预工作提供科学依据。方法采用方便抽样法选取2017年10月至2018年3月在重庆市某三级甲等儿童医院就诊的白血病患儿主要照顾者为研究对象,以家庭管理模型作为理论框架,使用结构方程模型构建并验证家庭管理模型,分析和模拟各影响因素与家庭管理之间的关系。结果家庭功能、经济状况、文化水平以及居住地直接影响家庭管理,其中家庭功能对家庭管理消极结果效应值最大(直接效应值为0.533);社会支持通过影响家庭功能间接影响家庭管理消极结果(间接效应值为0.141);工作变化既可直接影响家庭管理积极结果,还可通过影响家庭功能间接影响家庭管理积极结果(直接效应值为-0.273,间接效应值为-0.114,总效应值为-0.387)。结论白血病患儿家庭管理的影响因素较多,应基于家庭功能、社会支持、经济状况、家长文化水平等方面制定干预措施,以促进家庭管理向积极方向发展。
Objective To investigate the influence factors of family management in children with leukemia in Chongqing and to provide a scientific basis for better interventions of family management.MethodsFrom October 2017 to March 2018,the caregivers of children with leukemia were selected by convenience sampling method.The family management style framework was used as the theoretical framework.The structural equation model was used to construct and validate the family management model,and to analyze the relationship among various influencing factors and family management.Results Family function,economic status,educational level and residence directly affected family management,among which family function had the greatest negative effect on family management(the score of direct effect was 0.533);social support indirectly affected family management by influencing family functions(the score of interconnect effect was 0.141);the job change can both directly and indirectly affect the positive results of family management by affecting family functions(direct effect value was-0.273,indirect effect value was-0.114,total effect value was-0.387).Conclusions There are many influence factors in the family management of children with leukemia.The intervention measures should be made on the basis of family function,economic status,social support and parents' educational level,in order to promote the development of family management in a positive direction.
Objective To investigate the influence factors of family management in children with leukemia in Chongqing and to provide a scientific basis for better interventions of family management.MethodsFrom October 2017 to March 2018,the caregivers of children with leukemia were selected by convenience sampling method.The family management style framework was used as the theoretical framework.The structural equation model was used to construct and validate the family management model,and to analyze the relationship among various influencing factors and family management.Results Family function,economic status,educational level and residence directly affected family management,among which family function had the greatest negative effect on family management(the score of direct effect was 0.533);social support indirectly affected family management by influencing family functions(the score of interconnect effect was 0.141);the job change can both directly and indirectly affect the positive results of family management by affecting family functions(direct effect value was-0.273,indirect effect value was-0.114,total effect value was-0.387).Conclusions There are many influence factors in the family management of children with leukemia.The intervention measures should be made on the basis of family function,economic status,social support and parents' educational level,in order to promote the development of family management in a positive direction.
引文
[1]MIRANDA-FILHO A,PINEROS M,FERLAY J,et al.Epidemiological patterns of leukaemia in 184countries:apopulation-based study[J].Lancet Haematol,2018,5(1):e14-e24.
[2]张娜,沈树红,王宁,等.年长儿童及青少年急性淋巴细胞白血病多中心临床研究[J].中华血液学杂志,2018,39(9):717-723.
[3]HUANG I C,BRINKMAN T M,MULLINS L,et al.Child symptoms,parent behaviors,and family strain in long-term survivors of childhood acute lymphoblastic leukemia[J].Psychooncology,2018,27(8):2031-2038.
[4]ERKER C,YAN K,ZHANG L,et al.Impact of pediatric cancer on family relationships[J].Cancer Med,2018,7(5):1680-1688.
[5]任益炯,季庆英,张佳妮,等.儿童急性白血病患者家庭负担调查[J].解放军医院管理杂志,2015,22(1):19-21.
[6]KNAFL K A,DEATRICK J A,HAVILL N L.Continued development of the family management style framework[J].J Fam Nurs,2012,18(1):11-34.
[7]舒勤,朱京慈.结构方程模型在医学研究中的应用及对护理研究的启示[J].中国实用护理杂志,2009,25(5):61-63.
[8]汤静燕,李志光,陈静.儿童肿瘤诊断治疗学[M].北京:人民军医出版社,2011.
[9]KNAFL K,DEATRICK J A,GALLO A.Assessment of the psychometric properties of the family management measure[J].J Pediatr Psychol,2011,36(5):495-505.
[10]张莹,魏珉.中文版家庭管理测量量表的信效度研究[J].中国实用护理杂志,2012,29(1A):22-25.
[11]ROBERTS C S,FEETHAM S.Assessing family functioning across three areas of relationships[J].Nurs Res,1982,31(4):231-236.
[12]张莹,魏珉.中文版Feetham家庭功能量表的信效度[J].解放军护理杂志,2009,25(5B):19-22.
[13]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,1994,4(2):98.
[14]KNAFL K A,DEATRICK J A.Family management style and the challenge of moving from conceptualization to measurement[J].J Pediatr Oncol Nurs,2006,23(1):12-18.
[15]孙玉倩,孙秉赋,王凤玲,等.恶性肿瘤患儿家庭管理方式及影响因素调查研究[J].中国全科医学,2016,6(3):1016-1019.
[16]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京:教育科学出版社,2004:16-36.
[17]张莹,魏珉,章雅青,等.家庭照护对慢性病患儿家庭功能的影响[J].上海交通大学学报:医学版,2013,33(5):531-536.
[18]马洁,许丽旋,林淑芬.白血病患儿母亲感受的研究[J].中华护理杂志,2012,47(3):222-224.
[19]田艳珍,任小红,谌静.信息和情感支持对急性白血病患儿家庭功能的影响[J].护理学杂志,2012,27(13):76-78.
[20]曾守锤.流动儿童的压力和社会支持状况及社会支持保护作用的研究[J].心理科学,2011,35(3):408-411.
[21]TAMARA O,LAURAL H,SUZANNE K G.Social support buffers the impact of functional impairments on caregiver psychological well-being in the context of brain tumor and other cancers[J].Psychooncology,2010,19(10):1116-1122.
[22]林晓霞,陈燕惠,陈珊,等.社会支持对学龄期白血病患儿及其家长的影响[J].中国儿童保健杂志,2016,24(12):1241-1244.
[23]陆红,周芬,徐丽华,等.白血病患儿全程照护模式的探索与实践[J].中国护理管理,2016,16(12):1604-1608.
[2]张娜,沈树红,王宁,等.年长儿童及青少年急性淋巴细胞白血病多中心临床研究[J].中华血液学杂志,2018,39(9):717-723.
[3]HUANG I C,BRINKMAN T M,MULLINS L,et al.Child symptoms,parent behaviors,and family strain in long-term survivors of childhood acute lymphoblastic leukemia[J].Psychooncology,2018,27(8):2031-2038.
[4]ERKER C,YAN K,ZHANG L,et al.Impact of pediatric cancer on family relationships[J].Cancer Med,2018,7(5):1680-1688.
[5]任益炯,季庆英,张佳妮,等.儿童急性白血病患者家庭负担调查[J].解放军医院管理杂志,2015,22(1):19-21.
[6]KNAFL K A,DEATRICK J A,HAVILL N L.Continued development of the family management style framework[J].J Fam Nurs,2012,18(1):11-34.
[7]舒勤,朱京慈.结构方程模型在医学研究中的应用及对护理研究的启示[J].中国实用护理杂志,2009,25(5):61-63.
[8]汤静燕,李志光,陈静.儿童肿瘤诊断治疗学[M].北京:人民军医出版社,2011.
[9]KNAFL K,DEATRICK J A,GALLO A.Assessment of the psychometric properties of the family management measure[J].J Pediatr Psychol,2011,36(5):495-505.
[10]张莹,魏珉.中文版家庭管理测量量表的信效度研究[J].中国实用护理杂志,2012,29(1A):22-25.
[11]ROBERTS C S,FEETHAM S.Assessing family functioning across three areas of relationships[J].Nurs Res,1982,31(4):231-236.
[12]张莹,魏珉.中文版Feetham家庭功能量表的信效度[J].解放军护理杂志,2009,25(5B):19-22.
[13]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,1994,4(2):98.
[14]KNAFL K A,DEATRICK J A.Family management style and the challenge of moving from conceptualization to measurement[J].J Pediatr Oncol Nurs,2006,23(1):12-18.
[15]孙玉倩,孙秉赋,王凤玲,等.恶性肿瘤患儿家庭管理方式及影响因素调查研究[J].中国全科医学,2016,6(3):1016-1019.
[16]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京:教育科学出版社,2004:16-36.
[17]张莹,魏珉,章雅青,等.家庭照护对慢性病患儿家庭功能的影响[J].上海交通大学学报:医学版,2013,33(5):531-536.
[18]马洁,许丽旋,林淑芬.白血病患儿母亲感受的研究[J].中华护理杂志,2012,47(3):222-224.
[19]田艳珍,任小红,谌静.信息和情感支持对急性白血病患儿家庭功能的影响[J].护理学杂志,2012,27(13):76-78.
[20]曾守锤.流动儿童的压力和社会支持状况及社会支持保护作用的研究[J].心理科学,2011,35(3):408-411.
[21]TAMARA O,LAURAL H,SUZANNE K G.Social support buffers the impact of functional impairments on caregiver psychological well-being in the context of brain tumor and other cancers[J].Psychooncology,2010,19(10):1116-1122.
[22]林晓霞,陈燕惠,陈珊,等.社会支持对学龄期白血病患儿及其家长的影响[J].中国儿童保健杂志,2016,24(12):1241-1244.
[23]陆红,周芬,徐丽华,等.白血病患儿全程照护模式的探索与实践[J].中国护理管理,2016,16(12):1604-1608.