Chinese General Practice ›› 2022, Vol. 25 ›› Issue (25): 3165-3170.DOI: 10.12114/j.issn.1007-9572.2022.0138

• Original Research·Community-based Management of Osteoarthritis • Previous Articles     Next Articles

Healthcare-seeking Perceptions and Behaviors and Behavior-related Factors in Community-living Osteoarthritis Patients: a Mixed-methods Study

  

  1. 1. Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
    2. Department of General Practice, Tongji University School of Medicine, Shanghai 200092, China
    3. Shanghai General Practice and Community Health Development Research Center, Shanghai 200090, China
    4. Department of Orthopedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
    5. Shanghai General Practice Clinical Quality Control Center, Shanghai 200090, China
  • Received:2021-12-02 Revised:2022-06-27 Published:2022-09-05 Online:2022-07-21
  • Contact: Hanzhi ZHANG
  • About author:
    QIU M S, LIU Q, ZHANG H Z, et al. Healthcare-seeking perceptions and behaviors and behavior-related factors in community-living osteoarthritis patients: a mixed-methods study [J] . Chinese General Practice, 2022, 25 (25) : 3165-3170, 3177.

社区骨关节炎患者的疾病认知与行为特点及就诊行为的影响因素:一项混合方法学研究

  

  1. 1.200090 上海市,同济大学附属杨浦医院全科医学科
    2.200092 上海市,同济大学医学院全科医学系
    3.200090 上海市全科医学与社区卫生发展研究中心
    4.200090 上海市,同济大学附属杨浦医院骨科
    5.200090 上海市全科医学临床质量控制中心
  • 通讯作者: 张含之
  • 作者简介:
    邱梦思,刘茜,张含之,等.社区骨关节炎患者的疾病认知与行为特点及就诊行为的影响因素:一项混合方法学研究[J].中国全科医学,2022,25(25):3165-3170,3177.[www.chinagp.net] 作者贡献:邱梦思、张含之进行文章的构思与设计;张含之、张立智、于德华进行研究的可行性分析;张含之、张立智参与调查问卷设计;邱梦思、刘茜、田久鹏进行数据收集;邱梦思进行研究实施、数据整理、统计学处理、结果的分析与解释、论文撰写;张含之进行论文修订,负责文章的质量控制及审校,并对文章整体负责,监督管理。
  • 基金资助:
    同济大学附属杨浦医院第九批攀登计划(Ye2202002); 上海市杨浦区中心医院学科带头人"攀登计划"(Ye2202002)

Abstract:

Background

Osteoarthritis is a chronic disease commonly seen in community settings, and the management of which is associated with numerous inter-related factors. Due to lack of appropriate healthcare-seeking perceptions and behaviors in osteoarthritis patients, it is difficult to diagnose, treat and manage osteoarthritis.

Objective

To understand healthcare-seeking perceptions and behaviors in community-living osteoarthritis patients, providing evidence for improving the diagnosis and treatment of such patients in the community.

Methods

This was a mixed-methods study. From May to June 2019, interviews for understanding osteoarthritis patients' healthcare-seeking perceptions and behavior-related factors, as well as management were conducted with a purposive sample of five orthopedic physicians and five general practitioners (GPs) from a general hospital in a regional healthcare consortium in Shanghai's Yangpu District, and a convenience sample of 12 GPs and 12 osteoarthritis patients from six community health centers (CHCs) in the same consortium. Then from June 2019 to December 2020, 425 patients with osteoarthritis were chosen from three randomly selected CHCs of the above-mentioned six ones to attend a survey using a quantitative questionnaire developed based on the themes derived from the above-mentioned interviews (excluding some highly subjective and less quantifiable indicators) for understanding their socio-demographic information, disease status, healthcare-seeking perceptions and behaviors, self-management and utilization of the APP for chronic disease management. Binary Logistic regression was used to analyze the influencing factors of healthcare-seeking behaviors in patients with osteoarthritis.

Results

The following themes were extracted from the interviews: patients' insufficient awareness of osteoarthritis, lack of management of osteoarthritis and influencing factors of patients' healthcare-seeking behavior. Three hundred and ninety-seven of the 425 cases (93.4%) who effectively completed the questionnaire were included for quantitative analysis. One hundred and fifty-two (38.3%) respondents understood osteoarthritis, and 79 (52.0%) of them acquired relevant knowledge from the media, and other 50 (32.9%) from ward-mates. Two hundred (50.4%) respondents knew the treatments for osteoarthritis, including 91 (45.5%) knowing exercise and physical therapies, and 105 (52.5%) knowing treatment with painkillers. The healthcare-seeking behaviors in osteoarthritis patients varied significantly by sex, BMI, pain level, impact of pain on sleep quality, and previous healthcare-seeking experience (P<0.05) . The results of regression analysis demonstrated that sex, BMI, pain level, previous treatment experience and impact of pain on sleep quality were associated with healthcare-seeking behavior (P<0.05) .

Conclusion

Community-living patients with osteoarthritis had insufficient awareness of healthcare-seeking and weak self-management awareness, and their healthcare-seeking behaviors were affected by multiple factors. To improve these patients' healthcare-seeking perceptions and behaviors, priority should be given to take actions to enhance patients' healthcare-seeking perceptions, train patients' self-management ability, better GPs' diagnostic and therapeutic skills, improve doctors and patients' negative attitude toward osteoarthritis treatment, and promote patients seeking healthcare actively.

Key words: Osteoarthritis, Community health services, Clinic visits, Root cause analysis, Mixed-methods study

摘要:

背景

骨关节炎作为社区常见慢性病,其影响因素众多且相互作用,当前患者的就医认知和行为不足,造成骨关节炎的诊治和管理困难。

目的

了解社区骨关节炎患者的就医认知和行为特点,为改善该类患者的社区就医诊治提供策略。

方法

本研究为混合方法学研究。2019年5—6月,采用目的抽样法从上海市杨浦区一家区域医疗中心的综合医院选取骨科医生和全科医生各5例,同时在区域内的其中6家社区卫生服务中心方便抽取12例全科医生、12例前来就诊的骨关节炎患者,进行多方访谈,了解访谈对象的疾病认知、疾病管理现况及就医行为影响因素。2019年6月至2020年12月,从以上6家社区卫生服务中心中随机选取3家,对前来就诊的425例骨关节炎患者进行问卷调查。结合访谈归纳的主题,除去部分具有较大主观性难以采用问卷量化的指标,设计定量问卷。调查问卷内容包括一般资料、患病现况、就医认知和行为、自我管理情况及慢性病APP利用。采用二元Logistic回归分析骨关节炎患者就医行为的影响因素。

结果

定性访谈共提炼出3个主题,分别为对骨关节炎认知不足、缺乏对骨关节炎的管理、影响就医行为的因素。定量研究共计回收有效问卷397份(93.4%)。397例调查对象中,152例(38.3%)了解骨关节炎相关知识;152例了解骨关节炎相关知识者中,知识来源为媒体、病友的分别有79例(52.0%)、50例(32.9%);397例调查对象中,200例(50.4%)表示了解骨关节炎治疗措施,其中分别有91例(45.5%)、105例(52.5%)知晓运动和物理治疗及止痛药措施。不同性别、体质指数(BMI)、关节疼痛程度、疼痛影响睡眠情况、既往就医经历骨关节炎患者就医情况比较,差异有统计学意义(P<0.05)。二元Logistic回归结果显示,性别、BMI、疼痛程度、疼痛影响睡眠情况、既往就医经历是就医行为的影响因素(P<0.05)。

结论

社区骨关节炎患者就医认知不足、自我管理意识薄弱,就医行为受多种因素影响。未来应注重提高患者就医认知,并培养患者自我管理能力;提高全科医生诊疗技能,改善医患双方消极态度,促进患者积极就医。

关键词: 骨关节炎, 社区卫生服务, 就诊, 影响因素分析, 混合方法学研究