广西医学

目的探讨日常生活能力在医养结合机构老年人健康信念、主观睡眠质量与主动心理健康之间的中介效应。方法选取广西10家医养结合机构的395名老年人作为研究对象，采用一般资料调查表、健康信念量表、自制主观睡眠质量问卷及Barthel指数对其进行调查。采用二元Logistic回归模型分析日常生活能力、健康信念、主观睡眠质量对老年人主动心理健康的影响。通过Stata 18.0软件构建广义结构方程模型，采用Process Bootstrap程序分析日常生活能力在医养结合机构老年人健康信念、主观睡眠质量与主动心理健康之间的中介效应。结果 395名医养结合机构老年人的健康信念量表总分、主观睡眠质量问卷得分、Barthel指数总分分别为（38.48±5.27）分、（3.31±1.17）分、（78.13±25.28）分，其中有352名（89.11%）老年人存在主动心理健康。二元Logistic回归分析结果显示，模型4中医养结合机构老年人的健康信念量表总分和主观睡眠质量问卷得分对其主动心理健康存在正向影响（P<0.05），而Barthel指数总分对其主动心理健康的影响无统计学意义（P>0.05）。医养结合机构老年人的健康信念和主观睡眠质量均对其主动心理健康产生直接正向影响（P<0.05），日常生活能力在健康信念与主动心理健康间起部分中介作用，其效应占比为15.00%；日常生活能力在主观睡眠质量与主动心理健康间起部分中介作用，其效应占比为16.34%。结论在医养结合机构中，大部分老年人存在主动心理健康，且老年人健康信念和主观睡眠质量可直接影响其主动心理健康，并通过日常生活能力对主动心理健康产生间接影响。

Objective To explore the mediating effect of activities of daily living between health beliefs, subjective sleep quality, and proactive mental health in the elderly in integrated medical and nursing care institutions. Methods A total of 395 elderly individuals from 10 integrated medical and nursing care institutions in Guangxi were selected as the research subjects. They were surveyed using a general information questionnaire, the health belief scale, the self⁃designed subjective sleep quality questionnaire, and the Barthel index. Binary Logistic regression model was used to analyze the effects of activities of daily living, health beliefs, and subjective sleep quality on proactive mental health in the elderly. A generalized structural equation model was constructed using Stata 18.0 software, and the Process Bootstrap procedure was applied to analyze the mediating effect of activities of daily living between health beliefs, subjective sleep quality, and proactive mental health. Results Among the 395 elderly individuals, health belief scale total score, subjective sleep quality questionnaire score, and Barthel index total score were (38.48±5.27), (3.31±1.17), and (78.13±25.28), respectively, therein 352 elderly individuals (89.11%) exhibited proactive mental health. Binary Logistic regression analysis revealed that in Model 4, health belief scale total score and subjective sleep quality questionnaire score had a positive effect on their proactive mental health in the elderly in integrated medical and nursing care institutions (P<0.05), while no statistically significant difference was observed in Barthel index total score on proactive mental health (P>0.05). Both health beliefs and subjective sleep quality had direct positive effects on proactive mental health in the elderly in integrated medical and nursing care institutions (P<0.05). Activities of daily living partially mediated the relation between health beliefs and proactive mental health, with a mediating effect proportion of 15.00%. Activities of daily living also partially mediated the relation between subjective sleep quality and proactive mental health, with a mediating effect proportion of 16.34%. Conclusion In integrated medical and nursing care institutions, most of the elderly have proactive mental health, and health beliefs and subjective sleep quality can directly affect their proactive mental health, exerting indirect effect on proactive mental health through activities of daily living.

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