背景：基层医疗对慢病患者进行健康管理具有重要意义，但部分疾病尚未被纳入健康管理范畴，例如痛经。痛经具有高患病率，对女性身心造成极大负面影响，然而患者利用医疗资源水平较低，导致其生活质量在月经期间显著下降。目的：（1）描述中国痛经患者自我管理行为现状；（2）分析疾病感知、服药信念、自我效能对痛经患者自我管理行为的影响路径；（3）比较各变量对痛经患者利用医疗资源和利用日常资源影响路径的异同。方法：通过文献研究，构建影响患者自我管理的潜在影响因素模型。在修订自我管理量表的基础上，设计并发放痛经患者自我管理行为影响因素问卷。运用SPSS、Amos进行描述性统计分析、方差分析、相关分析、回归分析及结构方程模型构建。结果：（1）自我管理量表信效度良好，Cronbach's α为0.91，量表具有5个因子，累计方差解释率达63.90%。（2）疾病感知、服药信念、自我效能、自我管理得分分别为44.98±7.98分、-1.64±5.54分、31.40±4.89分、86.80±12.40分，自我管理量表子维度得分排序依次为利用日常资源、获取知识、交流宣泄、心理暗示、利用医疗资源。（3）疾病感知对患者利用医疗资源和利用日常资源具有不同影响路径，自我效能和服药信念可正向作用于患者的自我管理行为；理解力、控制感通过负向作用于自我效能间接影响利用日常资源和利用医疗资源，同时控制感可直接正向作用于利用日常资源；认知可直接或间接通过服药信念正向作用于利用医疗资源；情绪可正向作用于利用日常资源，负向通过服药信念间接作用于利用医疗资源。结论：痛经女性利用医疗资源水平较低，针对性的措施应当为提升患者对疾病控制的信念、对疾病的了解程度及重视程度，降低患者因疾病受到的情绪影响，从而提升患者的服药信念和自我效能，进而增进其利用医疗资源的水平，提高患者生活质量。建议：在教育层面，改善患者疾病感知偏差；在实践层面，提供多层次健康管理服务以改善患者对疾病的认知；提升以患者为中心的基层医疗机构健康管理方式。
Background: Primary care for chronic disease management has achieved good results in many diseases, but some diseases including dysmenorrhea have also been neglected. Dysmenorrhea is a high prevalent disease and has a great negative impact on women‘s body and mind. However, patients‘ use of medical resources is low, resulting in a significant decline in their quality of life during menstruation. Objective: （1） Describe the self-management behavior of patients with dysmenorrhea in China; （2） Analyze the path of disease perception, medication belief, and self-efficacy on the self-management behavior of patients with dysmenorrhea; （3） Compare the similarities and differences of the influence paths of various variables on the utilization of medical resources and daily resources. Methods: Through reading the literature, construct a model of potential influencing factors that affect patient self-management. Based on the revision of the self-management scale, a questionnaire on the influencing factors of self-management behavior of patients with dysmenorrhea was designed and distributed. Use SPSS and Amos for descriptive statistical analysis, variance analysis, correlation analysis, regression analysis and structural equation model construction. Results: （1） The self-management scale revised in this study has good reliability and validity. Its Cronbach‘sα coefficient is 0.91. The scale is divided into 5 factors, and the cumulative variance explanation rate is 63.90%. （2） The score of illness perception, beliefs about medications, self-efficacy, self-management were 44.98±7.98, -1.64±5.54, 31.40±4.89, 86.80±12.40. The scores of the self-management sub-dimensions are in order of daily resources, knowledge acquisition, communication and catharsis, psychological suggestion, and medical measures. （3） Illness perception has different influence paths on patients‘ use of medical resources and daily resources. Self-efficacy and medication beliefs can positively affect patients‘ self-management behavior. Understanding and control indirectly affect the use of daily resources and the use of medical resources through a negative effect on self-efficacy. Control directly affects the use of daily resources positively. Cognition can directly or indirectly act on the use of medical resources through the belief about medication. Emotions can positively act on the use of daily resources, and negatively act on the use of medical resources through beliefs about medications. Conclusion: Women with dysmenorrhea have a low level of utilization of medical resources. Targeted measures should be to enhance patients’ belief in treatment control, understanding and attention to disease, and to reduce the emotional impact, so as to enhance patients’ belief about medications and self-efficacy, thereby enhancing their level of utilization of medical resources, then improving the quality of life. Suggestions: At the level of education, to improve patients’ disease perception bias. At the practical level, multi-level heath management services are provided to improve patients’ cognition of disease. Improve the health management of patient-centered primary medical institutions.
