基于健康行动过程取向模型分析2型糖尿病患者膳食模式及血糖控制的影响因素

doi:10.19723/j.issn.1671-167X.2025.06.019

摘要/Abstract

摘要：

目的: 基于健康行动过程取向(health action process approach, HAPA)模型探究2型糖尿病患者膳食模式和血糖控制的影响因素。方法: 选取山东省东营市东城医院下属的11个社区卫生中心内的2型糖尿病患者作为研究对象，通过静脉抽血检测患者的糖化血红蛋白(glycosylated hemoglobin, HbA1c)水平，采用一般资料调查表、膳食频率调查问卷、2型糖尿病自我管理量表、HAPA量表收集信息。通过因子分析将患者的膳食模式划分为不同类型，通过结构方程模型分析HAPA模型各维度对于患者膳食模式和血糖控制的影响。结果: 共纳入819例2型糖尿病患者，总体HbA1c水平为7.1%±1.1%。研究对象的总体饮食管理得分为5.0 (1.0, 7.0)，具体日常饮食被划分为中低血糖生成指数(glycemic index，GI)膳食模式、肉类膳食模式、水果膳食模式、高GI/淀粉类膳食模式、蛋奶类膳食模式。结构方程模型结果显示，积极结果预期(β=0.417，P＜0.001)、消极结果预期(β=-0.239，P＜0.001)和感知风险严重性(β=0.075，P=0.036)影响饮食管理行为意向；饮食管理行为意向影响行动计划(β=0.531，P＜0.001)和应对计划(β=0.228，P＜0.001)；行动计划影响总体饮食管理行为(β=0.183，P＜0.001)；总体饮食管理行为影响中低GI膳食模式(β=0.133，P＜0.001)、水果膳食模式(β=-0.103，P=0.003)、高GI/淀粉类膳食模式(β=-0.110，P=0.002)和蛋奶类膳食模式(β=0.076，P=0.031)；中低GI膳食模式(β=-0.086，P=0.013)、肉类膳食模式(β=0.084，P=0.015)影响HbA1c水平。此外，行动自我效能可以影响行为意向(β=0.384，P＜0.001)、行动计划(β=0.122，P=0.006)和应对计划(β=0.146，P=0.001)。维持自我效能可以影响行动计划(β=0.170，P＜0.001)、应对计划(β=0.408，P＜0.001)和总体饮食管理行为(β=0.265，P＜0.001)。结论: 纳入的2型糖尿病患者的膳食模式存在差异，且每周饮食管理的水平欠佳，〖JP+2〗HAPA模型对于2型糖尿病患者的膳食模式和血糖控制水平具有较好的解释作用，因此，今后可基于HAPA模型制定针对性的饮食干预，提高患者的总体饮食管理水平，促进患者养成低GI的健康膳食模式，从而改善血糖水平，提高生活质量。

关键词: 2型糖尿病, 健康行动过程取向模型, 膳食模式

Abstract:

Objective: To explore the factors influencing dietary patterns and blood glucose control in patients with type 2 diabetes based on the health action process approach (HAPA) model. Methods: Patients with type 2 diabetes were selected in 11 community health centers affiliated to Dongcheng Hospital of Dongying City, Shandong Province. The glycosylated hemoglobin (HbA1c) level was detected by venous blood collection, and general data questionnaire, food frequency questionnaire, the Summary of Diabetes Self-Care Activities measure and HAPA scale were used to collect information. The dietary patterns of the patients were divided into different types by factor analysis. The effects of various dimensions of HAPA model on dietary patterns and blood glucose control of the type 2 diabetes patients were analyzed by structural equation model. Results: A total of 819 patients with type 2 diabetes were enrolled in the study, and the overall HbA1c level was 7.1%±1.1%. The overall diet management scores of the study subjects were 5.0 (1.0, 7.0), and the specific daily diets were divided into medium/low glycemic index (GI) dietary pattern, meat dietary pattern, fruit dietary pattern, high GI and starch dietary patterns, and egg and milk dietary pattern. Structural equation model results showed that positive outcome expectancies (β=0.417, P < 0.001), negative outcome expectancies (β=-0.239, P < 0.001) and perceived risk severity (β=0.075, P=0.036) affected dietary management behavior intention. Beha-vioral intention of diet management affected action planning (β=0.531, P < 0.001) and coping planning (β=0.228, P < 0.001). Action planning influenced overall diet management behavior (β=0.183, P < 0.001). The overall diet management behavior affected medium/low GI dietary pattern (β=0.133, P < 0.001), fruit dietary pattern (β=-0.103, P=0.003), high GI and starch dietary pattern (β=-0.110, P=0.002) and egg and milk dietary pattern (β=0.076, P=0.031). Medium/low GI dietary pattern (β=-0.086, P=0.013) and meat dietary pattern (β=0.084, P=0.015) affected the level of HbA1c. In addition, action self-efficacy can affect behavior intention (β=0.384, P < 0.001), action planning (β=0.122, P=0.006) and coping planning (β=0.146, P=0.001). Maintenance self-efficacy affected action planning (β=0.170, P < 0.001), coping planning (β=0.408, P < 0.001), and overall diet management behavior (β=0.265, P < 0.001). Conclusion: There were differences in dietary patterns among the participants with type 2 diabetes, and the weekly diet management behavior was not good enough of the patients with type 2 diabetes, because HAPA model could explain the dietary patterns and blood glucose control level of type 2 diabetes patients. In the future, targeted dietary interventions can be developed based on the HAPA model to improve the overall diet management level of patients and promote patients to develop a healthy diet pattern with low GI, thus controlling blood sugar level and improving quality of life.

Key words: Type 2 diabetes, Health action process approach model, Dietary pattern

中图分类号:

R193.3

闵鹤葳, 吴一波, 史宇晖, 李明子, 孙昕霙. 基于健康行动过程取向模型分析2型糖尿病患者膳食模式及血糖控制的影响因素[J]. 北京大学学报（医学版）, 2025, 57(6): 1145-1152.

Hewei MIN, Yibo WU, Yuhui SHI, Mingzi LI, Xinying SUN. Analyzing the influential factors of dietary patterns and blood glucose control in type 2 diabetes patients based on the model of health action process approach model[J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1145-1152.

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Dimension	Number	Definition	Sample question	Cronbach’s α
Perceived risk susceptibility	3	Awareness of the probability of the occurrence of T2DM-related risk	My blood sugar levels are likely to rise	0.918
Perceived risk severity	2	Awareness of the severity of T2DM-related risk	The aggravation of diabetes will affect my normal life and work	0.883
Positive outcome expectancies	3	Expectation of potential positive outcomes of diet management	Adopting a diabetic diet can make me feel better	0.801
Negative outcome expectancies	3	Expectation of potential negative outcomes of diet management	I waste more energy following a diabetic diet	0.706
Intention	3	Willingness to engage in diet management	I will learn about diabetes diet	0.769
Action planning	4	Planning for when, where, and how to engage in diet management	I know when to eat healthy	0.892
Coping planning	3	Planning for management to address obstacles that may disrupt diet management	I already know what to do if something happens that interferes with my eating plan	0.942
Action self-efficacy	3	Confidence in carrying out diet management	While it took some time to adjust to the new way of eating, I remained confident in sticking to my diet plan	0.620
Maintenance self-efficacy	5	Confidence in addressing obstacles that may disrupt diet management	Even when I’m out, I’m confident I’ll stick to my eating plan	0.923
Recovery self-efficacy	3	Confidence in overcoming setbacks and resuming diet management after failure	I have confidence in sticking to my eating plan when I encounter difficulties (like not having time to buy or cook the right foods)	0.850

Items	Population (n = 819)
Age/years, ${\bar x}$±s	64.7±8.2
Gender, n (%)
Male	444 (54.2)
Female	375 (45.8)
Nation, n (%)
Han	813 (99.3)
Minority	6 (0.7)
Residence, n (%)
Urban	615 (75.1)
Rural	204 (24.9)
Education level, n (%)
Junior high school or lower	382 (46.6)
Senior high school or technical secondary school	265 (32.4)
Junior college or higher	172 (21.0)
Marital status, n (%)
Unmarried	5 (0.6)
Married	745 (91.0)
Divorced or bereft of one’s spouse	69 (8.4)
Average household monthly income/yuan, n (%)
≤1 000	85 (10.4)
>1 000-≤3 000	185 (22.6)
>3 000-≤5 000	282 (34.4)
＞5 000	267 (32.6)
HbA1c/%, ${\bar x}$±s	7.1±1.1

Component	Medium/low GI pattern	Meat pattern	Fruit pattern	High GI and starchy pattern	Egg and milk pattern
Low/medium GI staple food	0.682
High GI staple food		0.276	0.351	0.433	-0.246
Tubers products	0.292			0.719
Starchy vegetables	0.694			0.277
Green vegetables	0.636	0.211		-0.281
Low/medium GI fruits	0.225		0.755
High GI fruits			0.782
Red meat		0.758
White meat		0.719
Processed meat				0.645
Eggs					0.707
Milk products					0.727
Teas		0.491

Dimension	Total score	Actual score, M (P₂₅, P₇₅)
Perceived risk susceptibility	15	9.0 (6.0, 11.0)
Perceived risk severity	10	6.0 (4.0, 8.0)
Positive outcome expectancies	15	12.0 (10.0, 13.0)
Negative outcome expectancies	15	10.0 (8.0, 12.0)
Intention	15	12.0 (10.0, 13.0)
Action planning	20	16.0 (12.0, 16.0)
Coping planning	15	12.0 (9.0, 13.0)
Action self-efficacy	15	10.0 (8.0, 12.0)
Maintenance self-efficacy	25	18.0 (14.0, 20.0)
Recovery self-efficacy	15	9.0 (7.0, 11.0)

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