Author: Yinan Zhao
Zhao, Yinan, 2024 The Research on the Developmental Trajectory of Self-Management Behavior and Facilitation Mechanisms of Older People with Declined Intrinsic Capacity in the Community, Flinders University, College of Nursing and Health Sciences
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Objective:
(1) To analyze the self-management behavioral characteristics and related influencing factors of older people with declined intrinsic capacity in the community and to lay the foundation for further research on the behavioral mechanisms.
(2) Based on the self-management behavioral characteristics of older people with declined intrinsic capacity in the community, construct a self-management behavioral integration model for this population and verify its applicability and effectiveness.
(3) Based on the integration model, explore the trajectory of self-management behavior and the promotion mechanism of older people with declined intrinsic capacity in the community.
Methods:
(1) Research on self-management behavioral characteristics and influencing factors of older adults with declined intrinsic capacity in the community. A retrospective cohort study was used to analyze two waves of data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. Generalized Linear Regression (GLR) and Multivariate Logistic Regression (MLR) were employed to explore the characteristics and factors affecting self-management behaviors of older adults with declined intrinsic capacity in the community, respectively. In addition, a cross-sectional study was used to investigate the population of older people with declined intrinsic capacity in four communities in Yuelu District and Changsha County, Changsha City, Hunan Province, to supplement these results.
(2) Integration and validation of the self-management behavior model for older people with declined intrinsic capacity in the community. First, based on the theoretical integration method, the researcher integrated the variables and structures of the Health Action Process Approach (HAPA) and Decomposed Theory of Planned Behavior (DTPB) and initially constructed an integrated model of self-management behavior for older people with declined intrinsic capacity in the community (preliminary draft). Second, the literature review method was used to establish a pool of self-management behavior predictors, and the final self-management behavior predictor system was determined through two rounds of Delphi Expert and Interviews. Finally, during the period from November 2022 to June 2023, older people with declined intrinsic capacity registered at two community health centers in Zhuzhou City, Hunan Province, were selected as the study subjects, and validation factor analysis was used to verify the reliability and validity of the self-management behavioral predictor index system; structural equation modeling was used to analyze the goodness of fit of the self-management behavioral integration model.
(3) Research on the trajectory of self-management behavior change and promotion mechanism of older people with declined intrinsic capacity in the community. Based on the above self-management behavior integration model, and a 3-month longitudinal observational study, the research applied a Group-based Trajectory Model and Multivariate Logistic Regression to clarify the developmental trajectory of self-management behavior and factors affecting the developmental trajectory. The Linear Mixed Model was used to explore the effects of the indicators in the integration model on self-management behaviors to clarify the behavioral facilitation mechanism.
Results:
(1) There were significant gender differences in self-management behaviors among community-dwelling older people, with females showing more positive and stable self-management behaviors. The self-management behavior score for males was -0.12 ± 1.76, whereas the self-management behavior score for females was 0.56 ± 1.89, and cognitive and psychological dimensions of intrinsic capacity were significantly associated with self-management behavior. Regarding the self-management behavioral characteristics of older people with reduced intrinsic capacity in the community, it was found that cognitive function (β = -3.787, P = 0.037) was negatively correlated with self-management behavior, and e-health literacy (β = 0.831, P = 0.010), and social support (β = 0.367, P < 0.001) were positively correlated with self-management behavior.
(2) First, by integrating the HAPA and the DTPB, an integrated model of self-management behavior for older people with declined intrinsic capacity in the community was preliminarily constructed, containing attitude towards behavior (perceived usefulness, perceived ease of usefulness, and compatibility), subjective norms (peers influence, superiors influence), perceived behavioral control (self-efficacy, resource facilitating conditions, technological facilitating conditions, and risk perception), outcome expectancy, and behavioral intention, planning and self-management behavior, a total of 16 variables covering cognitive, psychological, and environmental aspects. Second, the self-management behavior prediction index system was constructed through two rounds of Delphi study with experts. The Cronbach's ɑ coefficients for the dimensions of the measurement instrument ranged from 0.658-0.932, with component reliabilities ranging from 0.854-0.957, and mean variance extractions ranging from 0.617-0.898, which proves that the measurement model has good reliability and validity.
(3) The model verification study found that the revised integrated model fit the empirical data well, with an f2 ranging from 0.010 to 0.981. In addition, perceived easiness (β = 0.311, P < 0.001) and compatibility (β = 0.754, P < 0.001) had a positive effect on behavioral attitudes, peer influence (β = 1.091, P < 0.001) had a positive effect on subjective norms, and self-efficacy (β = 0.604, P < 0.001), resource accommodations (β = 0.198, P = 0.012) and technological conveniences (β = 0.353, P < 0.001) had a positive effect on perceived behavioral control. In addition, perceived behavioral control (β = 0.383, P < 0.001), behavioral attitudes (β = 0.378, P < 0.001), and outcome expectations (β = 0.175, P = 0.003) were significantly positively correlated with behavioral intentions, which were significantly positively correlated with plans, which were significantly positively correlated with self-management, which were significantly positively correlated with self-management, which were significantly positively correlated with self-management (β = 0.304, P < 0.001) was significantly positively correlated with self-management behavior.
(4) Three trajectory group patterns of self-management behavior development in older people with declined intrinsic capacity in the community over a 3-month: decline group (33.3%), stable group (24.5%), and increase group (42.4%). Compared to older people with incomes greater than 1,000 yuan, older people with incomes less than 1,000 yuan had a lower risk of decline in self-management behaviors (OR = 0.06, 95% CI: 0.02-0.21, P < 0.001), and compared to the non-declining group of self-management behaviors, declining group (OR = 2.13, 95% CI: 1.18- 3.87, P = 0.013) of older people had higher outcome expectancy scores. Behavioral attitudes (β = 2.738, P < 0.001), behavioral intentions (β = 0.957, P = 0.046), plans (β = 1.315, P = 0.008), outcome expectations (β = 3.353, P < 0.001), behavioral intentions (β = 0.957, P = 0.046) were significant predictors of self-management behaviors in older people.
Conclusion:
(1) The self-management behavioral characteristics of older people with declined intrinsic capacity in the community are influenced by personal characteristics (age, gender, chronic disease condition, cognitive function, and psychological ability) and environmental/extrinsic factors (social support and e-health literacy).
(2) Based on HAPA and DTPB, an integrated model of self-management behavior for older adults with diminished intrinsic capacity was constructed, which covered 16 variables.
(3) Older people with diminished intrinsic capacity in the community presented three trajectories of self-management behaviors over a three-month period, namely, a declining group, an ascending group, and a stable group.
Keywords: Intrinsic capacities; Self-management; Behavioral mechanisms, Trajectory analysis.
Subject: Nursing thesis
Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Nursing and Health Sciences
Supervisor: Lily Xiao