自我决定理论干预心血管疾病自我保健：系统综述

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling Pub Date : 2025-04-22 DOI:10.1016/j.pec.2025.108794

Yasser Saeedian , Anjali Agarwal , Paul Jansons , Matthew Fuller-Tyszkiewicz , Ralph Maddison

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引用次数: 0

摘要

背景：心血管疾病（CVD）是世界范围内导致死亡和残疾的主要原因。有效的自我保健行为对于心血管疾病的二级预防至关重要，然而，许多人未能长期参与这些自我保健活动。自我决定理论（SDT）为理解参与自我照顾的动机提供了一个强有力的理论框架。基于sdd的干预措施可能会改善心血管疾病患者的自我保健，但尚未得到系统的评价。目的通过一项系统综述来确定基于sdd的干预措施对心血管疾病自我保健的全球措施以及特定自我保健活动的有效性。方法于2024年8月通过MEDLINE、CINAHL、Embase、Global Health、APA PsycINFO、SocINDEX进行文献检索。纳入标准包括随机对照试验和聚类随机试验，这些试验测试了基于sdt的干预对心血管疾病成人自我保健活动的影响。结果共筛选文献251篇，纳入7项研究。结果显示，在所纳入的研究中，SDT原则的应用不一致。有些人根据SDT纳入了所有的心理需求，而另一些人则只关注选定的需求。尽管如此，支持人们的自主权成为所有干预措施的一贯核心组成部分。三项研究报告了全球自我保健的改善，两项研究发现了身体活动的改善，而一项研究发现身体活动没有显著影响，另一项研究发现饮食习惯和吸烟行为没有显著影响。对自我照顾的测量存在相当大的差异，一些研究侧重于全球测量，而另一些研究则针对自我照顾的特定方面，如饮食或运动，这就禁止了荟萃分析。结论：本系统综述的研究结果显示，基于sdt的干预具有增强CVD患者自我保健的潜力。然而，有限的符合条件的研究和方法的异质性排除了明确的结论，以提高自我保健的有效性。实践启示卫生保健专业人员应在采用整体方法进行自我保健的同时，培养能力、关系和自主支持。结合小组干预和一对一干预，结合健康教育和目标设定，可促进维持自我保健依从性。

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Self-determination theory interventions in self-care of cardiovascular disease: A systematic review

Background

Cardiovascular disease (CVD) is a leading cause of death and disability worldwide. Effective self-care behaviours are critical for the secondary prevention of CVD, however many individuals fail to engage in these self-care activities in the long-term. Self-determination theory (SDT) offers a robust theoretical framework for understanding motivations for engaging in self-care. SDT-based interventions may improve self-care in people with CVD but has yet to be systematically reviewed.

Objectives

A systematic review was conducted to determine the effectiveness of SDT-based interventions on global measures of self-care of CVD, as well as specific self-care activities.

Methods

A literature search was conducted in August 2024 using MEDLINE, CINAHL, Embase, Global Health, APA PsycINFO, and SocINDEX. The inclusion criteria involved randomised controlled trials and cluster randomised trials that tested the effect of SDT-based interventions on self-care activities among adults with CVD.

Results

A total of 251 publications were screened and 7 studies included in the review. Results revealed inconsistent application of SDT principles across the included studies. While some incorporated all psychological needs according to SDT, others focused on only selected needs. Nevertheless, supporting people’s autonomy emerged as a consistent core component across all interventions. Three studies reported improvements in global self-care, two found improvements in physical activity, while one found no significant effect on physical activity, and another found no significant effect on dietary habits and smoking behaviours. There was considerable variation in the measurement of self-care with some studies focussed on global measures, while others targeted specific aspects of self-care such as diet or exercise, which prohibited meta-analysis.

Conclusions

Findings from this systematic review showed that SDT-based intervention demonstrated potential for enhancing self-care in individuals with CVD. However, the limited number of eligible studies and methodological heterogeneity preclude definitive conclusions about their effectiveness for improving self-care.

Practice implications

Healthcare professionals should foster competence, relatedness, and autonomy support while adopting a holistic approach to self-care. Combining group and one-to-one interventions and integrating health education and goal-setting can promote maintained self-care adherence.

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来源期刊

Patient Education and Counseling 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.60

自引率

11.40%

发文量

384

审稿时长

46 days

期刊介绍： Patient Education and Counseling is an interdisciplinary, international journal for patient education and health promotion researchers, managers and clinicians. The journal seeks to explore and elucidate the educational, counseling and communication models in health care. Its aim is to provide a forum for fundamental as well as applied research, and to promote the study of organizational issues involved with the delivery of patient education, counseling, health promotion services and training models in improving communication between providers and patients.