发达地区残疾儿童照护者应对行为现状及影响因素分析

doi:10.3969/j.issn.1006-9771.2021.10.007

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (10): 1167-1175.doi: 10.3969/j.issn.1006-9771.2021.10.007

• 专题残疾儿童康复与照护研究 • 上一篇下一篇

发达地区残疾儿童照护者应对行为现状及影响因素分析

刘慧琳^1,²,陈刚^1,^2,³(),吕军^1,^2,³,孙梅^1,^2,³,夏聪^1,²,郑红颖^1,²,励晓红^1,²,张诗雅^1,²

1.复旦大学公共卫生学院,上海市 200032
2.复旦大学中国残疾问题研究中心,上海市 200032
3.国家卫生健康委员会卫生技术评估重点实验室（复旦大学）,上海市 200032

收稿日期:2021-08-20 修回日期:2021-09-13 出版日期:2021-10-25 发布日期:2021-10-29
通讯作者: 陈刚 E-mail:gchen@shmu.edu.cn
作者简介:刘慧琳(1997-),女,汉族,上海市人,硕士研究生,主要研究方向：健康服务政策与治理。
基金资助:
国家社会科学基金重大项目(17ZDA078);国家自然科学基金面上项目(71774030);上海市哲学社会科学规划一般课题(2018BGL005)

Coping Behaviors and Its Influential Factors for Caregivers of Children with Disabilities in Developed Areas in China

LIU Hui-lin^1,²,CHEN Gang^1,^2,³(),LÜ Jun^1,^2,³,SUN Mei^1,^2,³,XIA Cong^1,²,ZHENG Hong-ying^1,²,LI Xiao-hong^1,²,ZHANG Shi-ya^1,²

1. School of Public Health, Fudan University, Shanghai 200032, China
2. China Research Center on Disability, Fudan University, Shanghai 200032, China
3. National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China

Received:2021-08-20 Revised:2021-09-13 Published:2021-10-25 Online:2021-10-29
Contact: CHEN Gang E-mail:gchen@shmu.edu.cn
Supported by:
National Social Science Foundation of China (Major)(17ZDA078);National Natural Science Foundation of China (General)(71774030);Shanghai Philosophy and Social Science Project(2018BGL005)

摘要/Abstract

摘要：

目的了解照护者在残疾儿童康复情境下的应对行为并分析相关的影响因素。方法 2019年12月至2020年1月以及2020年8月至9月,方便抽样选取残疾儿童照护者中的358例父母。采用父母应对方式量表(CHIP)在残疾儿童康复情境下对照护者应对行为进行评估,并通过多元线性逐步回归模型分析影响应对行为的因素。结果残疾儿童照护者应对行为总作用得分为(106.00±23.45),平均作用得分为(2.36±0.52)。照护者因素中母亲(B = 7.607, 95%CI 2.477~12.737, P = 0.004)、不需要照顾他人(B = 5.758, 95%CI 1.174~10.343, P = 0.014)的照护者应对行为得分更高。儿童因素中,伙伴数量越多(B = 2.925, 95%CI 1.233~4.618, P < 0.001)、参与公共空间活动越频繁(B = 3.906, 95%CI 1.743~6.068, P < 0.001)、康复效果有变化(B = -16.832, 95%CI -31.471~-2.193, P = 0.024)的照护者应对行为得分更高;儿童年龄3~< 6岁(B = -7.914, 95%CI -15.157~-0.671, P = 0.032)、残疾类型为智力残疾(B = -11.153, 95%CI -21.360~-0.947, P = 0.032)的照护者应对行为得分更低。环境因素中感知社会态度越友好(B = 2.560, 95%CI 0.615~4.505, P = 0.010)的照护者应对行为得分更高。结论残疾儿童照护者需要掌握在儿童康复情境下的应对行为方法。在处理残疾儿童康复相关问题时,照护者应对行为受到儿童个体、照护者及环境多维因素的共同影响。

关键词: 应对行为, 残疾儿童, 照护者, 影响因素

Abstract:

Objective To investigate the current status of coping behaviors among caregivers of children with disabilities in the context of rehabilitation and its influencing factors.Methods From December, 2019 to January, 2020, and August to September, 2020, a total of 358 caregivers (parents) of children with disabilities were surveyed in Shanghai. They were evaluated in the context of rehabilitation of children with disabilities with Coping Health Inventory for Parents (CHIP). Multiple linear stepwise regression analysis was used to explore the influencing factors.Results The total score of CHIP was (106.00±23.45) and the average score of CHIP was (2.36±0.52). Among the caregiver factor, mothers (B = 7.607, 95%CI 2.477 to 12.737, P = 0.004), and caregivers who didn't need to care for others (B = 5.758, 95%CI 1.174 to 10.343, P = 0.014) reported higher CHIP score. Among the child factors, higher CHIP score was reported in caregivers who had more partners (B = 2.925, 95%CI 1.233 to 4.618, P < 0.001), participated in public space activities more frequently (B = 3.906, 95%CI 1.743 to 6.068, P < 0.001) and perceived changes in rehabilitation outcomes (B = -16.832, 95%CI -31.471 to -2.193, P = 0.024); CHIP score was lower in thoses of 3 to < 6 years old (B = -7.914, 95%CI -15.157 to -0.671, P = 0.032) and with intellectual disability children (B = -11.153, 95%CI -21.360 to -0.947, P = 0.032). Among the environmental factors, caregivers who perceived more friendly social attitude (B = 2.560, 95%CI 0.615 to 4.505, P = 0.010) reported higher CHIP score.Conclusion It is proposed to learn the coping needs of caregivers of children with disabilities in the context of rehabilitation. The coping behaviors of caregivers are influenced by multiple factors, such as children's individual, caregivers and environment.

Key words: coping behaviors, children with disabilities, caregivers, influencing factors

中图分类号:

刘慧琳,陈刚,吕军,孙梅,夏聪,郑红颖,励晓红,张诗雅. 发达地区残疾儿童照护者应对行为现状及影响因素分析[J]. 《中国康复理论与实践》, 2021, 27(10): 1167-1175.

LIU Hui-lin,CHEN Gang,LÜ Jun,SUN Mei,XIA Cong,ZHENG Hong-ying,LI Xiao-hong,ZHANG Shi-ya. Coping Behaviors and Its Influential Factors for Caregivers of Children with Disabilities in Developed Areas in China[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(10): 1167-1175.

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维度	使用频率(%)	总作用得分	平均作用得分
维度一：保持家庭团结、合作和乐观态度	96.71±6.96	47.70±10.21	2.51±0.54
维度二：寻求社会支持,维护自尊和心理稳定	88.64±17.42	39.73±10.37	2.21±0.58
维度三：向医务人员咨询、与其他父母交流	94.83±11.66	18.57±5.56	2.32±0.70
总量表	93.15±10.38	106.00±23.45	2.36±0.52

序号	条目	作用得分	排序	使用频率(%)	排序	维度
1	我会努力保持家庭的稳定	2.76±0.61	1	99.44	2	维度一
2	我会和家庭成员作为一个整体一起努力	2.75±0.61	2	99.72	1	维度一
3	我会相信我的爱人(或前夫/妻)会支持我和孩子	2.70±0.72	3	99.44	2	维度一
4	我会定期带孩子到康复机构接受训练	2.70±0.69	4	98.04	14	维度一
5	我会投入更多精力照顾我的孩子	2.69±0.65	5	98.88	5	维度一
?	?	?	?	?	?	?
16	我会相信我的孩子通过康复训练情况会好转	2.50±0.84	16	99.16	4	维度一
?	?	?	?	?	?	?
37	我会在工作中投入时间和精力	2.15±1.06	37	75.70	44	维度二
?	?	?	?	?	?	?
41	我会允许自己生气	1.90±1.01	41	94.69	27	维度二
42	我会专心于自己的爱好	1.87±1.10	42	79.05	43	维度二
43	我会把我的家庭情况告诉朋友和邻居,得到他们的理解和帮助	1.86±1.12	43	83.52	41	维度三
44	我会相信老天爷(佛/上帝/神灵)会保佑我	1.40±1.20	44	81.01	42	维度一
45	我会在本职工作以外还做第二份工作	1.36±1.24	45	54.19	45	维度二

变量		n	总作用得分	t/F值	P值
家庭角色	父亲	97	101.13±27.75	-2.142^a	0.034
	母亲	261	107.80±21.42
年龄(岁)	< 30	22	112.56±13.54	1.649^b	0.195
	30~< 40	223	105.48±22.91
	40~< 50	102	106.14±25.84
	≥ 50	11	102.07±27.04
婚姻	已婚	340	106.43±23.12	1.259^a	0.224
	其他	18	97.81±28.56
文化程度	初中及以下	19	111.74±22.17	0.647^b	0.585
	高中或中专	63	103.66±22.10
	大专	81	107.06±25.37
	本科及以上	195	105.75±23.23
就业状态	全职	199	105.28±24.81	-0.646^a	0.519
	其他	159	106.89±21.67
患病情况	有疾病	73	99.40±23.64	-2.717^a	0.007
	无疾病	285	107.69±23.14
是否焦虑	有焦虑	127	100.82±24.55	-3.135^a	0.002
	无焦虑	231	108.84±22.38
是否需要照顾他人	需要	144	101.60±26.61	-2.799^a	0.006
	不需要	214	108.96±20.61

变量		n	总作用得分	t/F值	P值
性别	男	227	107.42±20.79	1.405^a	0.161
	女	131	103.54±27.38
年龄(岁)	< 3	52	114.16±14.53	4.555^b	0.003
	3~< 6	148	107.37±22.83
	6~< 12	119	103.98±23.53
	12~< 15	21	96.35±31.52
	15~18	18	95.66±30.35
残疾类型	视力残疾	24	104.86±30.63	3.836^b	0.001
	听力残疾	57	114.85±16.77
	言语残疾	24	105.78±17.61
	肢体残疾	83	107.86±21.99
	智力残疾	35	95.71±27.72
	精神残疾	51	103.40±20.70
	多重残疾	45	97.46±27.37
	未定残	39	112.41±21.77
明确诊断	有	308	105.44±23.53	-1.123^a	0.262
	无	50	109.45±22.93
睡眠质量	有睡眠问题	67	98.61±30.78	-2.295^a	0.024
	无睡眠问题	291	107.70±21.12
情绪稳定性	稳定	304	107.18±22.96	-2.280^a	0.023
	不稳定	54	99.33±25.23
伙伴数量	0个	135	99.56±26.41	6.993^b	< 0.001
	1个	42	105.17±22.81
	2个	65	107.31±17.52
	3个	32	117.19±15.06
	≥ 4个	84	111.48±22.65
康复效果	有变化	349	106.54±22.88	2.758^a	0.006
	无变化	9	84.90±35.41
公共空间活动参与	从不	17	85.44±34.72	3.898^b	0.006
	偶尔	142	103.32±24.01
	经常	112	108.20±22.99
	频繁	44	111.64±17.68
	每天	43	111.44±17.06

变量		n	总作用得分	t/F值	P值
家庭人均月收入	< 1000元	7	99.64±29.03	2.597^b	0.036
	1000~< 3000元	47	97.65±25.12
	3000~< 5000元	77	105.73±26.42
	5000~< 10000元	105	105.60±22.99
	≥ 10000元	122	110.08±20.05
总体无障碍建设	无障碍	337	106.43±23.71	-1.405^a	0.161
	有障碍	21	99.03±17.76
公共政策	不满意	32	108.02±16.09	8.702^b	< 0.001
	较少满意	59	100.33±24.26
	一般满意	182	105.19±22.48
	较多满意	69	108.34±28.28
	非常满意	16	121.97±10.77
社会态度	不友好	33	96.44±22.87	9.675^b	< 0.001
	较不友好	125	105.40±20.50
	一般友好	48	99.83±32.46
	较友好	105	106.57±22.74
	友好	47	119.33±15.40

发达地区残疾儿童照护者应对行为现状及影响因素分析

Coping Behaviors and Its Influential Factors for Caregivers of Children with Disabilities in Developed Areas in China

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维度	变量(参照变量)	B	S.E.	95%CI	β	t值	P值
照护者	家庭角色(父亲)	7.607	2.608	2.477~12.737	0.144	2.917	0.004
	是否需要照顾他人(需要)	5.758	2.331	1.174~10.343	0.121	2.471	0.014
儿童	年龄(< 3岁)
	3~< 6岁	-7.914	3.682	-15.157~-0.671	-0.166	-2.149	0.032
	6~< 12岁	-7.916	4.022	-15.828~-0.004	-0.159	-1.968	0.050
	12~< 15岁	-10.695	5.983	-22.464~1.075	-0.107	-1.787	0.075
	15~18岁	-11.646	6.376	-24.188~0.896	-0.109	-1.827	0.069
	残疾类型(未定残)
	视力残疾	-7.741	5.831	-19.211~3.730	-0.083	-1.327	0.185
	听力残疾	-3.417	4.696	-12.655~5.821	-0.053	-0.728	0.467
	言语残疾	-7.993	5.574	-18.958~2.971	-0.085	-1.434	0.153
	肢体残疾	-0.959	4.333	-9.482~7.564	-0.017	-0.221	0.825
	智力残疾	-11.153	5.189	-21.360~-0.947	-0.141	-2.150	0.032
	精神残疾	-3.258	4.649	-12.404~5.888	-0.049	-0.701	0.484
	多重残疾	-9.067	4.965	-18.833~0.699	-0.128	-1.826	0.069
	伙伴数量	2.925	0.861	1.233~4.618	0.200	3.399	< 0.001
	公共空间活动参与	3.906	1.099	1.743~6.068	0.181	3.552	< 0.001
	康复效果(有变化)	-16.832	7.442	-31.471~-2.193	-0.113	-2.262	0.024
环境	家庭人均月收入(< 1000元)
	1000~< 3000元	0.079	8.840	-17.309~17.467	0.001	0.009	0.993
	3000~< 5000元	4.799	8.672	-12.259~21.857	0.084	0.553	0.580
	5000~< 10000元	5.438	8.556	-11.393~22.268	0.106	0.636	0.526
	≥ 10000元	9.016	8.572	-7.845~25.877	0.182	1.052	0.294
	社会态度	2.560	0.989	0.615~4.505	0.135	2.589	0.010
常量		80.008	15.353	49.809~110.208		5.211	< 0.001

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