家长医患沟通效能对孤独症谱系障碍儿童康复效果的影响

doi:10.3969/j.issn.1006-9771.2024.05.012

Abstract

Abstract:

Objective To explore the potential influencing factors and complex pathways affecting rehabilitation effect for children with autism spectrum disorder (ASD) from the perspective of parental efficacy in doctor-patient communication, and to provide evidence for improving the quality of rehabilitation service for children with ASD.

Methods An anonymous face-to-face questionnaire survey was conducted to collect general demographic information of parents of children with ASD at designated rehabilitation institutions in Gansu province. The data included parental efficacy in doctor-patient communication, parental compliance of treatment and children's rehabilitation outcomes were collected. A structural equation model was used to explore the impact mechanism of parental communication efficacy on the rehabilitation outcomes of children with ASD.

Results Data from 519 parents at 37 rehabilitation institutions across 13 cities/counties in Gansu province were collected. Significant positive correlations were found between parental efficacy in doctor-patient communication, doctor-patient relationships, parental compliance with treatment and rehabilitation outcomes for children with ASD (P < 0.05). Through structural equation model analysis, the standardized direct effect of children with ASD from parents' doctor-patient communication efficacy was 0.151 (P= 0.023). The mediating effect of doctor-patient relationship and parental compliance with treatment were 0.160 (P= 0.001) and 0.111 (P= 0.001), respectively, with a chained mediating effect of 0.035 (P= 0.001). The pathway "parental efficacy in doctor-patient communication → doctor-patient relationship → ASD child's rehabilitation outcome" accounted for the highest proportion of the total mediating effect, at 52.29%.

Conclusion Parental doctor-patient communication efficacy may positively impact on the rehabilitation outcomes of children with ASD directly, and indirectly through the doctor-patient relationship and parental compliance with treatment. Rehabilitation institutions should focus on fostering parental communication skills and enhancing high-quality and humanized rehabilitation services.

Key words: autism spectrum disorder, children, doctor-patient communication efficacy, rehabilitation outcome, structural equation model

CLC Number:

R749.93

WEI Ning, ZENG Yanling, JIANG Na, ZHANG Qian, YI Xiaozhe, WANG Jianyun, WANG Dengting, ZHANG Yan, PEI Hongbo, HUANG Chaorong. Impact of parental efficacy in doctor-patient communication on rehabilitation outcomes for children with autism spectrum disorder[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 577-585.

Figures/Tables 8

Table1

Table 2

The distribution of the scores of each dimension in different feature (n = 519)"

变量	分组	n(%)	PCE	DPR	PTC	REC
性别	男	122 (23.51)	29.42±0.41	12.66±0.17	15.34±0.29	10.49±0.34
性别	女	397 (76.49)	28.88±0.21	12.33±0.09	15.08±0.15	9.68±0.18^a
年龄/岁	18~45	439 (84.59)	28.93±4.34	12.40±1.91	15.13±3.14	9.95±3.52
	46~69	76 (14.64)	29.36±3.60	12.43±1.72	15.18±3.04	9.50±3.80
	≥ 70	4 (0.77)	30.75±2.99	12.86±1.30	14.75±0.50	8.50±4.66
户籍类型	农村	251 (48.36)	28.68±0.26	12.27±0.11	14.86±0.20	9.33±0.22
户籍类型	城镇	268 (51.64)	29.31±0.26	12.54±0.12	15.39±0.19	10.37±0.22^b
婚姻状况	非在婚	71 (13.68)	28.41±0.53	12.23±0.23	14.44±0.34	9.04±0.42
婚姻状况	已婚	448 (86.32)	29.10±0.20	12.43±0.09	15.25±0.15^c	10.00±0.17^d
家庭角色	父亲	94 (18.11)	29.61±4.68	12.60±1.98	15.53±3.32	10.68±3.63
	母亲	357 (68.79)	28.92±4.14	12.36±1.88	15.08±3.14	9.73±3.48
	祖父母	46 (8.86)	28.83±3.62	12.56±1.56	15.20±2.84	9.23±3.97
	外祖父母	15 (2.89)	29.80±3.90	12.55±1.82	14.73±2.19	9.65±4.16
	其他	7 (1.35)	24.57±5.13^e	11.08±2.16	13.43±1.51	10.65±2.47
学历状况	初中及以下	143 (27.55)	28.61±4.00	12.15±1.86	14.87±3.26	9.32±3.69
	高中/中专	137 (26.40)	28.87±4.17	12.58±1.79	15.09±3.14	10.08±3.59
	大专/本科	216 (41.62)	29.36±4.48	12.45±1.94	15.33±2.99	10.04±3.41
	硕士及以上	23 (4.43)	28.91±3.48	12.62±1.90	15.22±3.28	10.45±4.09
当前或曾经从事的职业	无业或待业	217 (41.81)	28.71±4.18	12.33±1.83	15.00±3.30	9.51±3.87
	制造或加工业、建筑或采矿业、运输业等	47 (9.06)	28.15±4.36	12.15±1.80	14.72±2.74	9.74±2.99
	农/林/渔/牧等农业	236 (5.01)	29.54±3.97	11.84±1.65	14.92±2.71	9.40±3.17
	商业/服务业/自由职业	74 (14.26)	29.76±3.94	12.76±1.87	15.54±2.96	9.83±3.56
	行政干部	47 (9.06)	29.13±4.54	12.24±2.00	15.11±3.45	10.16±3.60
	文化教育行业	45 (8.67)	28.96±4.46	12.60±1.81	15.67±2.86	11.43±3.18
	卫生健康行业	27 (5.20)	30.52±4.12	12.78±1.77	15.26±2.90	10.13±2.93
	军人或警察	36 (6.94)	28.69±4.35	12.63±2.32	15.08±3.06	10.10±3.28
家庭类型	核心家庭	238 (45.86)	29.13±4.37	12.52±1.89	15.34±3.26	10.22±3.53
	主干家庭	222 (42.77)	29.02±4.05	12.38±1.87	15.06±2.96	9.88±3.47
	联合家庭	16 (3.08)	29.00±4.23	12.53±1.83	15.06±3.21	10.49±3.96
	单亲/重组家庭	15 (2.89)	28.00±4.94	11.48±1.96	14.53±2.95	8.67±3.57
	留守儿童家庭	19 (3.66)	29.00±4.24	12.27±1.68	15.11±2.66	7.10±3.34
	其他	9 (1.73)	26.89±3.95	11.74±1.80	12.78±3.23	6.89±3.45^f
家庭人均月收入/元	< 1000	86 (16.57)	29.05±3.75	12.22±1.78	15.07±3.17	8.73±3.51
	1000~1999	76 (14.60)	28.67±4.34	12.45±1.75	14.47±3.53	9.81±4.00
	2000~2999	119 (20.93)	29.23±4.37	12.71±1.80	15.72±3.32	10.35±3.53
	3000~3999	105 (20.23)	28.61±4.17	12.23±1.95	14.82±2.44	9.16±3.35
	4000~4999	62 (11.95)	28.79±4.87	12.33±1.99	15.06±2.89	10.65±2.86
	5000~5999	47 (9.06)	29.89±4.23	12.35±2.16	15.28±2.83	10.53±3.45
	≥ 6000	24 (4.62)	29.33±3.37	12.63±1.79	15.88±3.80	11.55±3.92^g

Table 2

Table 3

Figure 1

Table 4

Table 5

Table 6

Table 7

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潜变量	潜变量命名	测量变量	测量变量命名
家长医患沟通效能	PCE	沟通使我对孩子的病情有了清晰认知	PCE1
		沟通使我得到服务过程中的指导帮助	PCE2
		沟通使我增强了对孩子的康复信心	PCE3
		沟通使我得到了康复人员的关心友善	PCE4
		沟通使孩子的康复效果得到实质改善	PCE5
医患关系	DPR	康复人员服务态度的认可	DPR1
		康复人员服务能力的认可	DPR2
		家长康复服务体验感受	DPR3
家长治疗依从性	PTC	遵循康复训练方案及内容	PTC1
		遵循康复训练方法及技巧	PTC2
		遵循康复训练要求时长	PTC3
家庭社会特征	FSC	主要照顾者身份	FSC1
		家庭人均月收入	FSC2
		家庭类型	FSC3
		家庭户籍类别	FSC4
ASD儿童康复效果	REC	社会和(或)交流能力	REC1
		狭窄、重复和刻板的行为模式、兴趣和活动	REC2
		其他症状	REC3

变量	家长医患沟通效能	医患关系	家长治疗依从性	ASD儿童康复效果
家长医患沟通效能	1.000
医患关系	0.611^a	1.000
家长治疗依从性	0.448^a	0.420^a	1.000
ASD儿童康复效果	0.380^a	0.374^a	0.360^a	1.000

拟合指标	χ²/df	RMSEA	GFI	AGFI	NFI	RFI	IFI	TLI	CFI
检验值	2.587	0.055	0.933	0.913	0.946	0.938	0.966	0.961	0.966
检验结果	理想	理想	理想	理想	理想	理想	理想	理想	理想
参考值	< 3	< 0.08	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9

假设	路径关系	非标准化路径系数	标准化路径系数	标准误	临界比	P值	假设结果
H1	PCE→DPR	0.511	0.639	0.032	15.945	< 0.001	支持
H2	PCE→PTC	0.430	0.406	0.067	6.392	< 0.001	支持
H3	PCE→REC	0.206	0.151	0.090	2.280	0.023	支持
H4	DPR→PTC	0.268	0.202	0.076	3.541	< 0.001	支持
H5	PTC→REC	0.259	0.201	0.078	3.308	< 0.001	支持
H6	DPR→REC	0.313	0.184	0.102	3.065	0.002	支持
H7	FSC→PCE	0.974	0.307	0.017	55.809	< 0.001	支持
H8	FSC→REC	1.061	0.245	0.037	28.853	< 0.001	支持

维度	直接效应	间接效应	总效应
FSC	0.245	0.115	0.360
PCE	0.151	0.225	0.376
DPR	0.184	0.041	0.225
PTC	0.201	-	0.215

Impact of parental efficacy in doctor-patient communication on rehabilitation outcomes for children with autism spectrum disorder

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路径	效应	效应值	95%CI	P值	效应占比/%
PCE→DPR→REC	间接效应	0.160	0.064~0.271	0.001	52.29
PCE→PTC→REC	间接效应	0.111	0.048~0.197	0.001	36.27
PCE→DPR→PTC→REC	间接效应	0.035	0.013~0.074	0.001	11.44
PCE→REC	总间接效应	0.306	0.190~0.447	< 0.001	100.00

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