摘要：

目的 在保護動機理論指導下，構建妊娠期糖尿?。╣estational diabetes mellitus，GDM）孕婦血糖管理決策行為模型。 方法 采用便利抽樣法，于2019年9月—2020年7月選取上海市和江蘇省6所醫(yī)院的1 261例GDM孕婦作為調查對象，采用GDM血糖管理決策行為問卷、保護動機問卷、知識問卷及一般資料調查表進行調查，采用多元線性回歸分析決策行為的影響因素，依據多因素分析結果構建決策行為初始模型，并采用結構方程模型對模型進行修正和優(yōu)化。 結果 該調查共收回有效問卷1 181份。保護動機中的易感性、嚴重性、反應效能、自我效能、反應代價是GDM孕婦血糖管理決策行為的影響因素（P<0.001）。結構方程模型結果顯示，GDM孕婦在血糖管理中對嚴重性（β=0.204）、易感性（β=0.196）的感知及自我效能（β=0.336）對其決策行為產生直接正向影響，同時易感性也通過自我效能對決策行為產生間接正向影響（β=0.136）；反應代價對決策行為產生直接負向影響（β=-0.186），血糖管理知識通過影響反應代價對決策行為產生間接影響（β=0.016）。模型適配度檢驗指標均達到可接受的標準，各路徑系數均達到顯著水平（P<0.05）。 結論 產科護理人員可通過強化GDM孕婦對血糖管理不佳的易感性和嚴重性的感知，提高其血糖管理信心，并提供血糖管理的相關知識，以減少對血糖管理障礙的感知，促進GDM孕婦積極的血糖管理決策行為。

關鍵詞: 妊娠期糖尿病, 血糖管理, 決策行為, 模式構建, 保護動機理論, 產科護理

Abstract:

Objective To construct the decision-making behavior model of blood glucose management among pregnant women with gestational diabetes mellitus（GDM） based on protection motivation theory. Methods A total of 1 261 pregnant women with GDM from 6 hospitals in Shanghai and Jiangsu province were selected by convenient sampling and investigated through the cross-sectional survey. The Self-Developed Blood Glucose Management Decision-Making Behavior Questionnaire，Protection Motivation Questionnaire，Knowledge Questionnaire and General Information Questionnaire were used to collect data. Multi-linear regression analysis was used to identify the influencing factors of decision-making behavior. Structural equation model was used to establish and revise the decision-making behavior model of blood glucose management. Results 1 181 pregnant women with GDM were included in this study. Vulnerability，severity，response efficacy，self-efficacy and response costs were influencing factors of blood glucose management decision-making behavior（P<0.001）. Perceived severity（β=0.204），vulnerability （β=0.196） and self-efficacy（β=0.336） had a direct positive influence on decision-making behavior. Perceived vulnerability had an indirect positive influence on decision-making behavior mediated by self-efficacy（β=0.136）. Response costs（β=-0.186） had a direct negative influence on decision-making behavior. Knowledge had an indirect influence on decision-making behavior mediated by response costs（β=0.016）. All the indicators for fit test were acceptable or optimal，and the path coefficients of model reached significant level（P<0.05）. Conclusion The decision-making behavior of blood glucose management among pregnant women with GDM could be improved through increasing perceived severity，vulnerability and confidence，providing more knowledge and decreasing barriers related to blood glucose management.

Key words: Gestational Diabetes Mellitus, Blood Glucose Management, Decision-Making Behavior, Model Construction, Protection Motivation Theory, Obstetric Nursing

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