国际护理科学（英文）2026，Vol.13Issue(2)：130-139,10.DOI:10.1016/j.ijnss.2026.02.010
基于自然决策理论的多病共存老年患者自我管理行为影响因素的组态路径分析
Pathways to self-management among older adults with multimorbidity in rural China:A fuzzy-set qualitative comparative analysis
摘要
Abstract
Objectives:This study aimed to investigate how individual,problem-related,and environmental factors interact to influence self-management behaviours among rural older adults with multimorbidity in China,to inform more context-sensitive interventions. Methods:A cross-sectional study was conducted in 9 healthcare facilities across Zhejiang Province,China,from July 2022 to May 2023,involving 487 rural older adults with multimorbidity via conve-nience sampling,who had been diagnosed with 2 or more chronic conditions.Data were collected through questionnaires and electronic health records to assess self-efficacy,psychological resilience,physical symptoms,the Charlson Comorbidity Index,social support,and resource accessibility.Fuzzy-set qualitative comparative analysis was employed to explore the complex,non-linear interactions between contextual factors,ultimately determining the sufficient conditions for self-management behaviours. Results:Correlation analyses revealed positive associations between self-management behaviours and self-efficacy,psychological resilience,social support,and resource accessibility(r=0.690-0.850,all P＜0.001),with self-efficacy(r=0.784)and social support(r=0.850)demonstrating the strongest correlations.Regression analysis revealed that self-efficacy(β=0.385)and social support(β=0.372)were the strongest factors of self-management behaviours.Fuzzy-set qualitative comparative analysis identified six factor configurations,categorized into four contextual types:"triple-enabling context,""symptom-resource driven context,""resource deficiency context,"and"symptom-disease over-whelmed context."Self-efficacy was consistently identified as a core condition across all configurations.Conclusions:Self-management among rural older adults with multimorbidity is shaped by complex,context-dependent interactions.Effective interventions should prioritize enhancing self-efficacy,expanding access to resources,and tailoring strategies to distinct contextual profiles.The study also demonstrates the utility of fuzzy-set qualitative comparative analysis for advancing context-sensitive healthcare solutions.关键词
模糊集定性比较分析/健康行为/多病共存/自然决策理论/护理/老年人/自我管理Key words
Fuzzy-set qualitative comparative analysis/Health behaviour/Multimorbidity/Naturalistic Decision-Making theory/Nursing/Older adults/Self-management引用本文复制引用
于嘉柠,邵静,陈丹丹,傅雨佳,杜昊阳,王丽娜,赵彬雨,陈莉瑾,郑子浩,刘晓婷..基于自然决策理论的多病共存老年患者自我管理行为影响因素的组态路径分析[J].国际护理科学（英文）,2026,13(2):130-139,10.基金项目
This work was supported by the Zhejiang Provincial Natural Science Foundation(Grant No.LY23G030008). （Grant No.LY23G030008）
