基于COM-B模型的天津市基层全科医生血脂管理行为影响因素研究
Influencing Factors of Lipid Management Behaviors among Primary Care General Practitioners in Tianjin Based on the Capability-Opportunity-Motivation-Behavior Model
徐琬 1王艳 2李玲璐 3刘欣 4贾洁 2敖原 2边波2
作者信息
- 1. 天津市，天津医科大学总医院心血管内科
- 2. 天津市，天津医科大学总医院全科医学科
- 3. 天津市，富民路街社区服务中心
- 4. 天津市，南营门社区服务中心
- 折叠
摘要
背景 我国血脂异常防控形势严峻，基层医疗机构是慢病防治的主战场。国家政策明确强化基层血脂管控，但现有研究缺乏系统性模型支撑，干预策略针对性不足，需深入研究。目的 基于能力、机会、动机-行为（COM-B）模型分析天津市基层全科医生血脂管理行为现状及影响因素，为制定优化策略提供实证依据。方法 采用整群抽样法，于2025年3—6月选取天津市16个行政区32家基层医疗机构的387名在岗临床医生，使用基于COM-B模型构建的四维评估问卷进行调查，收集人口学特征、血脂管理能力、机会资源、管理动机及血脂管理实践行为等主要指标；运用SPSS26.0软件进行统计分析，组间比较采用独立样本t检验或单因素方差分析；采用Pearson相关分析探讨各维度因素与血脂管理行为的关联，采用多重线性回归分析筛选血脂管理行为的主要影响因素并进行多重共线性检验。结果 基层全科医生血脂管理能力、机会、动机、行为维度得分分别为（8.04±1.96）（26.35±6.45）、（31.50±6.40）（15.96±3.68）分，得分率均在60%~66%之间；不同性别、从医年限、职称、每周接诊血脂异常患者数量的医生血脂管理行为得分比较，差异均有统计学意义（P<0.05）。Pearson相关性分析结果显示，血脂管理行为与能力、机会各维度因素呈正相关（r分别为0.140~0.416、0.165~0.379，P<0.01）；与动机维度的治疗安全顾虑呈负相关（r=-0.458，P<0.01），与自我效能呈正相关（r=0.190，P<0.01）。多重线性回归显示，从医年限（β=0.141）、每周接诊血脂异常患者数量（β=0.148），能力维度的知识水平（β=0.256）、复杂病例处理能力（β=0.129）、动机维度的自我效能（β=0.294）与血脂管理行为呈正相关（P<0.05）；动机维度的治疗安全顾虑与血脂管理行为呈负相关（β=-0.417，P0.05）。结论 天津市基层全科医生血脂管理行为处于中等水平，专业能力、自我效能等对其有正向影响，治疗安全顾虑是首要负向因素，需通过精准培训、资源保障与动机激励提升管理规范化水平，助力心血管疾病防控。
Abstract
Background The prevention and control of dyslipidemia in China face severe challenges, with primary healthcare institutions serving as the main front for chronic disease management. Although national policies have clearly emphasized strengthening lipid management at the primary level, current research lacks systematic model support and targeted intervention strategies, warranting further in-depth investigation. Objective To analyze the current status and influencing factors of lipid management behaviors among general practitioners in primary healthcare institutions in Tianjin based on the Capability, Opportunity, Motivation-Behavior (COM-B) model, and to provide empirical evidence for developing optimized intervention strategies. Methods A cluster sampling method was adopted. From March to June 2025, 387 practicing clinicians were selected from 32 primary healthcare institutions across 16 administrative districts in Tianjin. A four-dimensional assessment questionnaire based on the COM-B model was used to collect key indicators, including demographic characteristics, lipid management capability, opportunity, motivation, and management behaviors. Statistical analysis was conducted using SPSS 26.0. Independent-samples t-tests or one-way ANOVA were used for group comparisons. Pearson correlation analysis was performed to explore associations between each dimension and lipid management behaviors. Multiple linear regression analysis was used to identify main influencing factors, and multicollinearity diagnostics were conducted. Results The scores for the capability, opportunity, motivation, and behavior dimensions among general practitioners were (8.041.96), (26.356.45), (31.506.40), and (15.963.68), respectively, with percentage scores ranging from 60% to 66%. Significant differences in lipid management behavior scores were observed among doctors of different genders, years of practice, professional titles, and weekly numbers of dyslipidemia patients seen (P<0.05). Pearson correlation analysis showed that lipid management behavior was positively correlated with all factors in the capability and opportunity dimensions (r=0.140~0.416 and 0.165~0.379, P<0.01), negatively correlated with treatment safety concerns in the motivation dimension (r=-0.458, P<0.01), and positively correlated with self-efficacy (r=0.190, P<0.01). Multiple linear regression analysis indicated that years of practice (=0.141), number of dyslipidemia patients seen weekly (=0.148), knowledge level (=0.256), complex case management ability (=0.129) within the capability dimension, and self-efficacy (=0.294) within the motivation dimension were positively associated with lipid management behaviors (P<0.05), while treatment safety concerns (=-0.417, P0.05). Conclusion Lipid management behaviors among general practitioners in primary healthcare institutions in Tianjin are at a moderate level. Professional capability and self-efficacy have a positive influence on these behaviors, while concerns about treatment safety are the main negative factor. Standardization of management should be enhanced through targeted training, resource support, and motivational incentives, thereby supporting the prevention and control of cardiovascular diseases.关键词
全科医生/基层医疗/血脂管理/COM-B模型/诊疗行为/自我效能/治疗安全顾虑Key words
General practitioners/Primary care/Lipid management/COM-B model/Clinical behavior/Self-efficacy/Treatment safety concerns引用本文复制引用
徐琬,王艳,李玲璐,刘欣,贾洁,敖原,边波.基于COM-B模型的天津市基层全科医生血脂管理行为影响因素研究[EB/OL].(2026-06-29)[2026-07-03].https://chinaxiv.org/abs/202607.00002.学科分类
医学研究方法/医学现状、医学发展
