自我决定理论视角下冠心病患者参与心脏康复动机的质性研究

doi:10.3761/j.issn.2096-7446.2025.11.006

摘要/Abstract

摘要：

目的探究冠心病患者心脏康复过程中的动机类型，为促进此类患者康复参与及行为改变提供依据。方法运用描述性质性研究方法，对大庆市某2所三级甲等医院的20例冠心病患者进行半结构化访谈，采用定向内容分析法进行资料分析。结果共凝练出3个主题，9个亚主题。①自主动机：康复认知重构、治疗联盟沟通协同、获益感正反馈、心理韧性赋能。②受控动机：权威依从、家庭愧疚驱动。③无动机：自我管理缺失、回避型防御机制、医患信任危机。结论冠心病患者在心脏康复过程中表现出不同程度和类型的康复动机。为提高冠心病患者心脏康复依从性，医护人员应及时评估其康复动机类型并采取针对性干预措施，通过满足患者的基本心理需要促进心脏康复动机内化，从而提高心脏康复依从性。

关键词: 冠状动脉疾病, 心脏康复, 动机, 自我管理, 定性研究

Abstract:

Objective To explore the motivation types in coronary heart disease（CHD） patients during cardiac rehabilitation and to provide strategies for improving rehabilitation adherence and behavior change. Methods Using a descriptive qualitative research method，semi-structured interviews were conducted with 20 CHD patients from two tertiary class A hospitals in Daqing City. Directed content analysis was applied to the data analysis. Results Three themes with nine subthemes emerged. ①Autonomous motivation：rehabilitation cognitive restructuring，therapeutic alliance communication synergy，positive feedback on the sense of benefit，psychological resilience empowerment；②Controlled motivation：authority compliance and family guilt-driven；③Amotivation：lack of self-management，avoidance-based defense mechanisms，and doctor-patient trust crisis. Conclusion CHD patients demonstrate varying degrees and types of rehabilitation motivation during cardiac rehabilitation. Healthcare providers should promptly assess the type of rehabilitation motivation and take targeted intervention measures to promote the internalization of cardiac rehabilitation motivation by meeting the basic psychological needs of patients，thereby improving cardiac rehabilitation compliance.

Key words: Coronary Disease, Cardiac Rehabilitation, Motivation, Self-Management, Qualitative Research

巩雪, 张雪琪, 柴卓, 李茂华, 薛蔚, 张悦, 范志清, 韩永奎. 自我决定理论视角下冠心病患者参与心脏康复动机的质性研究[J]. 中华急危重症护理杂志, 2025, 6(11): 1316-1320.

GONG Xue, ZHANG Xueqi, CHAI Zhuo, LI Maohua, XUE Wei, ZHANG Yue, FAN Zhiqing, HAN Yongkui. A qualitative study of motivation to participate in cardiac rehabilitation in patients with coronary artery disease from the perspective of self-determination theory[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1316-1320.

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参考文献 18

[1]	国家心血管病中心, 中国心血管健康与疾病报告编写组, 胡盛寿. 中国心血管健康与疾病报告2023概要[J]. 中国循环杂志, 2024, 39(7):625-660.
	National Cardiovascular Disease Center, The Writing Committee of the Report on Cardiovascular Health and Diseases in China, Hu SS. Report on cardiovascular health and diseases in China 2023:an updated summary[J]. Chin Circ J, 2024, 39(7):625-660.
[2]	Su JJ, Yu DSF, Paguio JT. Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients:a systematic review and meta-analysis[J]. J Adv Nurs, 2020, 76(3):754-772. doi: 10.1111/jan.v76.3
[3]	Mikkelsen N, Dall CH, Frederiksen M, et al. The motivation for physical activity is a predictor of VO₂ peak and is a useful parameter when determining the need for cardiac rehabilitation in an elderly cardiac population[J]. PLoS One, 2022, 17(9):e0275091. doi: 10.1371/journal.pone.0275091
[4]	Alfrey KL, Gardner B, Judd J, et al. Physical activity behaviour and motivation during and following pulmonary and cardiac rehabilitation:a repeated measures study[J]. Behav Sci, 2024, 14(10):965. doi: 10.3390/bs14100965
[5]	Thompson G, Wilson IM, Davison GW, et al. “Why would you not listen? It is like being given the winning lottery numbers and deciding not to take them”:semi-structured interviews with post-acute myocardial infarction patients and their significant others exploring factors that influence participation in cardiac rehabilitation and long-term exercise training[J]. Disabil Rehabil, 2022, 44(17):4750-4760. doi: 10.1080/09638288.2021.1919213
[6]	Yang Z, Huang H, Xu LY, et al. From need to action:decoding the role of motivation in adherence to home-based cardiac rehabilitation exercise in chronic heart failure patients[J]. BMC Nurs, 2024, 23(1):913. doi: 10.1186/s12912-024-02617-1
[7]	Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation,social development,and well-being[J]. Am Psychol, 2000, 55(1):68-78. doi: 10.1037//0003-066x.55.1.68 pmid: 11392867
[8]	沈迎, 张瑞岩, 沈卫峰. 稳定性冠心病血运重建策略进展:2018中国稳定性冠心病诊断与治疗指南解读[J]. 心脑血管病防治, 2019, 19(2):107-111.
	Shen Y, Zhang RY, Shen WF. Progress of revascularization strategy for stable coronary heart disease:Interpretation of 2018 China guidelines for diagnosis and treatment of stable coronary heart disease[J]. Prev Treat Cardio Cereb Vasc Dis, 2019, 19(2):107-111.
[9]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 冠心病心脏康复基层指南(2020年)[J]. 中华全科医师杂志, 2021, 20(2):150-165.
	Chinese Medical Association, Chinese Medical Journals Publishing House, General Practice Branch of Chinese Medical Association, et al. Guideline for primary care of cardiac rehabilitation of coronary artery disease(2020)[J]. Chin J Gen Pract, 2021, 20(2):150-165.
[10]	Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9):1277-1288. doi: 10.1177/1049732305276687
[11]	陈烨, 曹松梅. 基于自我决定理论对中青年高血压患者自我护理体验的质性研究[J]. 解放军护理杂志, 2018, 35(2):13-18.
	Chen Y, Cao SM. Experience of self-care in middle-aged and young hypertension patients based on self-determination theory:a qualitative study[J]. Nurs J Chin PLA, 2018, 35(2):13-18.
[12]	罗晓兰, 李明. 医患沟通对患者依从性的影响机制探索[J]. 医学信息学杂志, 2024, 45(4):31-37.
	Luo XL, Li M. Study on the influencing mechanism of doctor-patient communication on patient compliance[J]. J Med Inform, 2024, 45(4):31-37. doi: 10.1016/S1386-5056(97)00031-2
[13]	刘硕, 王玉玲, 褚倩, 等. 心脏康复专科护士培训方案的构建[J]. 护理研究, 2023, 37(3):435-442.
	Liu S, Wang YL, Chu Q, et al. Construction of training program for cardiac rehabilitation specialist nurse[J]. Chin Nurs Res, 2023, 37(3):435-442.
[14]	周剑英, 许晖, 张芳, 等. 心脏康复分级诊疗模式在经皮冠状动脉介入术后患者中的应用[J]. 中华急危重症护理杂志, 2020, 1(6):495-499.
	Zhou JY, Xu H, Zhang F, et al. The application of hierarchical medical mode in cardiac rehabilitation of patients after percutaneous coronary intervention[J]. Chin J Emerg Crit Care Nurs, 2020, 1(6):495-499.
[15]	温朋飞, 熊欢. 城市已婚已育女性参与体育健身动机及转化的质性研究[J]. 成都体育学院学报, 2022, 48(6):107-113.
	Wen PF, Xiong H. Qualitative research on motivation and transformation of urban married and childbearing women participating in physical fitness[J]. J Chengdu Sport Univ, 2022, 48(6):107-113.
[16]	郑红颖, 胡嘉乐, 董柏君, 等. 医患共享决策评估工具的研究进展[J]. 中华护理杂志, 2018, 53(5):622-625.
	Zheng HY, Hu JL, Dong BJ, et al. Research progress and evaluation of assessment tools for shared decision making[J]. Chin J Nurs, 2018, 53(5):622-625.
[17]	李雪, 崔岩, 李少玲, 等. 赋能教育对PCI术后患者运动康复的影响[J]. 护理学杂志, 2021, 36(1):80-83.
	Li X, Cui Y, Li SL, et al. Effect of empowerment education on exercise rehabilitation for patients after percutaneous coronary intervention[J]. J Nurs Sci, 2021, 36(1):80-83.
[18]	Singh B, Murphy A, Maher C, et al. Time to form a habit:a systematic review and meta-analysis of health behaviour habit formation and its determinants[J]. Healthcare, 2024, 12(23):2488. doi: 10.3390/healthcare12232488