针对患者的自我护理行为，这篇文献中使用的是“时限性自我调节理论”：看看你可不可以使用？

理论介绍：

时限性自我调节理论（Temporal Self-Regulation Theory）是在“意图—行为”模型基础上，强调时间、行为优势和自我调节能力对健康行为共同影响的新理论。该理论认为一致性观念和时限性效价影响行为意图，行为优势和自我调节能力调节“意图—行为”联系的强度或直接影响行为。与其他健康行为模型的主要区别在于加入了影响行为的自我调节能力和时间因素。

文献参考：[1]程翠萍,张永红.时限性自我调节理论:健康行为研究的一种新取向[J].心理科学进展,2011,19(08):1186-1192.

以下是基于该理论设置的干预研究，文献来自《International Journal of Nursing Studies》（IF=3.78）：

Chew H S J, Sim K L D, Choi K C, et al. Effectiveness of a nurse-led temporal self-regulation theory-based program on heart failure self-care: A randomized controlled trial[J]. International Journal of Nursing Studies, 2021,115:103872.

一项基于时限性自我调节理论，护士主导的干预在心力衰竭患者自我护理中的应用：随机对照研究

Abstract摘要

Background Heart failure self-care is crucial for sustainable heart failure management but its adherence remains poor worldwide. Despite having an intention to change, individuals often face difficulties in modifying existing lifestyle habits and sustaining change motivations.

研究背景：心力衰竭患者的自我护理对于心力衰竭自我管理是至关重要的。但是，自我护理时的依从性现状仍然不容乐观。尽管个人有改变的意愿，但在改变现有的生活方式习惯和维持改变的动机方面往往会遇到困难。

Objectives To examine the effectiveness of a novel theory-driven nurse-led self-regulation program on improving heart failure self-care behaviours, future-thinking and behavioural automaticity.

研究目的：本研究旨在探讨一项基于时限性自我调节理论，护士主导的干预在心力衰竭患者自我护理行为、未来结果考虑和行动自律方面的效果。

Design A two-arm randomized controlled trial.

研究设计：一项双臂随机对照研究

Settings & Participants 144 patients with heart failure were recruited from September 2018 to July 2019 at a tertiary hospital in Singapore.

设置与研究对象：选取2018年9月-2019年7月来自新加坡一家三级医院的144例患者为研究对象。

Methods Participants were randomly assigned to a self-regulation intervention (n = 72) or usual care group (n = 72). The three-month intervention was developed based on the temporal self-regulation theory and consisted of one face-to-face session, a print booklet and three reinforcement telephone follow-ups at week 3, 6 and 9. Outcomes were measured at baseline (T0), immediate after a three-month intervention (T1) and a further three-month follow-up (T2). heart failure self-care was measured using the Self-Care of Heart Failure Index (SCHFI) maintenance subscale, future-thinking was measured using the Consideration of Future Consequences Scale (CFCS) and behaviour automaticity was measured using the Self-Reported Behavioural Automaticity Index (SRBAI). The outcomes were compared between groups by using generalized estimating equations (GEE) based on intention-to-treat principle.

研究方法：①研究对象被随机分为自我调节干预组（n=72）和对照组（n=72）；②基于时限性自我调节理论的干预方案总共持续3个月，具体包括一次面对面会议，宣教手册和分别在第3、6、9周的电话随访。③分别在基线(T0)、干预3个月后(T1)和3个月随访(T2)时测量结果。④使用的量表工具有：自我护理行为量表(SCHFI)、未来结果考虑量表（CFCS），基于自我包报告的自律量表。⑤采使用广义估计方程(GEE)对组间结果进行比较。

Results No significant differences were found between the groups at baseline except for age. Participants were on average 61 years old, men (79.2%), had mild heart failure symptoms (50.7%) and had three comorbidities (66.0% dyslipidaemia; 65.3% hypertension; 61.8% history of myocardial infarction). Baseline scores indicated poor heart failure self-care (52.9±17.2, cut off ≥70). GEE results showed significantly higher heart failure self-care improvements in intervention group than control group at both T1 (regression coefficient, B = 13.9, 95% CI: 8.02 to 19.9, p < 0.001) and T2 (B = 8.34, 95% CI: 1.68 to 15.0, p = 0.014) after adjusting for gender, living alone, education level, comorbidity and age. Results also showed significantly higher increase in future-thinking (B[95% CI]=0.694[.123, 1.26], p = 0.017) and behaviour automaticity (B[95% CI]=0.656[.085, 1.23], p = 0.024) at T1 and only increase in behaviour automaticity (B[95% CI]=0.674[.099, 1.25], p = 0.022) at T2. However, only the differences in self-care scores at T1 remained significant after Bonferroni correction. No significant differences were found for intention, quality of life and clinical biomarkers.

研究结果：①除去年龄外，两组间在基线比较无差异。②参与者平均年龄61岁，男性(79.2%)，有轻度心力衰竭症状(50.7%)，有三种共病(66.0%血脂异常；65.3%的高血压；61.8%有心肌梗死史)。③基线评分显示心力衰竭自我护理行为较差(52.9±17.2)。④GEE结果显示，干预组在T1和T2时，心力衰竭患者的自我护理行为改善明显高于对照组。同时，干预组在T1和T2时，心力衰竭患者的未来结果考虑改善明显高于对照组。仅仅在T2时，干预组患者的自律改善高于对照组。⑤然而，在Bonferroni校正后，只有T1自我护理得分的差异仍然显著。在意向、生活质量和临床生物标志物方面无显著差异。

Conclusions The program was effective in improving heart failure self-care and has potential for clinical implementation and generalisation to other chronic illnesses. Longer follow-up study is needed to uncover its long-term benefits on clinical outcomes.

研究结论：该项目有效地改善了心力衰竭的自我护理，并具有临床实施和推广到其他慢性疾病的潜力。需要更长的随访研究来揭示其对临床结果的长期益处。

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