目的 探讨阻碍医护人员推荐心脏康复决策行为发生的原因。方法 基于能力、机会、动机-行动模型（capability opportunity motivation-behavior model，COM-B）和理论域框架（theoretical domains framework，TDF）制定访谈提纲，选取25名医护人员进行半结构访谈，访谈资料以COM-B和TDF为编码框架，采用归纳主题法和演绎框架法分析。结果 医护人员心脏康复推荐决策行为的障碍因素包括医护人员缺乏推荐心脏康复的意愿和医护人员缺乏推荐心脏康复的行动策略，前者分析得出缺乏目的理解、缺乏信念支持、缺乏专业团队、不良经历、消极态度和缺乏社会环境支持6个主题；后者分析得出缺乏物质资源、缺乏知识和能力2个主题。结论 医护人员心脏康复推荐决策行为发生的障碍因素影响其向患者推荐心脏康复的意愿和行动策略。

Objective To explore the factors that hinder the decision-making behavior of medical staff on recommending cardiac rehabilitation.Methods An interview outline was developed based on the Capability Opportunity Motivation-Behavior model (COM-B model) and Theoretical Domains Framework (TDF),with 25 medical staff selected for semi-structured interviews.The interview data used COM-B and TDF as the coding framework,and the inductive topic analysis and deductive framework analysis were also used.Results The decision-making behavior of medical staff for recommending cardiac rehabilitation consisted of two parts:their unwillingness and lack of strategies to recommend cardiac rehabilitation.The former was attributed to not only a lack of understanding of the purpose,belief and professional team,but also adverse experiences,negative attitude and lack of support from the society,while the latter was due to a lack of material resources,knowledge and ability.Conclusions The obstacles to the decision-making behavior of medical staff for cardiac rehabilitation recommendation are the lack of willingness and strategies for action.

R473.54

复旦大学复星护理科研项目（FNF202069）