目的 探讨感知健康能力、婚姻宽恕在农村老年慢性病患者感知伴侣回应性与主动控制感间的链式中介作用，为制订提升患者主动控制感的干预措施提供依据。 方法 2023年7—8月，便利抽样湖南省及广东省共6个村庄的422名老年慢性病患者为研究对象。采用一般资料问卷、感知伴侣回应性量表、感知健康能力量表、婚姻特定侵犯宽恕量表及主动控制感量表对其进行调查。 结果 农村老年慢性病患者的感知伴侣回应性、感知健康能力、婚姻宽恕、主动控制感得分分别为67.50(62.00,72.00)分、33.00(31.00,36.00)分、51.00(47.00,53.00)分和54.00(52.00,56.00)分；各变量间均呈正相关（ r =0.305~0.418，均 P ＜0.001）；感知健康能力和婚姻宽恕在农村老年慢性病患者感知伴侣回应性与主动控制感间发挥链式中介作用，总间接效应量为0.260，占总效应的46.3%。 结论 感知伴侣回应性可通过感知健康能力与婚姻宽恕的链式中介作用，间接影响农村老年慢性病患者的主动控制感水平。

Objective To explore the chain mediating effects of perceived health competence and marital forgiveness in the influencing mechanism of perceived partner responsiveness and sense of agency in rural elderly chronic disease patients，so as to provide a basis for development of interventions for patients’ sense of active control.Methods A sample of 422 rural elderly chronic disease patients from 6 villages in Hunan Province and Guangdong Province were selected from July to August 2023 by using general information questionnaire,Perceived Partner Responsiveness Scale,Perceived Health Competence Scale,Sense of Agency Scale and Marital Offence-Specific Forgiveness Scale.Results The scores of perceived partner responsiveness，perceived health competence,marital forgiveness and sense of agency were 67.50(62.00,72.00),33.00(31.00,36.00)，51.00(47.00,53.00)and 54.00(52.00,56.00).There were positive correlations（ r=0.305~0.418，allP ＜0.001),and there was a chain mediating effect between perceived health competence and marital forgiveness had a chain mediating effect between perceived partner responsiveness and sense of agency in rural elderly patients with chronic diseases,with a total indirect effect size of 0.260,accounting for 46.3% of the total effect.Conclusions perceived partner responsiveness can indirectly affect the level of sense of agency in rural elderly chronic disease patients through the chain mediating effects of perceived health competence and marital forgiveness.

R47