目的 探讨老年慢性心力衰竭患者自我管理行为的促进和障碍因素，为改善疾病自我管理提供依据。 方法 基于理论域框架，采用描述性质性研究，以目的性抽样法选取上海市某三级甲等医院心内科的老年慢性心力衰竭患者17例为研究对象进行半结构式访谈，资料分析采用定向内容分析法。 结果 促进因素有积极预后期望、自我管理信心、家庭责任驱动；障碍因素有心力衰竭知识缺乏、技能掌握不充分、社交支持有限、资源可及性较差、医疗保险报销比例不足、社会角色冲突与心理情绪困扰。 结论 以基于理论域框架归纳的促进和障碍因素为目标导向，通过激发患者内在动力，提升其自我管理信心；同时重视家庭同伴支持，加强外部资源助力，可以有效提升老年慢性心力衰竭患者的自我管理。

Objective To explore the promoting and hindering factors of self-management behaviors of elderly patients with chronic heart failure，and to provide a basis for improving self-management of the disease.Methods A descriptive qualitative study was designed and conducted based on the theoretical domain framework.By purposive sampling method，17 elderly patients with chronic heart failure in the Cardiology Department of a tertiary A hospital in Shanghai were selected and semi-structured interviews were conducted.The data was analyzed by directed content analysis.Results Promoting factors included positive prognostic expectations，confidence in self-management and family responsibility.Hindering factors included insufficient heart failure knowledge，inadequate skills，limited social support，poor resource accessibility，insufficient reimbursement ratio of health insurance，conflicts of social roles，and psychological and emotional distress.Conclusions Self-management of elderly patients with chronic heart failure could be effectively promoted by stimulating the patients’ intrinsic motivation，enhancing their confidence in self-management，emphasizing family and peer support，and strengthening external resource assistance，with the promoting and hindering factors summarized based on the theoretical domain framework as the goal orientation.

R473.54

国家自然科学基金（72104056）；复旦-复星护理科研基金（FNF202354）