Abstract: Background　The incidence of obesity-related nonalcoholic fatty liver disease（NAFLD） in obese young and middle-aged people is gradually increasing，but the practice of Traditional Chinese Medicine health management（TCM-HM） is unsatisfied.The problems such as low motivation，poor compliance，and low utilization of TCM resources still exist.Patients are the key to health management.However，there are rare studies seeking patients' awareness of disease and TCM-HM based on the social behavioral theory.Objective　To explore the influencing factors of young and middle-aged people with obesity-related NAFLD participating in TCM-HM based on the theory of planned behavior（TPB）．Methods　Participants were volunteers who underwent physical examination in the Hepatology Research clinic of Hubei Provincial Hospital of TCM and enrolled into the biological sample database of overweight/obesity from October to December 2016.A total of 552 questionnaires were issued，552 were collected，and 432 were valid，with an effective recovery rate of 78.26%.The questionnaire pool was established by in-depth interviews and literature method.An initial questionnaire was formed through expert consultation and multiple rounds of revision by the research group.After preliminary investigation，it was revised and adjusted for several times.The formal questionnaire was produced named the survey of behavioral intention for young，middle-aged patients with obesity-related NAFLD participating in TCM-HM.Exploratory factor analysis（EFA） was used to catch potential factors.The Structural Equation Model（SEM） for behavioral intention of TCM-HM for the young and middle-aged patients with obesity-related NAFLD was constructed，and confirmatory factor analysis（CFA） was performed.Results　EFA identified seven potential factors including subjective norm，self-efficacy，negative attitude，health perception，perceived behavior control，TCM-HM intention and actual behavior in 65 measurements；CFA confirmed the correlation between the seven potential factors mentioned，and the SEM had a good fitting evaluation〔comparative fit index（CFI）=0.949，Bentler-Bonett normed fix index（NFI）=0.977，Tucker-Lewis index（TLI）=0.932，goodness-of-fit index（GFI）=0.868，χ2/df=2.436，root-mean-square error of approximation（RMSEA）=0.065〕；the hypothesis test results showed that positive correlation initiated between subjective norm，perceived behavioral control and TCM-HM intention（path coefficient were 0.144，0.098，respectively，P<0.001）；negative attitude remained negative correlation with health perception and TCM-HM intention（path coefficient were -0.097 and -0.168，respectively，P<0.001）；there was no correlation between self-efficacy and TCM - HM intention（the path coefficient was -0.023，P=0.471）．From the perspective of the behavior，behavior was verified with no correlation among subjective norm，self-efficacy，health perception（path coefficient were -0.038，0，0.095，respectively，P values were 0.457，0.991，0.083，respectively），and perceived behavior control and actual behavior had a positive correlation（path coefficient was 0.093，P<0.001），while negative attitude and actual behavior had a negative correlation（path coefficient was -0.110，P<0.001）．TCM-HM intention had no correlation with actual behavior（path coefficient was -0.091，P=0.074）．Conclusion　TPB-based model construction is applicable to explain the intention of TCM-HM in young and middle-aged people with obesity-related NAFLD.Subjective norm，negative attitude，health perception and perceived behavior control can affect TCM-HM intention，but the gap still exists between TCM-HM intention and actual behavior.When NAFLD TCM-HM model is established，TCM resources must be optimized to guarantee the quality，especially strengthen the availability and feasibility of resources.At the same time，it is important to standardize TCM information and improve the patients knowledge of fatty liver disease.Further，it is beneficial to analyze the patients' personality and behavioral pattern in order to formulate personalized TCM-HM plan.

Key words: Liver diseases；Fatty liver；Nonalcoholic fatty liver disease；Obesity；TCM health management；Theory of planned behavior；Models, structural

摘要： 背景　中青年肥胖性非酒精性脂肪性肝病（NAFLD）的发病率逐年升高，但中医健康管理的实践效果不尽如人意，依然存在积极性不高、依从性较差、中医资源利用率较低等问题。健康管理的主体是患者，而结合计划行为理论（TPB）进行患者的疾病意识和中医健康管理认知研究尚不多见。目的　基于TPB探讨中青年肥胖性NAFLD患者参与中医健康管理的影响因素。方法　选取2016年10—12月在湖北省中医院肝病研究型门诊进行体检并被纳入肝病研究型门诊超重/肥胖人群生物样本库建档的志愿者，发放调查问卷552份，收回552份，有效问卷432份，有效回收率为78.26%。采用深度访谈和文献法收集问卷指标池，通过专家咨询和课题组多轮修订后形成初始问卷，经预调查后反复修正调整，形成了正式问卷《中青年肥胖性非酒精性脂肪性肝病患者中医健康管理行为意向调查表》。采用探索性因子分析寻找潜在因子，构建中青年肥胖性NAFLD患者中医健康管理行为意向的结构方程模型，进行验证性因子分析。结果　探索性因子分析在65个测量指标体系中找出主观规范、自我效能、负性态度、身体健康感知、感知行为控制、中医健康管理意向及实际行为7个潜在因子；验证性因子分析验证了上述7个潜在因子的相互关系，结构方程模型拟合评价较好〔比较拟合指数（CFI）=0.949，本特勒-波内特规范拟合指数（NFI）=0.977，Tucker-Lewis指数（TLI）=0.932，拟合优度指数（GFI）=0.868，χ2/df=2.436，近似均方根残差（RMSEA）=0.065〕；假设检验结果显示：主观规范、感知行为控制与中医健康管理意向具有正相关性（路径系数分别为0.144、0.098，P<0.001），负性态度、身体健康感知与中医健康管理意向具有负相关性（路径系数分别为-0.097、-0.168，P<0.001），自我效能与中医健康管理意向不具有相关性（路径系数为-0.023，P=0.471）；主观规范、自我效能、身体健康感知与实际行为不具有相关性（路径系数分别为-0.038、0、0.095，P值分别为0.457、0.991、0.083），感知行为控制与实际行为具有正相关性（路径系数为0.093，P<0.001），负性态度与实际行为具有负相关性（路径系数为-0.110，P<0.001）；中医健康管理意向与实际行为不具有相关性（路径系数为-0.091，P=0.074）。结论　基于TPB的模型构建适用于解释中青年肥胖性NAFLD患者中医健康管理意愿；主观规范、负性态度、身体健康感知、感知行为控制这些因素可以影响中医健康管理意向，中医健康管理意向与实际行为的发生还存在距离。建立NAFLD中医健康管理模式时，应优化中医资源，保证质量，尤其要加强资源的可用性和可行性建设。同时，规范中医信息，提高患者对NAFLD的认知，具有重要意义。进一步分析患者的个性和行为模式，有利于制定个性化的中医健康管理计划。

关键词: 肝疾病；脂肪肝；非酒精性脂肪性肝病；肥胖；中医健康管理；计划行为理论；模型, 结构