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基于健康信念模式的健康教育对社区高血压患者的干预效果评价
作者:沈莹 王陶陶 高敏 胡康 朱小柔 张幸 王冯彬 何朝 孙昕霙

摘要:

目的  评价基于健康信念模式的健康教育对社区高血压患者血压控制的干预效果。方法  于2016年9月至2017年9月以北京市顺义区人口规模和医疗卫生条件相当的6家社区卫生服务中心为研究现场,招募400例新近诊断的高血压患者,以社区为单位,采用整群随机分组将研究对象分为干预组(206例)和对照组(194例)。对干预组进行3次20~30 min基于健康信念模式的健康教育,对照组仅接受常规护理。干预前后分别收集两组研究对象的基本情况、健康素养和健康信念等信息,并进行血压测量。采用双重差分模型分析两组对象干预前后的血压变化及影响因素。结果  干预组和对照组中完成研究的患者分别为134和129例。调整年龄、性别、家庭月收入、医疗保险、常见慢性病、高血压家族史等因素后,干预使健康信念的感知服药障碍维度得分提高了1.65分(P=0.016),感知高血压严重性维度得分下降了0.73分(P=0.018)。干预使高血压患者收缩压下降了7.37 mmHg(1 mmHg=0.133 kPa),舒张压下降了4.07 mmHg,β(95%CI)值分别为-7.37(-11.88,-2.86)、-4.07(-7.30,-0.84)。健康信念的感知高血压易感性和自我效能维度对患者血压变化的影响有统计学意义(P值均<0.05)。结论  基于健康信念模式的健康教育可明显改善社区高血压患者的血压水平。

关键词:健康知识,态度,实践;高血压;社区医学;干预性研究

Abstract:

Objective  To evaluate the effectiveness of health belief model-based health education intervention in improving blood pressure control of patients with hypertension in community settings.Methods  From September 2016 to September 2017, 400 newly diagnosed patients with hypertension were recruited from 6 community healthcare centers with comparable population size and health services in the Shunyi District of Beijing. All community healthcare centers were randomly assigned to the intervention group (206 patients) and the control group (194 patients). Patients in the intervention group received 3 lectures (20-30 min for each) of health belief model-based health education. Patients in the control group received usual care. The basic characteristics, health beliefs, and health literacy were collected, and blood pressure was measured before and after the intervention, respectively. The difference-in-difference model was used to analyze the change of blood pressure and the influencing factors between two groups before and after the intervention.Results  A total of 134 patients in the intervention group and 129 patients in the control group completed the study. After adjusting for the age, gender, family income, medical insurance, chronic diseases and family history, the score of perceived barriers was increased by 1.65 (P=0.016), and perceived seriousness was decreased by 0.73 (P=0.018). The systolic blood pressure of patients was decreased by 7.37 mmHg (1 mmHg=0.133 kPa, P=0.001) and diastolic blood pressure was decreased by 4.07 mmHg (P=0.014), respectively. The β (95%CI) values were -7.37 (-11.88,-2.86) and -4.07 (-7.30, -0.84). The perceived susceptibility and self-efficacy had a significant influence on the blood pressure of patients (P<0.05).Conclusion  Health belief model-based health education intervention could significantly improve the blood pressure control of patients with hypertension in the community settings.

Key words: Health knowledge, attitudes, practice;Hypertension;Community medicine;Intervention studies

发表日期:2020/2

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2020.02.008.T001:表1 干预前两组研究对象基本情况的均衡性比较

    10.3760/cma.j.issn.0253-9624.2020.02.008.T001:表1 干预前两组研究对象基本情况的均衡性比较

  • 10.3760/cma.j.issn.0253-9624.2020.02.008.T002:表2 两组完成研究者和失访者基本情况的均衡性比较[n(%)]

    10.3760/cma.j.issn.0253-9624.2020.02.008.T002:表2 两组完成研究者和失访者基本情况的均衡性比较[n(%)]

  • 10.3760/cma.j.issn.0253-9624.2020.02.008.T003:表3 干预前后两组健康素养和健康信念得分情况(±s)

    10.3760/cma.j.issn.0253-9624.2020.02.008.T003:表3 干预前后两组健康素养和健康信念得分情况(±s)

  • 10.3760/cma.j.issn.0253-9624.2020.02.008.T004:表4 干预前后高血压患者收缩压变化的影响因素

    10.3760/cma.j.issn.0253-9624.2020.02.008.T004:表4 干预前后高血压患者收缩压变化的影响因素

  • 10.3760/cma.j.issn.0253-9624.2020.02.008.T005:表5 干预前后高血压患者舒张压变化的影响因素

    10.3760/cma.j.issn.0253-9624.2020.02.008.T005:表5 干预前后高血压患者舒张压变化的影响因素

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