Research on the effect of health education based on empowerment theory on elderly hypertensive patients
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摘要:
目的 评价基于赋权理论的健康教育对社区老年高血压患者的血压控制水平，戒烟、限酒、合理膳食及规律锻炼达标率，健康素养水平的影响，为社区老年高血压患者进行自我健康管理提供理论依据与实践方法。 方法 于2020年5—9月以社区年度健康体检为契机，从洛阳市6个社区选择符合纳排标准的高血压患者80例。采用随机数字表法将患者分为实验组(40例)和对照组(40例)。对照组仅接受社区常规健康教育，实验组在此基础上，将赋权理论运用到社区老年高血压患者的健康教育中。干预前后分别收集2组患者的生活习惯及危险因素控制状况调查问卷、健康素养等信息进行分析。 结果 干预后，实验组和对照组的收缩压[(132.1±5.3)mm Hg vs.(142.5±10.8)mm Hg，1 mm Hg=0.133 kPa]和舒张压[(81.8±5.2)mm Hg vs.(87.5±7.1)mm Hg]比较，差异有统计学意义(均P＜0.001)。干预后，实验组合理膳食、限酒和运动达标率分别为73.7%(28/38)、94.7%(36/38)、92.1%(35/38)，对照组合理膳食、限酒和运动达标率分别为27.8%(10/36)、77.8%(28/36)、72.2%(26/36)，2组各项达标率相比差异均有统计学意义(均P＜0.05)；2组间戒烟达标率比较，差异无统计学意义(P=0.463)。干预后，实验组和对照组的健康素养得分[(104.13±6.12)分vs. (86.97±8.02)分]及4个维度得分比较，差异均有统计学意义。 结论 基于赋权理论的健康教育可明显改善社区高血压患者的血压水平及健康素养水平，提高其自我管理意识及能力。 Abstract:Objective To evaluate the impact of health education based on the empowerment theory on the blood pressure control level of elderly hypertensive patients in a community, the rates of compliance to smoking cessation, alcohol restriction, reasonable diet and regular exercise and their health literacy levels, and to provide a theoretical basis and practice methods for the self-health management of elderly hypertensive patients in community. Methods From May 2020 to September 2020, taking the community annual health checkup as an opportunity, we selected 80 hypertensive patients who met the inclusion and exclusion criteria from six communities in Luoyang City. With the random-number-table method, the patients were equally divided into experimental (40 cases) and control (40 cases) groups. The control group only received regular health education in the community. The experimental group applied the health education based on the empowerment theory of elderly hypertensive patients in the community. Before and after the intervention, the two groups of patients' living habits and risk factor control questionnaires, health literacy and other information were collected for analysis. Results After intervention, the systolic blood pressure [(132.1±5.3) mm Hg vs. (142.5±10.8) mm Hg, 1 mm Hg=0.133 kPa] and diastolic blood pressure [(81.8±5.2) mm Hg vs. (87.5±7.1) mm Hg] between the experimental and control groups were significantly different (all P < 0.001). The rates of reasonable diet [73.7% (28/38) vs. 27.8% (10/36)], alcohol restriction [94.7% (36/38) vs. 77.8% (28/36)] and exercise compliance [92.1% (35/38) vs. 72.2% (26/36)] between the experimental and control groups were significantly different (all P < 0.05). There was no significant difference between the two groups in the smoking cessation rate (P=0.463). After the intervention, the health literacy scores [(104.13±6.12) points vs. (86.97±8.02) points] and the four dimensions of the experimental group and the control group were significantly different. Conclusion Health education based on the empowerment theory can significantly improve the blood pressure and health literacy levels of hypertensive patients in a community and improve their self-management awareness and ability. -
Key words:
- Hypertension /
- The aged /
- Empowerment theory /
- Health literacy
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表 1 2组高血压患者基线资料比较
Table 1. Comparison of baseline data between two groups of patients with hypertensive
组别 例数 性别(例) 年龄(x±s，岁) 文化程度(例) 职业状况(例) 心血管疾病家族史(例) 男性 女性 小学及以下 初中 高中及以上 退休 无业 有 无 实验组 38 20 18 75.63±6.58 9 20 9 36 2 11 27 对照组 36 16 20 75.75±6.78 10 20 6 33 3 11 25 统计量 0.496a 0.076b 0.645c 0.023a P值 0.481 0.939 0.698 0.670d 0.880 注：a为χ2值, b为t值，c为U值，d为采用Fisher精确检验。 
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表 2 2组高血压患者干预前后血压比较(x±s，mm Hg)
Table 2. Comparison of blood pressure between two groups of patients with hypertensive before and after intervention(x±s, mm Hg)
组别 例数 收缩压 t值 P值 舒张压 t值 P值 干预前 干预后 干预前 干预后 实验组 38 149.2±12.4 132.1±5.3 11.366 ＜0.001 90.3±8.4 81.8±5.2 9.749 ＜0.001 对照组 36 148.2±13.5 142.5±10.8 9.775 ＜0.001 90.1±8.4 87.5±7.1 7.391 ＜0.001 t值 0.328 5.199 0.104 3.905 P值 0.744 ＜0.001 0.917 ＜0.001 注：1 mm Hg=0.133 kPa。
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表 3 2组高血压患者干预前后合理膳食、戒烟、限酒和运动达标情况比较[例(%)]
Table 3. Comparison of reasonable diet, smoking cessation, alcohol restriction and exercise standards between two groups of patients with hypertensive before and after intervention[cases(%)]
组别 例数 合理膳食达标 χ2值 P值 戒烟达标 χ2值 P值 干预前 干预后 干预前 干预后 实验组 38 8(21.1) 28(73.7) 21.111 ＜0.001 27(71.1) 33(86.8) 2.850 0.091 对照组 36 7(19.4) 10(27.8) 0.693 0.405 28(77.8) 29(80.6) 0.084 0.772 χ2值 0.030 15.595 0.438 0.538 P值 0.863 ＜0.001 0.508 0.463 组别 例数 限酒达标 χ2值 P值 运动达标 χ2值 P值 干预前 干预后 干预前 干预后 实验组 38 22(57.9) 36(94.7) 14.268 ＜0.001 21(55.3) 35(92.1) 13.300 ＜0.001 对照组 36 24(66.7) 28(77.8) 1.108 0.293 20(55.6) 26(72.2) 2.167 0.141 χ2值 0.605 4.549 0.001 5.047 P值 0.437 0.033 0.980 0.025
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表 4 2组高血压患者健康素养得分比较(x±s，分)
Table 4. Comparison of health literacy scores between two groups of patients with hypertensive(x±s, points)
组别 例数 慢性病健康素养 t值 P值 信息获取能力 t值 P值 干预前 干预后 干预前 干预后 实验组 38 86.82±11.45 104.13±6.12 16.051 ＜0.001 30.63±3.83 37.79±2.91 17.432 ＜0.001 对照组 36 83.36±8.72 86.97±8.02 15.712 ＜0.001 29.58±2.81 30.14±2.69 5.976 ＜0.001 t值 1.454 10.377 1.336 11.747 P值 0.150 ＜0.001 0.186 ＜0.001 组别 例数 交流互动能力 t值 P值 改善健康意愿 t值 P值 经济支持 t值 P值 干预前 干预后 干预前 干预后 干预前 干预后 实验组 38 36.87±3.86 41.92±1.98 12.181 ＜0.001 13.18±2.87 17.66±0.91 11.999 ＜0.001 6.32±1.28 6.76±1.10 4.583 ＜0.001 对照组 36 35.53±3.44 36.25±3.26 7.653 ＜0.001 12.33±2.01 14.56±1.80 18.479 ＜0.001 5.92±0.94 6.03±0.81 1.573 0.054 t值 1.574 8.998 1.470 9.298 1.527 3.257 P值 0.120 ＜0.001 0.146 ＜0.001 0.131 0.002
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[1] 张建, 范利. 老年医学[M]. 2版. 北京: 人民卫生出版社, 2016.ZHANG J, FAN L. Geriatric Medicine[M]. 2 version. Beijing: People' s Medical Publishing House, 2016. [2] 胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告2018》概要[J]. 中国循环杂志, 2019, 34(3): 209-220. doi: 10.3969/j.issn.1000-3614.2019.03.001HU S S, GAO R L, LIU L S, et al. Summary of the 2018 report on cardiovascular diseases in China[J]. Chinese Circulation Journal, 2019, 34(3): 209-220. doi: 10.3969/j.issn.1000-3614.2019.03.001 [3] 国家卫生计生委. 国家卫生计生委关于印发《国家基本公共卫生服务规范(第三版)》的通知[J]. 中华人民共和国国家卫生和计划生育委员会公报, 2017(3): 21. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGB201703005.htmNational Health Commission of the People' s Republic of China. Circular of the National Health and Family Planning Commission on Issuing National Basic Public Health Service Standard (Third Edition)[J]. Gazette of the National Health and Family Planning Commission of People' s Republic of China, 2017(3): 21. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGB201703005.htm [4] WANG Z W, CHEN Z, ZHANG L F, et al. Status of hypertension in China: Results from the China hypertension survey, 2012-2015[J]. Circulation, 2018, 137(22): 2344-2356. doi: 10.1161/CIRCULATIONAHA.117.032380 [5] 何丽梅. 社区慢性病管理存在的问题及工作思路[J]. 临床医药文献电子杂志, 2020, 7(41): 171-172. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX202041157.htmHE L M. Problems and working ideas of chronic disease management in community[J]. Journal of Clinical Medical Literature, 2020, 7(41): 171-172. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX202041157.htm [6] 孙一勤, 姜安丽. 慢性病健康赋能理论研究[J]. 中华医院管理杂志, 2017, 33(9): 700-703. doi: 10.3760/cma.j.issn.1000-6672.2017.09.019SUN Y Q, JIANG A L. Research on health empowerment theory of chronic diseases[J]. Chinese Journal of Hospital Administration, 2017, 33(9): 700-703. doi: 10.3760/cma.j.issn.1000-6672.2017.09.019 [7] 顾爱芹, 贾敏, 徐红. 授权教育结合家庭支持在冠心病老年患者管理中的应用效果[J]. 当代护士(下旬刊), 2018, 25(4): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-DDHZ201804017.htmGU A Q, JIA M, XU H. Application effect of empowerment education combined with family support in the management of elderly patients with coronary heart disease[J]. Modern Nurse, 2018, 25(4): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-DDHZ201804017.htm [8] 中国老年医学学会高血压分会, 国家老年疾病临床医学研究中心中国老年心血管病防治联盟. 中国老年高血压管理指南2019[J]. 中国心血管杂志, 2019, 24(1): 1-23. doi: 10.3969/j.issn.1007-5410.2019.01.001Hypertension Branch of Chinese Geriatrics Society, National Clinical Research Center for Geriatric Diseases, Chinese Alliance of Geriatric Cardiovascular Disease. 2019 Chinese guidelines for the management of hypertension in the elderly[J]. Chinese Journal of Cardiovascular Medicine, 2019, 24(1): 1-23. doi: 10.3969/j.issn.1007-5410.2019.01.001 [9] 孙浩林. 慢性病病人健康素养量表的研究及其初步应用[D]. 上海: 复旦大学, 2012.SUN H L. Study and preliminary application of health literacy Scale for chronic disease patients[D]. Shanghai: Fudan University, 2012. [10] HERBERT R J, GAGNON A J, RENNICK J E, et al. A systematic review of questionnaires measuring health-related empowerment[J]. Res Theory Nurs Pract, 2009, 23(2): 107-132. doi: 10.1891/1541-6577.23.2.107 [11] PERKINS D D, ZIMMERMAN M A. Empowerment theory, research, and application[J]. Am J Community Psychol, 1995, 23(5): 569-579. doi: 10.1007/BF02506982 [12] FUNNELL M M, ANDERSON R M. Empowerment and self-management of diabetes[J]. Clin Diabetes, 2004, 22(3): 123-127. doi: 10.2337/diaclin.22.3.123 [13] 樊宇华. 个体化健康管理及随访对原发性高血压患者高血压相关知识、态度及行为的影响[J]. 医学临床研究, 2017, 34(10): 2074-2076. doi: 10.3969/j.issn.1671-7171.2017.10.073FAN Y H. Effects of individualized health management and follow-up on hypertension-related knowledge, attitude and behavior in patients with essential hypertension[J]. Journal of Clinical Research, 2017, 34(10): 2074-2076. doi: 10.3969/j.issn.1671-7171.2017.10.073 [14] FERRI C, FERRI L, DESIDERI G. Management of hypertension in the elderly and frail elderly[J]. High Blood Press Cardiovasc Prev, 2017, 24(1): 1-11. doi: 10.1007/s40292-017-0185-4 [15] 龚婧如, 杨涛, 陆惠平, 等. 区域中心医院与社区医院临床药师协同管理门诊高血压患者的效果研究[J]. 医药论坛杂志, 2021, 42(13): 1-6. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX202113001.htmGONG J R, YANG T, LU H P, et al. Study on effect of cooperative management of outpatient hypertension patients by clinical pharmacists in regional central hospital and community hospital[J]. Journal of Medical Forum, 2021, 42(13): 1-6. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX202113001.htm [16] HOURZAD A, POULADI S, OSTOVAR A, et al. The effects of an empowering self-management model on self-efficacy and sense of coherence among retired elderly with chronic diseases: A randomized controlled trial[J]. Clin Interv Aging, 2018, 13: 2215-2224. [17] 李川川, 张彦. 对《国际高血压学会2020国际高血压实践指南》与我国高血压防治策略的思考[J]. 中华高血压杂志, 2020, 28(9): 815-817. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202009008.htmLI C C, ZHANG Y. The Thinking of "International Society of Hypertension 2020 International Hypertension Practice Guidelines" and our hypertension prevention strategy[J]. Chinese Journal of Hypertension, 2020, 28(9): 815-817. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202009008.htm [18] 张晗, 熊巨洋, 管文博, 等. 慢性病管理效果分析: 以国家慢性病综合防控示范区为例[J]. 中国医院, 2019, 23(1): 15-17. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYU201901007.htmZHANG H, XIONG J Y, GUAN W B, et al. Analyzing the management effects of chronic diseases: Taking national demonstration zone of chronic diseases comprehensive prevention and control as an example[J]. Chinese Hospitals, 2019, 23(1): 15-17. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYU201901007.htm [19] 陈燕华, 房梦雅, 耿劲松, 等. 中国大陆高血压健康素养研究的文献计量分析[J]. 医学信息, 2020, 33(9): 1-5, 8. https://www.cnki.com.cn/Article/CJFDTOTAL-YXXX202009002.htmCHEN Y H, FANG M Y, GENG J S, et al. A bibliometric analysis of the research on hypertension health literacy in China' s Mainland[J]. Medical Information, 2020, 33(9): 1-5, 8. https://www.cnki.com.cn/Article/CJFDTOTAL-YXXX202009002.htm [20] 张桂侠, 王莉, 何荣. 基于个案分析的行为矫正策略在高血压患者中的应用效果研究[J]. 中国临床研究, 2016, 29(3): 400-402. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201603037.htmZHANG G X, WANG L, HE R. Application effect of behavior modification strategy based on case analysis in patients with hypertension[J]. Chinese Journal of Clinical Research, 2016, 29(3): 400-402. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201603037.htm -
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