缺血性脑卒中患者出院健康行为综合提醒系统的构建与评价

摘要

目的 构建基于健康信念模式的缺血性脑卒中患者出院健康行为综合提醒系统并评价该系统的效果.方法 采用方便抽样法,选取2015年2月-2016年3月在广东省中医院、中山大学附属第三医院、中山大学附属第二医院住院的87例高血压合并缺血性脑卒中患者.根据健康信念模式构建缺血性脑卒中患者出院健康行为综合提醒系统,对纳入患者进行为期6个月的干预,包括出院前面对面健康信念教育与出院后持续6个月的延续护理[出院后电话提醒、每周短信提醒,发放《脑卒中患者健康信念手册暨月历》(《手册》)日记并指导患者进行月历自我管理].6个月后76例(87.4％)患者完成随访,采用自行设计的问卷进行问卷调查,问卷主要内容包括:干预实施情况及对干预方案的满意度.共发放问卷76份,回收有效问卷76份,问卷的有效回收率为100.0％.采用目的抽样法,选取其中10例患者进行半结构访谈,采用质性研究的现象学分析法收集、整理资料,并分析、提炼主题.结果 76例患者出院前健康信念教育访谈平均时长(29.0±5.9) min;出院后l周、1个月、3个月时电话随访平均时长分别为(6.8±3.0)、(10.8±5.3)、(8.9±4.3) min接收短信方面,所有患者/亲属每周均接收到短信,其中22例(28.9％)短信由患者的亲属(配偶或子女)接收.使用《手册》中月历自我管理记录单方面,从来不用者5例(6.6％),使用时间＜1个月20例(26.3％),1～3个月32例(42.1％),＞3个月11例(14.5％),6个月8例(10.5％).使用血压记录单方面,从来不用者5例(6.6％),使用时间＜1个月10例(13.2％),1～3个月26例(34.2％),＞3个月20例(26.3％),6个月15例(19.7％).患者对出院健康信念教育、出院电话随访、出院短信教育的满意度评分分别为(9.88±0.43)、(9.59±0.75)、(9.81±0.39)分,对《手册》的满意度评分为(9.45±0.71)分半结构访谈共提炼出6个主题:健康信念教育可增强风险意识、增长知识、增强信念、促进健康行为;《手册》内容全面实用、图文并茂、方便平时查阅;月历管理法可协助纠正不良生活方式;血压记录单简练清晰、方便记录;电话及短信提醒有助于强化;生活方式更健康,但纠正不良嗜好仍需时间.结论 缺血性脑卒中患者对出院健康行为综合提醒系统的满意度较高,具有科学性、可操作性、有效性,值得推广.%Objective To develop a comprehensive reminder system based on health belief model (CRS-HBM) and evaluate its effect on healthy behaviors among discharged ischemic stroke patients.Methods We enrolled a convenience sample of 87 hypertensive ischemic stroke inpatients who received treatment in Guangdong Provincial Hospital of Chinese Medicine,The Third Affiliated Hospital,Sun Yat-Sen University and Second Affiliated Hospital of Sun Yat-Sen University from February 2015 to March 2016.The CRS-HBM was developed and applied to a program conducted in these patients consisting of face-to-face health belief-related education before discharge and a 6-month intervention after discharge including telephone-based education,weekly automated text message-based education,health education through written materials [Handbook of Health Beliefs for Stroke Patients & Monthly Calendar and Journal (hereinafter referred to as the Handbook) and guidance for self-management of the monthly calendar and journal covered in the Handbook].Seventy-six (87.4％) patients completed the whole 6-month intervention and they were surveyed by a self-designed questionnaire covering the implementation status of CRS -HBM and patient satisfaction with the CRS-HBM-based intervention program.The survey achieved a response rate of 100.0％.Ten out of 76 patients were purposively selected for semi-structured interview.The qualitative research method of phenomenology was used to collect,sort,analyze the results of interview and summarize themes.Results The mean time of face -to-face interview before discharge for 76 patients was (29.0 ±5.9) min.The mean time were (6.8 ±3.0),(10.8 ±5.3),(8.9 ±4.3) min for telephone-based education conducted at 1 week,1 month,and 3 months after discharge respectively.All the patients or their relatives received text messages every week during the intervention period,and 22 (28.9％) of them indicated that the text messages were received by their relatives (spouse or children).As for using the self-management sheet included in the Handbook,5 (6.6％) never used,20 (26.3％) used it for less than 1 month,32 (42.1％) used it for l-3 months,11 (14.5％) used it for over 3 months,only 8 (10.5％) used it for the whole 6-month intervention after discharge.As for using the blood pressure record sheet,5 (6.6％) never used it;10 (13.2％) used it for less than 1 month,26 (34.2％) used it for 1-3 months.20 (26.3％) used it for over 3 months,only 15 (19.7％) used it for the whole 6 month after discharge.The scores of patient satisfaction with health belief-related education before discharge,telephone-based education and text message-based education following discharge and the Handbook were (9.88 ± 0.43) (9.59 ± 0.75) (9.81 ±0.39) (9.45 ±0.71) respectively.The 6 themes concluded based on the results of semi-structured interviews are as follows:Health belief-related education could enhance the level of risk awareness of stroke,improve knowledge related to stroke,reinforce the health beliefs and promnote healthy behaviors;The Handbook was comprehensive,practical,illustrated,and convenient for reading;The self-management of the monthly calendar and journal covered in the Handbook could help to modify unhealthy lifestyles;The blood pressure record sheet was concise and convenient to record;Telephone-based education and text message-based education enhanced the intervention effect;The lifestyles were becoming more healthy,but it takes time to correct bad habits.Conclusion Patient satisfaction with the CRS-HBM program is pretty good.The program is scientific,operating,effective and worth popularizing.