综合提醒系统对脑卒中患者出院6个月知信行和临床结局的效果

doi:10.3969/j.issn.1006-9771.2020.07.023

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (7): 856-862.doi: 10.3969/j.issn.1006-9771.2020.07.023

综合提醒系统对脑卒中患者出院6个月知信行和临床结局的效果

沈梦杰¹,王霄¹,谭菊香²,王少洲³,张迎梅⁴,万丽红¹()

1.中山大学护理学院,广东广州市 510089
2.中山大学附属第三医院岭南医院,广东广州市 510530
3.中山大学附属第三医院神经内科,广东广州市 510630
4.广东省中医院,广东广州市 510120

收稿日期:2019-08-06 修回日期:2020-06-11 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 万丽红 E-mail:wanlh@mail.sysu.edu.cn
作者简介:沈梦杰(1994-),女,彝族,云南个旧市人,硕士研究生,主要研究方向：脑卒中护理。万丽红,女,博士,教授。
基金资助:
广州市科普专项(201609010050);广东省科技发展专项(2016A020215039)

Effect of Comprehensive Reminder System on Health Knowledge, Belief and Behaviors, and Clinical Outcomes for Stroke Patients Six Months after Discharge

SHEN Meng-jie¹,WANG Xiao¹,TAN Ju-xiang²,WANG Shao-zhou³,ZHANG Ying-mei⁴,WAN Li-hong¹()

1. School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong 510089, China
2. The Third Affiliated Hospital of Sun Yat-sen University-Lingnan Hospital, Guangzhou, Guangdong 510530, China
3. Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China
4. Guangdong Traditional Chinese Medical Hospital, Guangzhou, Guangdong 510120, China

Received:2019-08-06 Revised:2020-06-11 Published:2020-07-25 Online:2020-07-24
Contact: WAN Li-hong E-mail:wanlh@mail.sysu.edu.cn
Supported by:
Guangzhou Special Program for Scientific Knowledge(201609010050);Guangdong Special Program for Scientific Development(2016A020215039)

摘要/Abstract

摘要：

目的探讨健康信念综合提醒系统对脑卒中患者出院后6个月健康知识、信念、行为、卫生服务利用情况及临床结局的效果。方法 2015年2月至2016年3月,方便抽样广州市3家综合医院高血压并发缺血性脑卒中出院患者174例,分为对照组(n = 87)和干预组(n = 87)。对照组予常规健康教育;干预组在此基础上采用“基于健康信念模式的综合提醒系统”进行健康教育和延续护理。出院6个月后,采用脑卒中健康知识问卷(SKQ)、脑卒中患者健康信念简表(SF-HBMS-SP)和脑卒中健康行为量表(HBS-SP)进行调查,并记录临床结局(急诊就诊、再住院、复发和死亡)。结果对照组75例、干预组76例完成调查。干预组SKQ (U = 903.000)、SF-HBMS-SP (t = -9.099)和HBS-SP (t = -7.786)总分均显著高于对照组(P < 0.001)。干预组门诊复诊率(97.37%)显著高于对照组(76.00%) ( P <0.001);两组急诊就诊数和再住院数无显著性差异(P > 0.05),死亡和复发率无显著性差异( P > 0.05)。结论健康信念综合提醒系统能提高脑卒中患者出院后健康知识、信念、行为和门诊复诊率,但尚未对临床结局产生明显效果。

关键词: 脑卒中, 健康信念综合提醒系统, 健康教育, 知识, 信念, 行为

Abstract:

Objective To investigate the effect of Comprehensive Reminder System Based on Health Belief Model (CRS-HBM) on health knowledge, belief, behaviors, utilization of health services and clinical outcomes in stroke patients after discharge. Methods From February, 2015 to March, 2016, 174 stroke patients with hypertension were divided into control group (n = 87) and intervention group (n = 87). The control group received routine stroke health education, and the intervention group received the CRS-HBM program in addition. They were investigated with Stroke Knowledge Questionnaire (SKQ), Short Form Health Belief Model Scale for Stroke Patients (SF-HBMS-SP), Health Behavior Scale for Stroke Patients (HBS-SP), and the utilization of health services and clinical outcomes (emergency, re-hospitalization, recrudescence and death) were recorded six months after discharge.Results A total of 75 cases in the control group and 76 in the intervention group finished the research. The total scores of SKQ (U = 903.000), SF-HBMS-SP (t = -9.099) and HBS-SP (t = -7.786) were more in the intervention group than in the control group (P< 0.001). The outpatient re-visit rate was more in the intervention group (97.37%) than in the control group (76.00%) (P< 0.001). The incidence of emergency, re-hospitalization, recrudescence and death were not significantly different between the two groups (P > 0.05). Conclusion The application of CRS-HBM can improve the health knowledge, belief, behaviors for stroke patients after discharge, but there are not enough effects on clinical outcomes.

Key words: stroke, Comprehensive Reminder System Based on Health Belief Model, health education, knowledge, belief, behavior

中图分类号:

R743.3

沈梦杰,王霄,谭菊香,王少洲,张迎梅,万丽红. 综合提醒系统对脑卒中患者出院6个月知信行和临床结局的效果[J]. 《中国康复理论与实践》, 2020, 26(7): 856-862.

SHEN Meng-jie,WANG Xiao,TAN Ju-xiang,WANG Shao-zhou,ZHANG Ying-mei,WAN Li-hong. Effect of Comprehensive Reminder System on Health Knowledge, Belief and Behaviors, and Clinical Outcomes for Stroke Patients Six Months after Discharge[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 856-862.

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参考文献 32

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项目		对照组(n = 75)	干预组(n = 76)	χ²值	P值
性别	男	50	50	0.013	0.909
	女	25	26
年龄(岁)	35~44	5	2	2.571	0.261
	45~59	30	25
	60~86	40	49
文化程度	小学及以下	12	12	6.801	0.079
	初中	20	29
	高中及中专	33	19
	大专及以上	10	16
首发/复发	首发	59	49	3.733	0.053
	复发	16	27
病程(年)	0~< 1	61	53	3.301¹⁾	0.196
	1~< 2	2	6
	2~26	12	17
mRS评分	0	33	34	2.799	0.247
	1	33	26
	2~3	9	16
高血压病程(年)	0~< 1	23	10	7.283	0.122
	1~< 5	18	25
	5~< 10	8	10
	10~< 15	13	13
	15~45	13	18

项目	对照组(n= 75)	干预组(n= 76)	U/t值	P值
SKQ^a
总分	69.17±21.81	72.21±20.46	2643.00	0.440
运动锻炼	73.33±44.52	72.37±45.01	2822.50	0.894
营养	67.33±39.84	75.66±35.11	2551.00	0.206
低盐饮食	52.00±50.30	67.11±47.30	2419.50	0.059
戒烟	73.33±44.52	71.05±45.65	2785.00	0.755
限酒	84.00±36.91	80.26±40.07	2743.50	0.550
服药	54.67±40.51	57.46±40.59	2738.00	0.664
血压监测	74.00±32.22	76.32±31.06	2748.00	0.664
脑卒中危险因素	67.87±27.82	70.00±27.81	2692.50	0.554
脑卒中先兆	84.44±28.65	88.60±24.07	2671.50	0.390
脑卒中处理	68.00±46.96	72.37±45.01	2725.50	0.559
SF-HBMS-SP
总分	4.01±0.52	4.15±0.42	-1.872	0.063
易感性	3.97±0.65	4.18±0.72	-1.956	0.052
严重性	3.97±0.89	4.22±0.71	-1.915	0.057
健康动力	4.52±0.77	4.69±0.47	-1.615	0.108
自我效能	4.29±0.75	4.38±0.60	-0.837	0.404
益处	4.43±0.72	4.48±0.55	-0.481	0.631
障碍^b	2.92±0.95	3.06±1.04	-0.839	0.403
HBS-SP
总分	2.50±0.42	2.53±0.52	-0.374	0.709
HPLPⅡ运动锻炼	1.79±0.63	1.96±0.63	-1.677	0.096
HPLPⅡ营养	2.56±0.55	2.61±0.63	-0.517	0.606
低盐饮食	2.84±1.12	2.84±1.12	-0.012	0.991
血压监测	2.28±1.13	2.41±1.28	-0.650	0.516
戒烟^b	3.25±1.21	3.24±1.24	0.083	0.934
限酒^b	3.73±0.58	3.71±0.73	0.213	0.831
服药^b	3.26±0.86	2.96±0.99	1.985	0.050

项目	对照组(n = 75)	干预组(n = 76)	U/t值	P值
SKQ^a
总分	79.08±16.74	92.98± 7.04	903.000	< 0.001
运动锻炼	80.33±40.08	98.46±12.40	1623.000	0.001
营养	77.87±37.11	98.46± 8.70	1449.500	< 0.001
低盐饮食	60.66±49.26	96.92±17.40	1263.500	< 0.001
戒烟	83.61±37.33	100.00±0.00	1657.500	0.001
限酒	90.16±30.03	100.00±0.00	1787.500	0.010
服药	69.40±35.64	99.49± 4.13	996.500	< 0.001
血压监测	81.97±25.87	97.69±10.57	1390.000	< 0.001
脑卒中危险因素	77.21±20.91	85.23±15.82	1493.500	0.015
脑卒中先兆	91.80±20.78	95.90±15.03	1786.000	0.097
脑卒中处理	86.89±34.04	98.46±12.40	1753.000	0.012
SF-HBMS-SP
总分	3.90±0.52	4.59±0.30	-9.099	< 0.001
易感性	3.98±0.62	4.67±0.47	-6.969	< 0.001
严重性	3.77±0.72	4.62±0.51	-7.628	< 0.001
健康动力	4.25±0.73	4.83±0.36	-5.670	< 0.001
自我效能	4.18±0.66	4.70±0.45	-5.173	< 0.001
益处	4.28±0.74	4.77±0.41	-4.539	< 0.001
障碍^b	3.01±0.86	4.00±0.73	-6.997	< 0.001
HBS-SP
总分	2.75±0.40	3.23±0.35	-7.786	< 0.001
HPLPⅡ运动锻炼	2.00±0.58	2.77±0.57	-8.294	< 0.001
HPLPⅡ营养	2.87±0.52	3.12±0.46	-3.069	0.003
低盐饮食	3.15±0.93	3.68±0.70	-4.035	< 0.001
血压监测	3.20±1.07	3.59±0.75	-2.610	0.010
戒烟^b	3.40±1.13	3.75±0.64	-2.347	0.021
限酒^b	3.91±0.34	3.91±0.41	-0.020	0.984
服药^b	3.34±0.81	3.87±0.39	-5.063	< 0.001

综合提醒系统对脑卒中患者出院6个月知信行和临床结局的效果

Effect of Comprehensive Reminder System on Health Knowledge, Belief and Behaviors, and Clinical Outcomes for Stroke Patients Six Months after Discharge

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