摘要
背景 老年慢性病患者记忆力与生活自理能力逐渐下降,仅依靠其个人力量进行疾病的自我管理难以达到良好效果,需要更多来自他人的帮助.在对老年慢性病患者进行健康教育时不能仅单独面向老年人,更需要充分利用患者的社会网络,让其社会网络成员参与到老年患者的疾病管理中,以更有效地提高患者的自我管理能力.目的探讨基于患者社会网络的健康教育对社区老年慢性病患者自我管理能力的影响.方法 招募 2021 年 3 月—2022 年6 月在北京方庄社区卫生服务中心、清华长庚医院门诊、北京医院内分泌门诊就诊及红联村社区的老年慢性病患者,采用电脑生成的随机数字表,将患者按照招募入组的顺序各自进行编号,奇数为干预组,偶数为对照组,按照 1∶1随机分为干预组和对照组,干预组给予老年患者+其社会网络成员健康教育,对照组给予患者健康教育,干预周期 12个月;在干预前、干预第 6 个月、干预第 12 个月应用慢性病自我管理研究测量表(CDSMS)评估慢性病自我管理的效果,使用Lubben社会网络量表简表(LSNS-6)测评患者社会网络水平.结果 80 例患者入组,其中 1 例患者(对照组)因研究期间两次住院退出研究,最终 79 列患者完成研究:干预组患者 40 例+其社会网络成员 40 例,对照组39 例.CDSMS自我管理行为分量表的运动锻炼维度、认知性症状管理维度及自我效能分量表的时间与分组存在交互作用(F交互分别为 7.174、8.488、9.939,P<0.05);时间在CDSMS两个分量表上主效应显著(F时间分别是 13.527、12.188、7.576、5.058,P<0.05);分组在CDSMS自我管理行为分量表的三个维度上主效应显著(F分组分别是12.324、7.383、5.927,P<0.05).干预第6个月,干预组CDSMS运动锻炼维度得分高于对照组(t=2.852,P=0.006);干预第12个月,干预组CDSMS运动锻炼维度得分高于对照组(t=4.473,P<0.05)、认知性症状管理维度得分高于对照组(t=-2.780,P=0.005)、自我效能分量表得分高于对照组(t=2.993,P=0.004).结论 为期 12 个月的基于患者社会网络的健康教育,可改善老年慢性病患者的部分自我管理行为,提高自我效能水平.
Abstract
Background The memory and self-care abilities of older adults with chronic diseases are gradually declining,and relying solely on their personal strength for disease self-management is difficult to achieve good results,requiring more help from others.When providing health education to older adults with chronic diseases,it is not only necessary to focus solely on the elderly,but also to fully utilize the patient's social network and involve social network members in the disease management of the patients,to more effectively improve their self-management ability.Objective To explore the impact of social network-based health education on the self-management ability of older adults with chronic diseases in community.Methods From March 2021 to June 2022,older adults with chronic diseases who visited Beijing Fangzhuang Community Health Service Center,Clinic of Tsinghua Changgeng Hospital and Endocrinology Clinic of Beijing Hospital,Hongliancun Community were recruited.Using a computer-generated random number table,the older adults were assigned numbers in the order of recruitment,with odd numbers being intervention group and even numbers being control group.They were randomly divided into an intervention group and a control group in a 1∶1 ratio.The older adults in the intervention group received health education with their social network members,while those in the control group received health education alone.The Chronic Disease Self-Management Study Scale(CDSMS)was used to evaluate the effectiveness of chronic disease self-management before intervention,at the 6th and 12th months of intervention,meanwhile the Lubben Social Network-6(LSNS-6)was used to assess their social network level.Results Eighty older adults with chronic diseases were enrolled,of which 1 patient(in control group)withdrew from the study due to two hospitalizations during the study period.Finally,79 older adults completed the study:40 older adults in the intervention group+40 members of their social network,and 39 older adults in the control group.The exercise dimension,cognitive symptom management dimension of self-management behavior subscale,and self-efficacy subscale of CDSMS had an interactive effect on time and grouping(Finteration-values were 7.174,8.488,and 9.939,respectively,P<0.05);The main effect of time on the two subscales of CDSMS was significant(Ftime-values were 13.527,12.188,7.576,5.058,respectively,P<0.05);The main effects of grouping on three dimensions of CDSMS self-management behavior subscale were significant(Fgroup-values were 12.324,7.383,5.927,respectively,P<0.05).At the 6th month of intervention,the CDSMS exercise dimension score in the intervention group was higher than that in the control group(t=2.852,P=0.006),the difference was statistically significant.At the 12th month of intervention,the CDSMS exercise dimension score in the intervention group was higher than that in the control group(t=4.473,P<0.05),the score of cognitive symptom management dimension was higher than that in the control group(t=-2.780,P=0.005),the self-efficacy subscale score was higher than that in the control group(t=2.993,P=0.004),the differences were statistically significant.Conclusion A 12-month social network-based health education can improve some of the self-management behaviors and self-efficacy with chronic diseases.
国家科技期刊平台
NSTL
万方数据