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  

Development and Evaluation of a Comprehensive Reminder System for the Promotion of Healthy Behaviors among Discharged Ischemic Stroke Patients

作　　者：万丽红[1] 莫苗苗[2] 张小培[2] 欧翠玲[3] 李玲[4] 阮恒芳[3] 卢玉为 陈少贤[6] WAN Li-hong MO Miao-miao ZHANG Xiao-pei OU Cui-ling LI Ling RUAN Heng-fang LU Yu-wei CHEN Shao-xian(School of Nursing, Sun Yat- Sen University, Guongzhou 510089, China Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China Department of Neurology, The Third Affiliated Hospital, Sun Yat - Sen University, Guangzhou 510630, China Department of Neurology, The First Affiliated Hospital, Sun Yat -Sen University, Guangzhou 510080, China Department of Neurology, Second Affiliated Hospital of Sun. Yat - Sen University, Guangzhou 510120, China School of Public Health, Sun Yat -Sen University, Guangzhou 510089, China)

机构地区：[1]中山大学护理学院,广东省广州市510089 [2]广东省中医院神经内科,广东省广州市510120 [3]中山大学附属第三医院神经内科,广东省广州市510630 [4]中山大学附属第一医院神经内科,广东省广州市510080 [5]中山大学附属第二医院神经内科,广东省广州市510120 [6]中山大学公共卫生学院,广东省广州市510089

出　　处：《中国全科医学》2017年第28期3548-3553,共6页Chinese General Practice

基　　金：广东省科技计划社会发展领域课题(2016A020215039);2016年广州市科普专项(201609010050)

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曁月历》(《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1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�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 February2015 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 of100. 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�

关 键 词：卒中 健康行为 病人出院管理 综合提醒系统 

分 类 号：R743.3[医药卫生—神经病学与精神病学]