基于行为转变阶段模型的患者教育对高血压患者服药行为和血压的影响研究  

Improving Medication-taking Behavior and Blood Pressure in Hypertensive Patients Using the Stages of Change Model-based Health Education

作　　者：孙昕霙[1] 郭怡 陈平[1] 何朝[2] SUN Xinying;GUO Yi;CHEN Ping;HE Chao(Department of Social Medicine and Health Education,School of Public Health,Peking University,Beijing 100191,China;Shunyi Center for Disease Control and Prevention,Beijing 101399,China)

机构地区：[1]北京大学公共卫生学院社会医学与健康教育系,北京市100191 [2]北京市顺义区疾病预防控制中心,101399

出　　处：《中国全科医学》2022年第10期1220-1226,1237,共8页Chinese General Practice

基　　金：北京市自然科学基金资助项目(7202087)。

摘　　要：背景近年来我国成人高血压一直呈现患病率高、控制率低的特点,而患者的服药行为是影响血压控制的重要因素之一。目的探讨应用行为转变阶段模型的患者教育是否能够促进高血压患者的服药行为。方法本研究为社区随机对照试验研究,2016年9月至2018年6月选取北京市顺义区基本情况(人口规模、医疗卫生条件等)相当的6家社区卫生服务中心的400例高血压患者为研究对象,以社区为单位用抛硬币方法随机分为两组,其中3家为干预组(206例),3家为对照组(194例)。对干预组开展3次基于行为转变阶段理论设计的健康教育,对照组则进行常规管理。分别于基线及干预3、6、12个月对两组患者进行以询问社会人口学状况、服药行为、服药障碍为主要内容的问卷调查和血压测量。结果完成第1次随访、第2次随访、第3次随访的患者分别为375例(干预组202例,对照组173例)、290例(干预组147例,对照组143例)、263例(干预组134例,对照组129例)。干预组在干预后12个月处于行动维持期的比例由基线时的27.7%(57/206)提高为60.5%(81/134),对照组处于行动维持期的比例由基线时的50.0%(97/194)降低为38.9%(49/129)。两组随访患者服药行为阶段广义估计方程模型结果显示,控制其他变量后,组别与随访时间点的交互项{干预组×3个月〔OR(95%CI)=3.928(2.628,5.870)〕、干预组×6个月〔OR(95%CI)=3.651(2.333,5.712)〕、干预组×12个月〔OR(95%CI)=4.133(2.315,7.377)〕}差异有统计学意义(P<0.05);与对照组×基线比较,干预组的收缩压在3个月〔b(95%CI)=-4.616(-8.558,-0.675)〕、6个月〔b(95%CI)=-4.348(-8.569,-0.127)〕、12个月〔b(95%CI)=-6.462(-11.208,-1.716)〕均存在积极的干预×时间交互效应(P<0.05);而舒张压在3个月〔b(95%CI)=-3.549(-6.271,-0.827)〕存在积极干预×时间交互效应(P<0.05)。结论本研究证明基于行为转变阶段模型的干预策略能够有效改善高血�Background Hypertension in Chinese adults has been featured by high prevalence and low control rate recently.And medication-taking behavior is one of the important factors greatly affecting hypertension control in this group.Objective To assess whether stages of change model(SCM)based-health education could improve medicationtaking behavior in hypertensive patients.Methods This cluster randomized controlled trial was conducted in six community health centers with comparable service population size and healthcare conditions selected from Shunyi District,Beijing during September 2016 to June 2018.By use of coin tossing,three of the community health centers were randomly assigned to an intervention group,and another three to a control group,from which,a total of 400 hypertensive patients were recruited,206 from the intervention group and 194 from the control group,receiving three times of SCM-based health education,and usual management,respectively.Questionnaire surveys and blood pressure measuring were performed in all participants at baseline,3,6 and 12 months after intervention for understanding of their sociodemographic characteristics,medication-taking behavior,blood pressure level and barriers to medication adherence.Results The patients who completed the 3-month,6-month and 12-month follow-up numbered 375(intervention:202,control:173),290(intervention:147,control:143)and 263(intervention:134,control:129),respectively.After the end of the 12-month intervention,the percentage of patients in action and maintenance stages increased from 27.7%(57/206)to 60.5%(81/134)in the intervention group,while that in the control group decreased from 50.0%(97/194)to 38.9%(49/129).Generalized estimating equations on action stage showed statistically significant inter-group differences in the interaction terms at group enrollment time and follow-up periods after controlling for other confounding variables(P<0.05),that was intervention group×3-month follow-up〔OR(95%CI)=3.928(2.628,5.870)〕,intervention group×6-month follow-u

关 键 词：高血压 健康教育 行为改变阶段模型 服药行为 广义估计方程 

分 类 号：R544.1[医药卫生—心血管疾病]