On Family-based Community Health Education Towards Self-management Of Patients With Coronary Artery Disease

Purpose:1. to evaluate the effect of family-based health educationtowards self management of patients with coronary artery disease (CAD) inthe community, and determine whether this method is superior toconventional health education method so as to provide a basis for thecommunity to develop health education strategy;2. through theinvestigation of the marital quality, family care and family burden ofdisease of patients with coronary artery disease in the community, tounderstand the current family status and influences on the family life ofpatients with coronary artery disease in the community;3. to understandthe relevance of self efficacy, family burden of disease, marital quality andfamily care to the self management behaviors, and determine whether selfefficacy, family burden of disease, marital quality and family care haveinfluences on the establishment of self management behaviors, so as toprovide references to the further step of developing reasonable measuresfor the family-based community health education towards self managementof patients with coronary artery disease. Method: Based on the review of outpatients with coronary arterydisease of2third-grade class-A hospitals of Nanchong city,160patientswith coronary artery disease met with the inclusion criteria were sampledthrough the application of purpose sampling for the investigation through theself designed general questionnaire, family burden scale of disease, familyPAGAR scale, marital quality scale (2factors) and then the databaseinformation were established. On the basis of computer-generated randomnumber,160patients with coronary artery disease were divided into80patients in the intervention group and80patients in the control group, andthen the80patients with coronary artery disease in the intervention groupwere randomly divided into8sub-groups, going through6months of selfmanagement health education in10times of activities organized by8volunteers, specific program of activities referring to Guidance on HealthEducation Activities by professor Fuhua as the editor-in-chief, in addition,the family members of patients with coronary artery disease in theintervention group went through2times of activities of family heathmanagement education;80patients with coronary artery disease in thecontrol group were randomly divided into2groups, going through5monthsof conventional CAD health education in5times of activities, the familymembers of whose were not to participate in the health education process butparticipated in the last questionnaire. After the intervention, the self efficacyscale, self management scale, Seattle angina questionnaire and self designed CAD knowledge questionnaire were employed to evaluate the interventioneffect of two groups of experiments, and the test results of blood pressure,blood lipids as well as body mass index of the latest outpatient review to theintervention were collected and the database were established in the end.Results: Among160eligible patients,146patients fully completed theprocess of intervention, as76were in the intervention group,70were in thecontrol group and the response rate reached91.25%. There was no statisticalsignificance on the differences between the two groups in course of diseaseand population sociological features (P＞0.05). After6months ofintervention, there was notable statistical significance on the differencesbetween the two groups in self management behaviors (P＜0.01) as the selfmanagement behaviors of the intervention group was better than that of thecontrol group; there was notable statistical significance on the differencesbetween the two groups in4dimensions of angina pectoris stability, anginapectoris attacks, treatment satisfaction and understanding of disease (P＜0.01) as the intervention group was better than the control group in these4dimensions; there was notable statistical significance on the differencesbetween the two groups in the level of self efficacy (P＜0.01) as theintervention group had higher level of self efficacy than the control group;there was notable statistical significance on the differences between the twogroups in the test results in the laboratory including blood pressure, bloodlipids and body mass index (P＜0.01) as the intervention group had higher rate of blood pressure, blood lipids reaching the standard than the controlgroup; there was statistical significance on the differences between the twogroups in the rate reaching the standard of physical quality (P＜0.05) as therate reaching the standard of physical quality of the intervention group washigher than that of the control group; there was no statistical significance onthe differences between the two groups in the scores of knowledgequestionnaire for family members of patients with coronary artery disease(P＜0.01) as the family members of intervention group had higher scores;there was notable statistical significance on the differences between the twogroups in the annual average frequency of hospitalization (P＜0.01) as theannual average frequency of hospitalization of the intervention group wasfewer than that of the control group.146patients with coronary arterydisease had better marital satisfaction than that of domestic conventionalmodel (P＜0.01), but lower couple exchanges than of domestic conventionalmodel (P＜0.01);60.96%of146patients with coronary artery disease werein good family function but still39.04%of the patients with coronary arterydisease were in family dysfunction; according to the family burdeninvestigation of disease of146patients with coronary artery disease,economic burden (77.40%) and household daily activities (52.05%) wereranked the first and the second on the list of family burden of patients withcoronary artery disease. Scores of self efficacy survey showed significantpositive correlation with each dimension of self management scale of patients with coronary artery disease (P＜0.01); scores of family burden ofdisease showed significant positive correlation with bad habits management(P＜0.01), and significant negative correlation with cognitive emotionmanagement, emergency management, and treatment compliancemanagement (P＜0.01); scores of marital quality showed significantpositive correlation with bad habits management, cognitive emotionmanagement, and emergency management (P＜0.01); scores of family careshowed significant negative correlation with bad habits management andemergency management (P＜0.01). According to standardized regressioncoefficient, the influence of variables on the self management behavior wassorted by order from large to small: self efficacy (0.112)＞family burden ofdisease (-0.104)＞marital quality (0.065)＞family care (0.062).Conclusion: Family-based community health education and behavioralintervention towards self management of patients with coronary arterydisease benefits to establishing self management behaviors for the patientswith coronary artery disease, and has positive effects on improving the selfefficacy and quality of life of patients with coronary artery disease.Compared with conventional method of community health education,through the health management education on the family members of patientswith coronary artery disease, it may assist and supervise the patients withcoronary artery disease to perform a variety of health behaviors to a certainextent, and it may also be related to harmonize the family relationship of patients with coronary artery disease. The establishment of self managementbehaviors was affected by the self efficacy, family burden of disease andmarital quality. In this survey, the patients with coronary artery disease in thecommunity bore heavy family burden, in which economic burden was moreprominent; most patients with coronary artery disease were in good familyfunction but part of them were in family dysfunction, which was quite a fewproportions, and should be the nursing focus of the caregivers of community;with higher marital satisfaction in marital quality than the patients withcoronary artery disease in domestic conventional model, in addition that thissurvey was mainly on the aged patients with coronary artery disease, itindirectly reflected the marital model of the elderly in this community wassuccessful.