Research On Postoperative Health Behavior Of Total Hip Arthroplasty Patients Based On PRECEDE-PROCEED Model

Objective To investigate the health behavior,physical function,mental health and social environment of patients undergoing total hip arthroplasty to analyze the status and influencing factors of health behavior of THA patients after operation.Using PRECEDE-PROCEED model to find out its tendency factors,contributing factors and strengthening factors.Based on the influencing factors of health behavior,the nursing intervention program was formulated under the guidance of PRECEDE-PROCEED model,to explore the effect of this program on health behavior,joint function,social support,anxiety,depression and quality of life of patients after hip arthroplasty.Methods Study one is a cross-sectional survey: Using convenience sampling method,after the first total hip arthroplasty was conducted in First Affiliated Hospital of Anhui Medical University from October 2016 to January 2018,using general information questionnaire,Health Promotion Lifestyle Inventory(HPLPII),Harris Hip Joint Function Score Scale,Social Support Scale(SSRS),Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD).420 patients were surveyed by questionnaires.Study two is a kind of experimental study: 103 patients who underwent primary hip replacement in First Affiliated Hospital of Anhui Medical University from February 2018 to September 2018 were selected by convenience sampling method as the study subjects,51 in the control group and 52 in the intervention group.The control group received routine perioperative guidance,including health education,discharge guidance,outpatient review and telephone follow-up guidance.On the basis of the control group,the intervention group implemented the nursing intervention method based on PRECEDE-PROCEED model.Baseline survey was conducted when discharged.The intervention content included the evaluation results of five stages based on PRECEDE-PROCEED model theory,the formulation of targeted nursing interventionprograms for inclination factors,contributing factors and strengthening factors,and the self-realization of health behavior,health responsibility,exercise,nutrition and interpersonal relationship.Six dimensions of stress coping were intervened.The intervening period was 6 months.Health Promoting Lifestyle Inventory(HPLPII),Harris Hip Joint Function Score Scale,Social Support Scale(SSRS),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)and SF-36 were used to investigate the patients at discharge,1,3 and 6 months after operation.Results Study one: 1.The total score of health behavior of THA patients was(130.57±10.64).The average score of each dimension was(2.51 ± 0.20),which was in the middle level.Among all dimensions of health behavior,nutrition score was the highest,followed by stress coping,self-realization,interpersonal relationship and exercise,and health responsibility score was the lowest.Among 420 patients,3 patients(0.7%)had excellent health behavior,198 patients(47.1%)had good health behavior,208 patients(49.5%)and 11 patients(2.6%)had poor health behavior.2.Only 2 patients(0.5%)had excellent hip function score,59 patients(14.0%)had good hip function,167 patients(39.8%)and 192 patients(45.7%)had moderate and poor hip function score;3.The total score of social support for THA patients was(35.78±2.98)and that of social support was medium.420 patients had moderate social support;4.The anxiety score of THA patients was(13.84 ± 2.17)with anxiety symptoms;the depression score was(14.41 ± 1.97)with depressive symptoms;5.Influencing factors of health behavior in THA patients:Single-factor analysis of general demographic data showed that there were differences in health behavior level among patients with different gender,age,education level,source of medical expenses and awareness of contraindication posture and bad behavior after operation(P < 0.05).Multiple stepwise regression analysis showed awareness of contraindication posture and bad behavior and joints after operation.Function,social support and anxiety have effects on health behavior.Among them,contraindication posture and awareness of bad behavior,joint function and social support are positively correlated with health behavior,while anxiety level is negatively correlated with health behavior.Study two: There was no significant difference in general information,health behavior,joint function,social support,anxiety and depression level and quality of life between the intervention group and the control group at discharge(P > 0.05);and health behavior,joint function,social support and quality of life in the intervention group were higher than those in the control group at 1,3 and 6 months after operation(P < 0.05);The scores of anxiety and depression in the intervention group were lower than those in the control group 1,3 and 6 months after operation(P < 0.05).Conclutions 1.The health behavior of THA patients is in the middle level,especially the health responsibility is not ideal;2.The health behavior of THA patients is closely related to physiological,social and psychological factors.The main influencing factors are contraindication posture and bad behavior awareness,joint function,social support and anxiety level.The better the knowledge of contraindication posture and bad behavior,joint function and social support level,the lower the anxiety level,the higher the healthy behavior.To clarify the health behavior and its influencing factors of THA patients after operation is of reference significance for patients’ rehabilitation.Medical staff help patients develop beneficial physical,psychological and social adaptation health behaviors,provide targeted functional exercises and rehabilitation programs,enhance patients’ social support level,let patients know THA health information,reduce patients’ anxiety and improve patients’ health behavior level.3.Nursing intervention based on PRECEDE-PROCEED model,combined with the relevant factors affecting the health behavior of THA patients from a multi-dimensional perspective,focusing on tendency factor,promoting factor and strengthening Factor,formulated comprehensive intervention measures from the biological,psychological and social perspectives,intervened the bad life behavior after operation,urged patients to learn and master the knowledge and skills related to health behavior.To develop correct healthy behavior and living habits,improve the hip function of patients,reduce negative emotions,and ultimately improve the quality of life of patients.