Application Of Health Coaching In Self-management Of Hypertensive Patients

Background As a major risk factor for cardiovascular disease,hypertension not only endangers the physical and mental health of human beings,but also increases the medical burden of diseases in society.At the same time,as a lifestyle disease,the treatment of hypertension depends not only on drugs,but also on patients' good self-management.Our country current self-management model of hypertension lacks effective self-management support,which makes patients' self-management level low and lack of continuity in healthy behavior.Health coaching is a kind of self-management support technology which cooperates with patients to help them seek self-direction and lasting change,and promote the health and well-being.The application of health coaching in self-management of hypertensive patients helps to promote the transformation of their health behaviors and reduce the overall risk of complications such as cardiovascular disease.Objective This project is aim to construct the health coaching intervention program for hypertensive patients based on health coaching,to evaluate the application effect of health coaching in self-management of patients with hypertension,and providing experience for future research.Methods1.Through the literature to review the theoretical basis of health coaching,construct a theoretical framework,and form a preliminary draft of the health coaching intervention program in conjunction with the domestic guidelines of hypertension management and education;Experts were invited to implement semi-structured interviews,and conducted topic analysis to improve the intervention program,and finally through the pre-test to examine the applicability of the intervention program and form a final draft.2.Randomized controlled study was conducted in 106 hospitalized hypertensive patients from January to April 2018.The experimental group was divided into two groups according to random number table.There were 53 patients in the intervention group and the control group.The former used interventions based on health coaching,while the latter used routine hypertension health education.After three months,the results were evaluated.The main results included systolic blood pressure,diastolic blood pressure,blood pressure control rate and self-management behavior scores.Secondary outcomes included body weight,body mass index and self-efficacy scores.The General Data Collection Questionnaire(GDCQ),the Hypertensive Patient Self-Management Behavior Scale(HPSMBS),and the General Self-Efficacy Scale(GSES)were used as baseline survey and outcome assessment tools.The GDCQ included demographic data and disease data;The HPSMBS includes 4 dimensions,21 dimensions:8 questions for treatment management,5 questions for diet and exercise management,5 questions for living habits management and 3 questions for risk factor management.The GSES has 6 items,including role function,symptom management,emotional control and doctor communication.The statistical processing of all data was analyzed by SPSS 22.0 statistical software.The specific statistical methods were t-test,chi-square test,etc,and the difference was statistically significant at P<0.05.Results1.Through the literature research,semi-structured interviews,pre-tests to determine the final intervention program "Health Coaching Intervention Manual",the manual includes health coaching theory guidance,the role and responsibilities of health coaches and specific operational procedures.2.Results of the pre-intervention baseline survey shown there was no statistically significant difference between two groups of general data(age,gender,ethnicity,marital status,education level,monthly income,height,weight,source of medical expenses,years of hypertension,grade of hypertension,presence or absence of other diseases)and the baseline data of each observation index(systolic blood pressure,diastolic blood pressure,blood pressure control rate,body mass index,self-management behavior and self-efficacy score),P>0.05.So the data was balance and comparable between the two groups.3.After the intervention,the blood pressure decreased significantly in two groups.The systolic blood pressure and diastolic blood pressure of the intervention group were significantly lower than those of the control group(P<0.05).The blood pressure control rate of the two groups was significantly improved.The intervention group increased from 35.8%to 88.7%and the control group increased from 43.1%to 72.5%,and the blood pressure control rate of the intervention group was better than that of the control group,and the difference has statistical significance(P<0.05).4.After the intervention,the self-management behavior of the intervention group was significantly improved.The total score of HPSMBS increased by 14.21 ±5.80 compared with that pre-intervention.The scores of treatment management,diet and exercise management,living habits management and risk factors management increased by 5.04 ± 3.64,4.92±3.13,2.17 ±2.27,1.81±2.11,respectively,compared with those in pre-intervention.And the difference has statistical significance(P<0.05);Compared with pre-intervention,the total HPSMBS' score of the control group increased by 3.82±3.19,and the scores of treatment management,diet and exercise management,risk factors management increased by 1.76±2.21,1.29±1.88,0.63±1.40 respectively.But the living habits management score was not statistically significant(P>0.05).Comparing the two groups,the HPSMBS total score and the change scores of each dimension in the intervention group were better than the control group,and the difference has statistical significance(P<0.05).5.After the intervention,the self-efficacy level of the experimental group and the control group was significantly improved compared with pre-intervention.The GSES scores of the two groups increased by 8.09±6.51and 3.55±3.95 respectively,and the intervention group was higher than the control group,and the difference has statistical significance(P<0.05)6.After the intervention,the body weight of the intervention group decreased by 0.70± 1.17,but the decline was limited.The body mass index decreased by 0.22±0.45,and the difference has statistical significance(P<0.05).There was no significant difference in body weight and body mass index in the control group(P>0.05).The weight loss of the intervention group was higher than that of the control group(P<0.05)Conclusions1.Health coaching intervention program is effective and feasible in self-management of hypertensive patients;2.Health coaching can effectively promote the transformation of healthy behaviors of hypertensive patients and enhance their self-efficacy,thus improving self-management;3.Health coaching can improve the blood pressure control rate of hypertensive patients,and effectively reduce systolic blood pressure,diastolic blood pressure,thereby reducing the occurrence of complications such as cardiovascular disease;4.Health coaching help to control patient weight,which is a potential management method;5.Both intervention modes can improve the self-management level of patients with hypertension.The intervention mode based on health coaching is superior to the conventional health education intervention mode.