An Intervention Study On Self-management Of Middle-aged Stroke Patients Based On Health Beliefs And Theory Of Planned Behavior

ObjectiveTo construct a self-management intervention program for middle-aged stroke patients based on the integrated theory of Health Belief Model(HBM)and Theory of planned behavior(TPB),and explore the impact of self-management ability and quality of life.In order to improve providing important evidence for improving the selfmanagement ability,daily activities and quality of life of middle-aged stroke patients.MethodsThis study is based on the integrated theory model of health belief and planned behavior.On the basis of literature review and group discussion,in combination with relevant national norms and guidelines,15 experts in related fields of neurology were consulted by Delphi method for two rounds to determine the self-management intervention plan for middle-aged stroke patients.Using the convenience sampling method,according to the inclusion criteria,70 first-middle-aged stroke patients who were hospitalized in the first ward and fourth ward of neurology in a tertiary Class A hospital in Qingdao from May to September 2019 were selected as the research objects.According to the ward included in the study,the study objects included in the first ward were the control group,and the study objects included in the fourth ward were the intervention group,with 35 cases in each group.The control group is received routine neurological treatment and healthy education,and received two telephone follow-ups after discharge.On this basis,the intervention group is received self-management intervention based on integrated model health belief and theory of planned behavior,including 3 healthy education programs during hospitalization and 3 months of health education after discharge.Using stroke self-management behavior rating scale,Barthel Index(BI),quality of life scale for stroke and stroke prevention knowledge questionnaire,respectively in 1 months after intervention,3 months after intervention and intervention before to compare two groups of patients self management ability,daily life capacity,quality of life and stroke prevention knowledge.Statistical methods such as chi-square test,t-test,rank sum test and repeated measures analysis of variance were used to analyze the data by SPSS 22.0 software to evaluate the application effect of self-management intervention program based on the integration theory of health belief and planned behavior.Results1.The positive coefficients of the two rounds of consultation experts were 88.24% and 100%;the authoritative coefficients of the two rounds of consultation experts were 0.85 and 0.87;the coordination coefficients(Kendall’s W)of the two rounds of consultation experts were 0.314 and 0.334(P <0.05).After two rounds of expert letter consultation,the intervention programs for self-management of middle-aged stroke patients was finally determined.2.Effect evaluation of the self-management program for middle-aged stroke patients based on the integration theory of health belief and planned behavior:(1)1 month after the intervention and 3 months after the intervention,the total selfmanagement scores of the intervention group were(189.39 ± 6.30)points and(221.36 ± 3.27)points,and the total self-management scores of the control group patients were(141.59 ± 7.91)points and(154.65 ± 5.54)points,the total self-management score of the intervention group was higher than that of the control group(P <0.05);the scores of each dimension in the intervention group were higher than those in the control group at 1 and 3 months after intervention(P < 0.05).(2)1 month after intervention,there was no significant difference in stroke treatment score between the intervention group and the control group(P = 0.132).Except for the dimension of stroke treatment,the total score of stroke prevention knowledge and scores in other dimensions in the intervention group were higher than those in the control group(P <0.05).Three months after the intervention,the total score of stroke prevention knowledge and the scores of all dimensions in the intervention group were higher than those in the control group(P <0.05).(3)1 month after the intervention and 3 months after the intervention,the total scores of daily activities of the intervention group were(64.09 ± 8.24)points and(90.00 ± 6.00)points,and the total scores of the daily activities of the control group were(57.65 ± 6.88)points and(70.00 ± 5.90)points,the total score of daily activities of patients in the intervention group was higher than that of the control group(P <0.05).(4)1 month after the intervention and 3 months after the intervention,the total quality of life scores of the patients in the intervention group were(192.03 ± 5.64)points and(227.21 ± 3.77)points,and the total quality of life scores of the patients in the control group were(162.50 ± 4.53)points and(195.74 ± 4.63)points,the total quality of life scores of patients in the intervention group were higher than the control group(P <0.05);the scores of each dimension in the intervention group were higher than those in the control group at 1 and 3 months after the intervention(P < 0.05).ConclusionThe self-management intervention program for middle-aged stroke patients based on the integrated model of health belief and theory of planned behavior has high expert enthusiasm and authority,high consistency in the evaluation of intervention program by letter consultation experts,and consensus in expert opinions.The intervention plan is scientific to a certain extent.This intervention program is conducive to improving the self-management behavior of middle-aged stroke patients and their self-management capabilities;It is conducive to strengthening the learning of stroke prevention and treatment knowledge for middle-aged stroke patients;it is conducive to improving the daily life ability and quality of life of middle-age stroke patients,and enhancing their confidence in returning home and society.