| Objective:To investigate the quality of life and self-management level of patients with coronary heart disease and the cognitive level of prevention knowledge;to analyze the effect of the cross-theoretical model combined with the 5A nursing model on the quality of life and self-management behavior after the application of health education to patients with coronary heart disease,to explore the secondary prevention effect of health education model;and to find a health education model for secondary prevention of coronary heart disease with high feasibility,strong operability,low cost and high benefit.Methods:The inclusion and exclusion criteria of this study were determined,and148 eligible subjects were selected based on this.the patients were grouped according to the inpatient receiving ward,each with 74 cases,at patient enrollment,baseline data pairs were surveyed using the General Information Questionnaire,PKS-CHD,CSMS,Behavior Change Stage Assessment Scale,and CQQC,in order to understand the basic conditions of the patients,and compare the differences between the groups.The control group received nursing care through the routine clinical cardiology system nursing mode during the hospitalization stage,and carried out health education work in a routine manner;while the intervention group was based on the above conditions,Intervene it through the health education method of cross-theoretical model combined with 5A nursing model,to evaluate different behavioral stages,and to give appropriate intervention plans based on the evaluation situation,to give corresponding discharge guidance to patients before discharge,to follow up patients regularly after discharge,to intervene 1,3,6 At the end of 3 months and 6 months after the intervention of the patients,each scale or questionnaire was used to investigate the two groups of research subjects.The change of behavioral stage,knowledge level,self-efficacy,quality of life and the incidence of MACE were re-evaluated,and the changes in the scale scores of the patients before and after the intervention were compared and analyzed.Results:1 General informationA total of 140 patients with coronary heart disease completed this study,including 60 males（42.9%）and 80 females（57.1%）.The proportion of men and women is the same.The age range is 36 88 years old,and the average age is（62.54± 10.15）years old,by comparing the general information of the two groups,it was found that there were no significant differences in age,gender,living status,economic status,nature of work,marital status,type of medical insurance,caregivers,education level,complications and payment methods between the two groups（P > 0.05）.2 Knowledge levelThe results showed that there was no significant difference in the scores of disease-related knowledge between the two groups before intervention（P > 0.05）;At the end of 3 months and 6 months of intervention,the scores of relevant knowledge level of patients in the intervention group were significantly higher than those in the control group（P < 0.05）.The scores of knowledge level of patients in the two groups before intervention,after 3 months of intervention and at the end of 6 months of intervention were analyzed.The results showed that the scores of relevant knowledge of patients in the two groups were compared in different intervention time,intervention methods and the interaction between the two groups,The differences were statistically significant（P < 0.05）.3 Self-efficacyThe results of the study showed that there was no significant difference in the CSMS total score and each item between the two groups before the intervention（P>0.05）;At the end of 3 months and 6 months of intervention,the total score and items of CSMS in the intervention group were significantly different from those in the control group（P < 0.05）;At the end of the third month of intervention,the total score of CSMS in the intervention group increased significantly and was significantly higher than that in the control group.At the end of the sixth month of intervention,the total score of CSMS in the intervention group showed an upward trend,while that in the control group showed a downward trend,indicating that the health education of5 A nursing mode based on TTM model can improve the self-management behavior of patients.The total score and items of CSMS in the two groups before intervention、at the end of 3 and 6 months after the intervention were analyzed,The results showed that there were significant differences in the total score and items of CSMS between the two groups at different intervention timing or methods and their interaction（P <0.05）.4 Quality of lifeBefore the intervention,the CQQC total score of the intervention group was75.63±26.64,and the total score of the control group was 72.94±23.69.There was no significant difference in the total score of quality of life and the scores of each dimension item between the two groups（P>0.05）.The CQQC total score and each item score in the intervention group were higher than those in the control group,and the difference was statistically significant（P<0.05）.,the CQQC total score and each item score of the intervention group were higher than those of the control group,and were significantly higher than the control group,the difference was statistically significant（P<0.05）.,after the intervention,the total score of the quality of life of the intervention group was 106.81±24.15,and the total score of the control group was79.40 ± 23.44.After the intervention,the difference was statistically significant（P<0.05）,and the quality of life of the intervention group was significantly better after the intervention.In the control group,the differences in CQQC total scores between the two groups were statistically significant at different intervention time,intervention methods and their interaction（P<0.05）.5 Behavioral Change Stage AnalysisBefore the intervention,most of the 140 patients were in the unintentional stage and the intentional stage,accounting for 56.4%.After 3 months of the intervention,most of the patients in the intervention group were in the preparation stage and the action stage,25 and 22,respectively,with 1 remaining.In the unintentional stage,14 patients were in the intentional stage,and 8 patients were in the maintenance stage;12 patients in the control group were still in the unintentional stage,21 patients were in the intentional stage,17 patients were in the preparation stage and 12 patients were in the action stage,and 12 patients were in the maintenance stage.The stage is likewise with only 8 patients.There was a statistically significant difference in the behavioral stage between the two groups（P<0.05）,indicating that the intervention achieved certain effects in a short period of time,and most patients had progressed in the behavioral stage.With the extension of the post-intervention time,after 6 months of intervention,the number of people in the non-intention and intention stages of the intervention group gradually decreased,while the number of people in the action and maintenance stages gradually increased;the control group was mostly still in the intention and preparation stages.The difference was statistically significant（P<0.05）,indicating that the long-term intervention effect was consistent with the short-term effect,and the progress of the behavioral stage in the intervention group was still better than that in the control group.6 Rehospitalization rate and incidence of cardiac MACE in the two groupsWithin 6 months after the intervention,25 cases（35.7%）were rehospitalized in the control group and 10 cases（14.3%）in the intervention group.The results showed that the incidence in the intervention group was slightly lower than that in the control group（P<0.05）;Within 6 months after the intervention,the incidence of cardiovascular accidents in the two groups was 19 cases（27.1%）in the control group and 5 cases（7.1%）in the intervention group.There was significant difference between the two groups（P < 0.05）.Conclusion:There are many factors affecting the quality of life of patients with coronary heart disease,and many factors work together to make the quality of life of this group generally low.The disease and medical conditions are the most important factors affecting their quality of life.If patients with coronary heart disease have high self-efficacy,it is extremely beneficial to the improvement of their quality of life,and there is a positive correlation between the two.Compared with conventional health education,the cross-theoretical model combined with the 5A nursing model can significantly improve the self-management ability and quality of life of patients with coronary heart disease,reduce the incidence of cardiovascular accidents and readmission rates,and improve the effect of secondary prevention.This health education model evaluates and predicts the behavior change stage of patients with coronary heart disease,and gives the patients the content of education at the corresponding stage according to the prediction results,which can improve the effect of health education,and is more practical and feasible. |
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