Application Of Nursing Intervention Based On Integrated Health Behavior Change Theory In Postoperative Self-management Of Breast Cancer Patients

ObjectiveBased on the integrated theory of health behavior change,the postoperative self-management nursing intervention scheme for breast cancer patients was constructed,and the influence of the scheme on patients’ postoperative self-management ability,postoperative exercise compliance,shoulder joint function and postoperative complications was discussed.MethodsPart one: Constructing the self-management intervention program after breast cancer surgery based on the integrated theory of health behavior changeDomestic and foreign databases were searched to find relevant literature on the application of integrated theory of health behavior change in different populations and postoperative self-management nursing intervention of breast cancer patients.Through literature screening and literature methodology quality evaluation,information analysis and evidence summary were carried out on the final included literature,and intervention programs were preliminarily formulated based on the theoretical implementation steps.After discussion at expert meeting and preliminary test,further improvement was made and the final intervention plan was determined.Part two: Application of self-management intervention program after breast cancer based on integrated theory of health behavior changeAccording to the inclusion and exclusion criteria,breast cancer patients admitted to a grade-III Class A general hospital in Henan Province from December 2021 to September 2022 were selected.The intervention group was set in the first breast ward,and the control group was set in the second breast ward.According to the order of admission of patients,the sample number was gradually accumulated by block randomized method.Finally,44 patients were included in each of the two groups.The control group received routine nursing,and the intervention group implemented nursing intervention program based on the integrated theory of health behavior change on the basis of control group.The evaluation indexes were self-management ability,postoperative exercise compliance,shoulder joint function and postoperative complication rate.Data were collected before intervention,1 month after intervention,2 months after intervention and 3 months after intervention.Excel was established for data entry,SPSS 25.0 was used for data analysis,statistical description,t test of two independent samples,repeated measurement analysis of variance,rank sum test,Chi-square test and other methods were used.Result1.Through literature review of the application group of the integrated theory of health behavior change and a Chinese and English search of the literature on self-management of breast cancer patients published from the database to December 2021,13 RCT studies were finally included through literature screening.Through the evaluation of literature quality and the summary of the best evidence in the literature,combined with the implementation steps of the integrated theory of health behavior change,the nursing intervention measures were summarized to form the first draft of the self-management nursing intervention plan for breast cancer patients.After discussion at expert meetings and pre-trials,the preliminary intervention plan was revised,and the final self-management intervention plan based on the integrated theory of health behavior change after breast cancer surgery was formed.2.In this study,88 patients were included.During the intervention process,2 patients in the control group and 2 patients in the intervention group were lost to follow-up,and 42 patients in the control group and the intervention group respectively completed the study.There was no significant difference in baseline data between the two groups before intervention(P>0.05).3.Before intervention,there was no statistical significance in the self-management behavior of patients in the two groups in each dimension and total score(P>0.05).At 1 month,2 months,3 months after intervention,the total score of self-management behavior and scores in each dimension of patients in the intervention group were higher than those in the control group,and the difference was statistically significant(P<0.05).Repeated measures analysis of variance showed that there were time effects(F=66.992,P<0.001),intergroup effects(F=51.933,P<0.001),and interaction effects(F=8.365,P<0.001)between the two groups of patients at each time points.4.The postoperative exercise compliance score of the two groups was compared,and the results showed that the exercise compliance score of the intervention group was higher than that of the control group at 1 month,2 months and 3 months after the intervention,the difference was statistically significant(P<0.05).Repeated measurement analysis of variance showed that there were time effect(F=88.450,P<0.001),intergroup effect(F=13.822,P<0.001),and interaction effect between time and group(F=4.972,P=0.010)on exercise compliance scores in the two groups at each time points.5.Before intervention,there was no significant difference in shoulder joint function scores between the two groups(P>0.05).The shoulder joint function scores of the intervention group were higher than those of the control group at 1,2 and 3 months after intervention,and the difference was statistically significant(P<0.05).Repeated measures analysis of variance showed that there were time effect(F=2478.803,P<0.001),intergroup effect(F=12.590,P<0.001),and interaction effect(F=4.643,P=0.006)between the two groups of patients at each time point in the shoulder joint function score.6.There was significant difference in the incidence of postoperative complications between the two groups after intervention(P<0.05).Conclusion1.Based on literature search,expert meeting discussion and pre-test results,this study established an integrated health behavior change integrated nursing intervention plan for breast cancer patients after surgery,ensuring the feasibility and scientific nature of the intervention plan.2.Nursing intervention program based on the integrated theory of health behavior change can improve the postoperative self-management ability,postoperative exercise compliance and shoulder joint function of breast cancer patients,and prevent and reduce the occurrence of postoperative complications.