| ObjectivesThis study aimed to explore the current situation,influencing factors,experience and needs of health management among people at high risk of stroke based on health ecology theory and self-determination theory.And then constructed and evaluated the effect of this health management model among these people.MethodsThis study included four parts.1.A cross-sectional study about health management of people at high risk of strokeA stratified cluster random sampling method was used to investigate 2500 people at high risk of stroke from one tertiary grade A hospital and six community health service centers in Zhengzhou city.SPSS 21.0 was used for descriptive analysis of frequency,percentage,mean and standard deviation,Pearson correlation analysis,One-way ANOVA and Logistic regression analysis.Mplus 8.0 was used for Latent class analysis of health behaviors of people at high risk of stroke.P<0.05 was defined as statistically significant difference.2.A qualitative study about health management experience of people at high risk of strokeAn objective sampling method was used to collect 31 people at high risk from one tertiary grade A hospital and six community health service centers in Zhengzhou city and semi-structured in-depth interviews were conducted.The results were transcribed,coded,analyzed and summarized by using Colaizzi’s seven steps method.3.A Delphi study of health management model and points of people at high risk of strokeOn the basis of previous research,theoretical guidance and literature review,the health management model and points of people at high risk of stroke were constructed by a research group.Delphi method was used to consult 20 relevant experts,and the expert positive coefficient,authority coefficient,coordination coefficient and variation coefficient were used to evaluate and modify the health management points.4.The application of health management model of people at high risk of strokeA similar experimental study was used to verify the health management model,and 130 patients were included in the intervention group and the control group respectively.Health knowledge,health belief,health behavior,social support,e-health literacy,stress and depression were assessed by questionnaire before intervention and 1 month,3 months and 6 months after intervention;blood pressure,blood glucose,blood lipid,body mass index and homocysteine were measured and analyzed.The mean,standard deviation,frequency and percentage were used for descriptive analysis.The differences between the two groups were compared by independent sample t-test,and the differences between the three groups and above at different time were analyzed by repeated measurement ANOVA for continuous data.The difference between the two groups was analyzed by x2 test or Fisher exact test for classification data.P<0.05 was defined as statistically significant difference.Results1.Finally,2236 valid questionnaires were collected,with an average age of 65.16(SD=8.69),of which 1516 cases(67.8%)were over 60 years old.The top three risk factors of stroke were hypertension(71.1%),dyslipidemia(55.5%),lack of exercise or light physical jobs(51.3%).The total scores of health knowledge,health belief,health behavior,social support,e-health literacy,perceived stress and depression were 11.70(SD=2.65),55.80(SD=9.86),134.58(SD=9.14),28.03(SD=4.49),21.62(SD=4.02),41.64(SD=5.86)and 37.60(SD=3.56).The scores of health knowledge,health belief,social support and e-health literacy were positively correlated with the scores of health behavior and its dimensions(all P<0.001),and the correlation coefficient ranged from 0.321 to 0.821.The scores of perceived stress and depression were negatively correlated with the scores of health behavior and its dimensions(all P<0.001),and the correlation coefficient ranged from-0.492 to-0.310.Model fit indices(AIC=257509.610,BIC=260228.733,Entropy=0.956)supported a three-class model of health behaviors.The latent classes were Class 1(a good level of adaptive health behavior,33%,n=738),Class 2(a moderate level of adaptive health behavior,36%,n=805),and Class 3(a poor level of adaptive health behavior,31%,n=693).One-way ANOVA showed that there were significant differences in health knowledge(F=5.007),health belief(F=16.632),health behavior(F=46.610),social support(F=11.632),e-health literacy(F=6.126),perceived stress(F=13.362)and depression(F=12.623)among the three groups(all P<0.001).Logistic regression analysis(Class 2 vs.Class 3)showed that age(OR=1.667,95%CI:1.279-2.036),education status(OR=0.847,95%CI:0.506-0.929),family income(OR=0.506,95%CI:0.301-0.853),health knowledge(OR=0.593,95%CI:0.557-0.862),health belief(OR=0.533,95%CI:0.468-0.602),social support(OR=0.482,95%CI:0.273～0.906),perceived stress(OR=2.412,95%CI:1.400-4.155)and depression(OR=880,95%CI:2.149-3.859)were predictors of health behavior(all P<0.05).Logistic regression analysis(Class 1 vs.Class 3)showed that gender(OR=1.533,95%CI:1.468-1.600),spouse(OR=0.624,95%CI:0.562-0.790),family income(OR=0.543,95%CI:0.468-0.636),health knowledge(OR=0.499,95%CI:0.273-0.706),health belief(OR=0.742,95%CI:0.330-0.889),e-health literacy(OR=0.824,95%CI:0.382-0.921)and perceived stress(OR=3.363,95%CI:2.872-3.938)were predictors of health behavior(all P<0.05).2.A total of 31 people at high risk of stroke were included,the ages ranged from 40 to 86,with an average age of 60.71(SD=11.55).The experiences of health management were categorized into 3 themes.Theme 1:Still facing many problems in health management,limited knowledge,lack of confidence and poor compliance.Theme 2:Accumulated some value experiences of coping with problems of health management,becoming active learners,promoting social interaction and enhancing self-health management.Theme 3:Sensitivity to multiple influencing factors,the severity and complexity of disease management,family income and economic burden and value of social support.3.In this part,18 experts were consulted for two rounds.In the first round,34 health management points in three management stages were obtained.In the second round,37 health management points in three management stages were obtained.The positive coefficient of experts in the first round and the second round were 90%and 100%respectively.The experts authority coefficients in the two rounds were 0.909.The Kendall’s W coefficient in the two rounds were 0.206(P<0.001)and 0.419(P<0.001)respectively.The variation coefficients in the two rounds were from 0.104 to 0.221 and from 0.100 to 0.212 respectively.4.There were 113 cases in the control group and 116 cases in the intervention group,excluding people who have failed to follow up or dropped up.The health knowledge(Ftime=394.525,Fgroup=205.995,Ftime-group=122.533),health belief(Ftime=275.099,Fgroup=211.847,Ftime-group=157.799),health behavior(Ftime=56.732,Fgroup=94.141,Ftime-group=26.570),e-health literacy(Ftime=3630.445,Fgroup=26.463,Ftime-group=26.570)and social support(Ftime=6784.437,Fgroup=71.919,Ftime-group=213.432)of the two groups increased with time(all P<0.05),before intervention and after intervention(1 month,3 months and 6 months),and the differences between groups were statistically significant(all P<0.05).There was interaction between time and group(all P<0.05).Independent sample t-test showed that the scores of intervention group were higher than those of control group at three time points after intervention,The differences were statistically significant(all P<0.05).The scores of perceived stress(Ftime=2266.253,Fgroup=4.417,Ftime-group=44.399)and depression(Ftime=2496.443,Fgroup=21.414,Ftime-group=73.654)of the two groups decreased with time(all P<0.05),and the differences between the two groups were statistically significant(all P<0.05),Independent sample Mest showed that the scores of the intervention group were lower than those of the control group at three time points after the intervention,and the differences were statistically significant(all P<0.05).The systolic blood pressure(Ftime=779.499,Fgroup=285.048,Ftime-group=464.579),diastolic blood pressure(Ftime=1504.121,Fgroup=328.545,Ftime-group=842.842),fasting blood glucose(Ftime=119.524,Fgroup=83.882,Ftime-goup=68.631),triglyceride(Ftime=964.589,Fgroup=1051.312,Ftime-group=643.915),fasting blood glucose(Ftime=119.524,Fgroup=83.882,Ftime-group=68.631),triglyceride(Ftime=964.589,Fgroup=1051.312,Ftime-group=643.915),low density lipoprotein(Ftime=267.211,Fgroup=215.008,Ftime-group=61.957)and homocysteine(Ftime=72.424,Fgroup=24.323,Ftime-group=50.064)of the two groups decreased with time(all P<0.05),before intervention and after intervention(1 month,3 months and 6 months),and the differences between groups were statistically significant(all P<0.05),at three time points after the intervention,the scores of the intervention group were lower than those of the control group,and the differences were statistically significant(all P<0.05).The glycosylated hemoglobin of the two groups decreased with time(Ftime=355.674,P<0.05),before intervention and after intervention(1 month,3 months and 6 months),and there was interaction between time and group(Ftime-group=31.904,P<0.05),and the difference was no statistically significant(Fgroup=3.277,P=0.071).There was no significant difference between the two groups at 1 month after the intervention(t=0.437,P=0.662),but there was significant difference between the two groups at 3 months(t=2.036,P=0.042)and 6 months(t=6.653,P=0.000)after the intervention.The scores of the intervention group were lower than those of the control group.The high fdensity lipoprotein(Ftime=332.099,P<0.01)of the two groups increased with the time(all P<0.05),before intervention and after intervention(1 month,3 months and 6 months),the difference between the two groups was statistically significant(Fgroup=213.690,P<0.01),there was interaction between time and group(Ftime-group=371.961,P<0.01),at three time points after the intervention,the scores of the intervention group were higher than those of the control group,and the differences were statistically significant(all P<0.05).The total cholesterol(Ftime=133.608,Fgroup=115.946,Ftime-group=23.813)and body mass index(Ftime=792.103,Fgroup=4.827,Ftime-group=192.510)of the two groups decreased with the time(all P<0.05),before intervention and after intervention(1 month,3 months and 6 months),and the difference between the two groups was statistically significant(all P<0.05).Independent sample t-test showed that there was no significant difference between the two groups at 1 month after intervention(all P>0.05),but there was significant difference between the two groups at 3 and 6 months after intervention.The scores of the intervention group were lower than those of the control group,and the differences were statistically significant(all P<0.05).After 6 months of intervention,the control rate of hypertension(χ2=14.794,P=0.000),hyperglycemia(χ2=21.233,P=0.000),hyperlipidemia(χ2=6.365,P=0.012),Obesity(χ2=5.445,P=0.020),high homocysteine(χ2=3.917,P=0.048),smoking(χ2=4.505,P=0.034),drinking(χ2=4.011,P=0.045)and lack of exercise(χ2=4.351,P=0.03 7)were higher than that of the control group,the differences were statistically significant(all P<0.05).Fisher exact test showed that there was no significant difference in the incidence of stroke between the two groups(P=0.442).Conclusions1.The types of health behaviors about people at high risk of stroke are complex.Older age and male gender are risk factors of health behavior,while having spouse,good education and family income are protective factors of health behavior.After controlling for sociodemographic variables,good health knowledge,health belief,social support and e-health literacy were protective factors of health behavior,while stress and depression were risk factors of health behavior.2.People at high risk of stroke have encountered many problems in health management experience and also accumulated some coping experience.Health management was affected by many factors.3.health management model for people at high risk of stroke based on health ecology theory is necessary,reliable and practical.4.The health management model of people at high risk of stroke can improve the health knowledge,health belief,health behavior,e-health literacy and social support of people at high risk of stroke,reduce the level of stress and depression,control blood pressure,blood glucose,blood lipid,body mass index and homocysteine.This can provide help for systematic health management of people at high risk of stroke in future. |
PDF Full Text Request