| Background In recent years,with the development of economy and changes in human life style,hypertension has become a major problem affecting the health of residents in China.It brings heavy burden to individuals,families and the society and is especially the major cause that leads to the decline in the quality of life of elderly patients,and even their death.Under the premise of the aging population,the health education for elderly patients with hypertension is particularly important.The empowerment theory was introduced into the field of health promotion by the American scholar in the early 1990 s,which was aimed to help the patients discover and develop their potential ability,increase patients' critical thinking and self-management ability,and change their behavior through self-direction.Nowadays,this concept is increasingly popular in medical and health services industry,especially the field of the health education of chronic diseases.Objectives In this study,we intervene the elderly patients with hypertension in the community in two ways.One is the traditional health education and the other is the health education based on empowerment theory.With the comparison of the effects of two different health education methods on the lifestyle,self efficacy,and the awareness rate of hypertension of the elderly patients with hypertension,the author explores effective interventions to improve the lifestyle of elderly patients with hypertension in the community with the expectation of its promotion later on.Methods The random sampling method was used to select 170 patients from the elderly hypertensive patients who had health records in the community health service center in the west of Jiaozuo.The object of the study was chosen in strict accordance with the inclusion criteria and exclusion criteria.The patients were randomly divided into experimental group and control group with the method of generating random Numbers.Before intervention the patients had to sign the informed consent.Prior to the intervention and 3 months after that,questionnaires were issued respectively to have a face to face questionnaire survey.All the survey work was undertaken by the researcher personally.Survey Content: A.General information questionnaire,including age,sex,education level,medical expenses and other information;B.Health promotion lifestyle scale,including six dimensions-health responsibility,nutrition,human relations,stress management,physical activity and mental growth;C.Self efficacy questionnaire,including four factors such as,the daily life,health behaviors,drug management and personal management;D.Hypertension knowledge questionnaire,evaluation of patients with hypertension knowledge awareness rate;E.Body weight,blood pressure compliance rate,evaluation of the effect of health education on the physiological indicators.The control group adopted the traditional health education,i.e.in the form of lectures on the high blood pressure knowledge.The lectures were held in the education room in the community health service center,with the use of multimedia facilities,once a month,and three times in total.Each time lasted for 30 ~ 60 minutes.The experimental group took the health education under the empowerment theory.The team members were uniformly trained before the intervention.Patients were divided into five groups.In each group,one team member acted as the educator,and was in charge of the group,with the researcher included.Education activities were held once every two weeks in the health education room in the community health service center.It lasted for 30 ~ 60 min each time and there were altogether six times.After each activity,a follow-up telephone call was made.The activities were carried out in accordance with the five steps of empowerment education : identifying the problems,expressing feelings,setting goals,making plans and the results evaluation.The first and second steps were designed to encourage and help patients to realize their responsibility to manage their disease,and identify the problems needed to be changed through emotion venting;The third and fourth steps were about the patients' setting up short-term and long-term goals on the basis of the existing problems,and offering the plan and steps to change;Step five was to help the patients evaluate the effect and review what they have learned in this process,etc.The educators guided the patients to find out the problems,solve the problems andencourage the patients' communication and experience sharing.The educators gave priority to listening,and discovered the patients' problems in self-management and blood pressure control through discussions and conversations.The targeted education was carried out according to the patients' actual problems.Goals and plans were recorded each time.After the input and processing of the data with Excel database,the data were counted and analyzed by SPSS 19.0,The composition differences between qualitative data were compared by chi square test;Quantitative data were expressed as mean plus or minus standard deviation,the normal distribution of the data between the groups were compared using independent samples t test,the difference before and after the group using paired samples t test,Non-normal distribution using non-parametric rank sum test,with P < 0.05 as the difference with statistical significance.Results 1.The survey results of the patients in the two groups before the intervention The differences of the general information in these two groups of patients are not statistically significant(P>0.05).They are comparable.The patients in these two groups have no statistically significant difference in the scores of every dimension and the total score of the health promotion way(P>0.05),both of these two groups are in the unhealthy category.There is no statistically significant difference between the two groups in self-efficacy(P>0.05),both of these two groups are at the average level.The difference of the knowledge awareness rate of the two groups is not statistically significant as well(t =0.286,P=0.776).Neither the difference in blood pressure target rate(X~2=0.39,P=0.532)nor in body weight(t =0.238,P=0.812)is statistically significant.2.Changes in the control group before and after intervention After the intervention,the total score and the scores of every dimension in health promoting lifestyle are improved,and the difference before and after the intervention is statistically significant.The scores of self-efficacy are increased as well.The comparison of the scores in health behavior before and after intervention shows no statistically significant difference(t =-0.956,P=0.342).The differences in other dimensions are statistically significant(P<0.05).Knowledge awareness rate is raised(t =-8.946,P=0.000)and the difference is statistically significant.There is statistically significant difference in weight loss too(t =9.863,P=0.000).3.Changes in the experimental group before and after the intervention After the intervention,both the scores of health promoting lifestyle and self-efficacy scores are improved,and the difference is statistically significant(P < 0.05).Knowledge awareness rate is raised from 48.02% to 79.79% and the difference is statistically significant(t =-6.894,P=0.000).Body weight falls from 67.53 kg to 65.91 kg,which shows statically significant difference(t =13.589,P=0.000).4.Comparison of the findings between the control group and the experimental group After the intervention,the scores the patients get in the experimental group are higher than that in the control group in health promoting lifestyle and self efficacy.The difference is statistically significant(P<0.05).The blood pressure target rate in the experimental group reaches 40.0%.Compared with the rate(24.70%)in the control group,the difference is statistically significant as well(X~2=4.31,P=0.038).The change values of both health promoting lifestyle and self efficacy in the experimental group are higher than that in the control group,and suggests statistically significant difference(P<0.05).There is no statistically significant difference between the two groups in knowledge awareness rate and body weight(P>0.05).Conclusions Health education based on empowerment theory can significantly improve the lifestyle of elderly patients with hypertension,improve their self efficacy level and the awareness rate of hypertension knowledge. |
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