| Research Purpose:It aims to determine the feasibility of an interactive pictorial health education program based on Behavior Change Wheel（BCW）theory in hypertensive patients with low high blood pressure-health literacy（HBP-HL）in community and its effect on HBP-HL,self-efficacy,self-management ability and health-related quality of life（HRQOL）.Research Methods:In this study,an interactive pictorial tool and a BCW theory-based interactive pictorial health management program was developed by expert consultation and pre-experimentation.Two communities with similar conditions within Wuxing district were screened and selected by a convenience sampling method.60 research subjects were screened in each community according to inclusion and exclusion criteria from the recruit research subjects.Using the coin toss method,the two communities will be randomly allocated to the intervention group and the control group.The control group received routine community health education of 30-40 min/session for 11 sessions.The intervention group received BCW theory-based interactive pictorial health education program of 30-40 min/session for 11 sessions.The outcomes were measured by Chinese-High Blood pressure-Health Literacy Scale（C-HBP-HLS）,Chronic Disease Self-Efficacy scale,Hypertension Patients Self-Management Behavior Rating Scale（HPSMBRS）and the Short-Form Health Survey（SF-36）at baseline（T0）,6 months（T1）,9 months（T2）,and 12 months（T3）from trial entry.Using Wilcoxon test,t-test,chi-square test,two-factor repeated measures ANOVA,or generalized estimating equation to evaluate the effectiveness of this health management program.Feasibility was evaluated by the retention rate of study subjects in the intervention group throughout the intervention.Research Results:A total of 120 hypertensive patients were recruited,and 10 were shed in the middle of the study.Finally,a total of 110 research subjects（54 in the control group and 56 in the intervention group）completed the health management program and four measurements.The final retention rate of the intervention subjects was 93.3%.1.Baseline: There were no statistically significant differences between the two groups in general demographic data,hypertension related clinical data and other outcomes（P>0.05）.2.HBP-HL: After the intervention,there were interactions effects for the total HBP-HL score,medication labeling dimension,latest vital signs and food allergy avoidance dimension scores in two groups.Simple effect analysis showed a significant increase（P<0.001）in the overall level of HBP-HL in the intervention group compared to the control group at T2 and T3 levels.3.Self-efficacy: After the intervention,there were statistical differences in the total self-efficacy scores,and in the scores of each dimension between the two groups（P<0.05）.4.Self-management behavior change: After the intervention,the total HPSMBRS score,medication management dimension,diet management dimension,exercise management dimension,work and rest dimension,and emotional management dimension scores of the two study groups were statistically different,while the condition monitoring dimension scores showed no statistic difference.5.HRQOL: There were interactions（P<0.05）between treatment and time factors for the SF-36 total score,physical functioning dimension,social functioning dimension,and mental health dimension.Simple effects analysis showed that the total SF-36 score,physical functioning dimension,physical functioning dimension,emotional functioning dimension,vitality dimension,social functioning dimension,and mental health dimension scores were significantly higher in the intervention group than in the control group at the T2 and T3 levels,while there were no statistically significant differences（P>0.05）in the overall health dimension and the somatic pain dimension at the end of the intervention and after 3 months of follow-up.6.Clinical medical indicators related to hypertension:（1）There was an interaction of treatment and time factors for upper extremity systolic pressure and no interaction for upper extremity diastolic pressure.Simple effect analysis showed that both systolic and diastolic blood pressures in the upper extremity were significantly lower in the intervention group than in the control group at T2 and T3 levels.（2）After 9 months of intervention,urinary microalbumin/urinary creatinine were statistically different between the two groups（P<0.05）.（3）After the intervention,there was a significant difference（P<0.05）in BMI between the two study groups only for the time effect.Simple effects analysis showed that the BMI values of the intervention group were significantly lower than those of the control group at both T2 and T3 levels.（4）After the intervention,only the time effect was significant（P<0.05）for neck circumference,and the time effect and interaction effects were significant（P<0.05）for waist circumference,while the treatment factor effect,time effect and interaction effects were not significant for hip circumference in both study groups.Simple effects analysis showed that only the difference in waist circumference was statistically significant between the two groups,although the decreasing trend in both neck and hip circumference was better than that of the control group at the T2 and T3 levels.Research Conclusion:The BCW theory-based interactive pictorial health management program helps to improve HBP-HL,self-efficacy,self-management behavior change,and health status of hypertensive patients with low health literacy.In addition,the health management program is practical and feasible in the community context,and has some application value and promotion significance. |
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