Exploring The Effect Of Structured Education Integrated With Case Management On The Health Management Of Patients With Myocardial Infarction

Objective:To investigate the current health behaviour and health literacy of patients with myocardial infarction and explore their correlation.Based on the findings,a structured education programme on myocardial infarction was constructed using the Delphi method.Structured education integrated with case management intervention programme was developed;its impact on the self-management ability and quality of life of patients with myocardial infarction was investigated to promote the level of health behaviour,reduce the risk factors of myocardial infarction and improve the quality of life.Method:(1)Investigation stage: A purposive sampling method was adopted to select 151 cases of myocardial infarction patients from the cardiology departments of two hospitals in Jiang Xi Province from May to July 2021.Using the general information questionnaire,HPLPII and He LMS as tools to understand the current situation of health behaviors and health literacy of myocardial infarction patients and to analyze the correlation.(2)Delphi Methods: On the basis of the current situation survey,combined with the summary of domestic and international literature guidelines,a preliminary expert correspondence questionnaire for the structured education course on myocardial infarction was formed.15 experts were selected to conduct two rounds of expert correspondence.The mean,standard deviation,coefficient of variation and full score ratio of the correspondence items were statistically analysed to analyse the results of the correspondence.(3)Intervention research: Based on the results of Delphi,integration into case management resulted in a practice protocol for structured education integrated with case management.A purposive sampling method was used to select 76 patients with myocardial infarction in the cardiology department of a hospital in Nan Chang from October 2021 to January 2022.The lottery method was used to randomly select one of the hospital areas of the same hospital as the intervention group.Its implement the structured education integration case management programme,and the other hospital area as the control group received usual care.The intervention group received 4structured education sessions and was followed for 1 month using case management.After 1 month of intervention,the patients’ quality of life was assessed using the MIDAS and the CSMS to assess their self-management level.Result:(1)Investigation results: The average total score of HPLPII was(95.37±23.26)points,and the scores of each dimension were: nutrition(21.19±4.00)points,stress management(17.12±4.39)points,health responsibility(12.37±4.70)points,interpersonal support(17.04±4.94)points,self-actualization(15.35±5.81)points,exercise(12.29±5.44)points.The average total score of He LMS was(76.95±20.79)points,the scores of each dimension: Information acquisition ability(31.40±10.54)points,economic support willingness(8.28±2.13)points,communication and interaction ability(22.85±9.03)points,and health improvement willingness(14.43±2.86)points.(2)Correlation analysis showed that the HPLPII and He LMS of myocardial infarction patients was positively correlated(r=0.782,P?0.01).(3)Delphi expert consultation results: After the two rounds of expert consultation,the structured education for myocardial infarction included 38 teaching objectives,including cognitive 19 items,15 motor skills items,4 emotion items;29courses content,divided into 5 modules: 7 items of disease cognition,9 items of self-management of lifestyle of patients,4 items of drugs self-management,4 items of self-monitoring,and 5 items of bilateral heart health.The expert authority degree of expert consultation was 0.931,and the Kendall’s W expert coordination was 0.233 and0.294.(4)Intervention results: Before the intervention: There was no statistical difference between the two groups of scores(P>0.05).After the intervention: the scores on the CSMS was higher and the MIDAS was lower(P<0.05)than before the intervention in the myocardial infarction group.The differences of the scores on the CSMS and MIDAS were not statistically significant in the control group(P>0.05).Conclusion:(1)Patients with myocardial infarction have average level of HPLPII;and the health literacy is at a low level.The health literacy is positively correlated with health behaviors of patients with myocardial infarction.(2)Structured education integrated with case management can improve the self-management and quality of life of patients with myocardial infarction and is worthwhile in secondary prevention of myocardial infarction...