基于行为分阶段转变理论的护理干预在初产妇母乳喂养指导中的应用

Application of nursing intervention based on transtheoretical model and stages of change in breastfeeding for primiparas

目的探讨基于行为分阶段转变理论的护理干预对提高初产妇母乳喂养知识、自我效能感、纯母乳喂养持续时间的效果。方法选取2017年5-6月在产检的符合纳入和排除标准的130例初产妇作为研究对象,按随机数字表法进行分组,对照组分别于产前、住院期间和出院后3个阶段实施常规母乳喂养健康指导,试验组根据行为分阶段转变理论,将初产妇从孕期产检开始至产后6个月的时间段划分为5个阶段,对应不同阶段和行为转变过程实施母乳喂养干预。比较2组母乳喂养知识及母乳喂养效能。结果对照组初产妇干预前、产后第3天、产后第42天和第6个月的母乳喂养知识总得分分别为(8.76±1.14)、(8.92±1.21)、(9.90±1.27)、(9.94±1.29)分,试验组分别为(9.11±1.42)、(12.02±1.64)、(13.04±1.68)、(15.00±1.83)分,2组各阶段比较差异均有统计学意义(F时间=51.823、F组别=10.406、F交互=56.641,均P<0.01);对照组初产妇干预前、产后第3天、产后第42天和第6个月的母乳喂养自我效能总分分别为(84.62±1.14)、(88.96±1.41)、(86.65±1.47)、(84.31±1.57)分,试验组分别为(84.98±1.21)、(104.02±1.42)、(111.00±1.45)、(120.04±1.40)分,2组各阶段比较差异均有统计学意义(F时间=12.592、F组别=229.674、F交互=79.955,均P<0.01);初产妇产后第3天、第42天和第6个月的纯母乳喂养率比较,对照组分别为60.0%(33/55)、41.8%(23/55)、21.8%(12/55),试验组分别为84.7%(50/59)、76.3%(45/59)、49.2%(29/59),2组各阶段比较差异均有统计学意义(χ^2=8.804、14.038、9.235,均P<0.01)。结论基于行为分阶段转变理论的母乳喂养干预有助于提高初产妇母乳喂养知识和自我效能感、改善母乳喂养状况。

Objective To explore the effect of nursing intervention based on the transtheoretical model and stages of change on breastfeeding knowledge, self-efficacy, and duration of breastfeeding in newly born pregnant women, aimed to provide reference for breastfeeding behavior health education model for pregnant women. Methods The 130 primiparas who came to the hospital graded a class- three of Shanxi Province for perinatal examination were selected as the research subjects from May to June in 2017, they were divided into test group and control group by random digits table method. In the control group, the normal breastfeeding health guidance was carried out in the three stages of prenatal, hospitalized and after discharge. The test group divided the primipara from the beginning of pregnancy to 6th months postpartum period into 5 stages according to transtheoretical model and stages of change. The new strategy of breastfeeding should be formulated and implemented according to different stages and behavior changing processes. Results The total score of breastfeeding knowledge of primipara were (8.76±1.14), (8.92±1.21), (9.90±1.27), (9.94±1.29) points in control group before intervention, the 3rd day, the 42nd day and the 6th month after delivery, and they were (9.11±1.42), (12.02±1.64), (13.04±1.67), (15.00±1.83) points respectively in test group, the differences were statistically significant(Ftime= 51.823, Fgroup=10.406, Finteractive=56.641, all P<0.05). The total scores of breastfeeding self-efficacy of primipara were (84.62±1.14), (88.96±1.41), (86.65±1.47), (84.31±1.57) points respectively in control group before intervention, the 3rd day, the 42nd day and the 6th month after delivery, while in test group they were (84.98±1.20), (104.02±1.42), (111.00±1.45), (120.04±1.40) points, the differences were statistically significan (Ftime=12.592, Fgroup=229.674, Finteractive=79.955, all P<0.05). The pure breastfeeding rates of primipara were 60.0% (33/55), 41.8% (23/55), 21.8% (12/55) in control group on the 3rd day, the 42nd day and the 6th month after delivery, they were 84.7% (50/59), 76.3% (45/59), 49.2% (29/59) in the test group. The differences was statistically significant (χ^2=8.804, 14.038, 9.235, all P<0.01). Conclusion Breastfeeding intervention based on the theory of behavioral staged transition can help primipara to improve breastfeeding knowledge and self-efficacy, and improve breastfeeding status.