缺血性脑血管病患者和家属的健康素养对卒中教育的影响

Effect of health literacy on stroke education in patients with ischemic cerebrovascular disease and their family members

目的 探讨缺血性脑血管病患者和家属的健康素养对卒中教育的影响.方法 采用健康素养问卷调查表对缺血性脑血管病患者及其家属的健康素养进行问卷调查.被调查者随机通过神经内科医生讲述或自行阅读的方式接受卒中教育,并采用相应的调查问卷评价被调查者对卒中教育内容的掌握情况.结果 共有42例缺血性脑血管病患者（缺血性卒中34例,短暂性脑缺血发作8例）和57名缺血性脑血管病患者家属的资料收集完整纳入分析.健康素养得分为优组（得分＜10分）和得分为差组（得分≥10分）分别为61名和38名,前者年龄较轻者（x2=16.410,P＜0.001）、高中及以上学历者（68.85％对23.68％;x2=19.125,P＜0.001）构成比显著性高于后者,而患者构成比（32.79％对57.89％;x2=6.043,P=0.014）显著性低于后者,但两组男性构成比无显著性差异（55.74％对44.74％;x2=1.134,P=0.287）;多变量logistic回归分析显示,健康素养与被调查者年龄[≤40岁：优势比（odds ratio,OR） 7.753,95％可信区间（confidence interval,CI）1.208～49.740;P=0.031]和文化程度（高中及以上：OR3.993,95％ CI 1.305～ 12.218;P=0.015）独立相关,而与性别和角色无关.卒中教育得分为优（≥7分）和差（＜7分）的被调查者分别为57名和42名,前者年龄较轻者（x2 =17.095,P＜0.001）、高中及以上学历者（70.00％对23.08％;x2 =20.836,P＜0.001）、健康素养得分为优者（88.33％对20.51％;x2 =45.968,P＜0.001）构成比显著性高于后者,而性别、角色和卒中教育方式的构成比与后者无显著性差异;多变量logistic回归分析显示,仅健康素养优与卒中教育得分优独立相关（OR 20.147,95％ CI6.089 ～66.655;P ＜0.001）.结论 健康素养能显著影响缺血性脑血管病患者及其家属的卒中教育效果,在制定个体化卒中教育方案时应予考虑.

Objective To investigate the effect of health literacy on stroke education in patients with ischemic cerebrovascular disease and their family members.Methods Health literacy questionnaire was used to conduct the health literacy questionnaire survey for patients with ischemic cerebrovascular disease and their family members.The respondents received stroke education randomly through neurologists＇ explanation or self-reading.The corresponding questionnaire was used to evaluate the mastering of the content of stroke education for the respondents.Results The complete data of 42 patients with ischemic cerebrovascular disease （34 ischemic stroke and 8 transient ischemic attack） and 57 family members of the patients with ischemic cerebrovascular disease were collected and enrolled in the analysis.The good health literacy score group （＜ 10） and the poor health literacy score group （≥ 10） were 61 and 38 subjects respectively.The proportions of younger age （x2 =16.410,P ＜0.001） and high school or above （68.85％ vs.23.68％ ;x2 =19.25,P ＜ 0.001） of the former were higher than those of the latter,and the proportion of patients （32.79％vs.57.89％;x2 =6.043,P=0.014） was significantly lower than that of the latter,but there was no significant difference in the proportion of the males between the two groups （55.74％ vs.44.74％ ;x2 =1.134,P =0.287）.Multivariate logistic regression analysis showed that health literacy was independently associated with the age of respondents （≤40 years：odds ratio [OR] 7.753,95％ confidence interval [CI]1.208-49.740; P=0.031） and the level of education （high school and above：OR,3.993,95％ CI 1.305-12.218; P=0.015）,and it was not correlated with gender and role.Those with good stroke education score （≥7）and poor stroke education score （＜7） were 57 and 42,respectively.The proportions of younger age （x2 =17.095,P ＜0.001）,high school and above （70.00％ vs.23.08％ ;x2 =20.836,P ＜ 0.001）,and good health literacy score （88.33％ vs.20.51％;x2 =45.968,P＜0.001） were significantly higher than those of the latter,while there were no significant differences in the proportions of gender,role,and stroke education.Multivariatelogistic regression analysis showed that only the good health literacy was independently associated with the stroke education score （OR 20.147,95％ CI6.089-66.655; P＜0.001）.Conclusions Health literacy can significantly affected the effect of the stroke education in patients with ischemic cerebrovascular disease and their family members.In the development of individualized stroke education program,it should be considered.