基于健康信念模式的健康教育在老年0级糖尿病足患者中的应用

Effects of health education based on health befief model in elderly patients with 0 grade diabetic foot

目的 探讨基于健康信念模式的健康教育在老年0级糖尿病足患者中的应用效果.方法 采用便利抽样法,选取2014年1月1日—3月31日山东省烟台毓璜顶医院内分泌科病房的老年0级糖尿病足患者为研究对象.按随机数表法将患者分为观察组49例和对照组51例,至研究结束,观察组为47例,对照组42例.两组患者住院期间均给予相同的治疗、知识宣教,出院后对照组患者每月进行电话回访,答疑解惑;观察组患者按照健康信念模式进行健康教育.比较两组血糖、血脂控制情况,自护能力以及足部情况.结果 干预6个月和3年后,观察组患者FPG、2hPG、HbA1c、TG水平均较对照组低,差异均有统计学意义（P〈0.05）.干预3年后,观察组患者糖尿病自护行为优于对照组,差异有统计学意义（P〈0.05）,观察组足部发生溃疡/感染、畸形、水泡/胼胝、皮肤干燥/皲裂、下肢疼痛/抽搐、感觉缺失的情况均优于对照组,差异有统计学意义（P〈0.05）.结论 应用健康信念模式对老年0级糖尿病足患者进行健康教育,患者血糖、血脂控制效果更加持久、稳定,通过反复强化知识学习,纠正不良生活方式,患者糖尿病足自护能力提高,降低了向感染、溃疡、坏疽、截肢方向进一步发展的风险.

Objective To explore the effects of health education based on health belief model in elderly patients with 0 grade diabetic foot. Methods Elderly patients with 0 grade diabetic foot of endocrinology ward were selected by convenience sampling in Yantai Yuhuangding Hospital of Shandong Province as subjects form 1st January to 31st March 2014. Patients were divided into observation group （n=49） and control group （n=51） with the random number table. On the end of the study, there were 47 patients in observation group and 42 in control group. Patients of both groups all received the same treatment and knowledge education during hospitalization. After discharge, monthly telephone follow-up was carried out for patients in control group along with answering questions, while health education based on health belief model was applied for patients in observation group. The glucose and TG control condition, self-care behavior and foot situation were compared between two groups. Results Six months and three years after intervention, the fasting plasma glucose （FPG）, plasma glucose two hours after glucose load （2hPG）, glycosylated hemoglobin （HbA1c）, triglyceride （TG） of patients in observation group were lower than those in control group with significant differences （P〈 0.05）. Three years after intervention, the diabetes self-care behavior of patients in observation group was significantly better than that in control group （P〈0.05）; the situation of ulcer/infection, deformity, blister/callosum, xerosis cutis/chapped skin, pain/twitch of lower limbs and anaesthesia in the foot of patients in observation group was better than those in control group with significant differences （P〈0.05）. Conclusions The health education based on health belief model for elderly patients with 0 grade diabetic foot can make the effects of glucose control and blood lipid control lasting and stable. Besides, the self-care ability of diabetic foot of patients improves by knowledge learning again and again and correcting unhealthy life styles so as to reduce the risk of infection, ulcer, thanatosis and amputation.