解决导向电话干预对慢性病患者体质量风险管理的效果评价研究

Effect Evaluation of Telephone-based Solution-focused Interventions for the Management of Overweight and Obesity in Chronic Disease Residents

目的评价解决导向电话干预对慢性病患者体质量风险管理的效果,为丰富健康管理策略提供参考依据。方法选取2015年5月—2016年4月于杭州市拱墅区小河湖墅街道社区卫生服务中心就诊的68例慢性病患者,按照随机数字表法将其分为解决导向组(36例)和健康教育组(32例)。解决导向组进行解决导向电话干预,包括行为改变评估、改变决策制定、解决建构、行为改变建议;健康教育组进行健康教育电话随访,均在每周干预结束前收集减重信心、饮食和运动改变的主观评价得分,于干预前后各测1次体质量和腰围,并计算体质指数。结果解决导向组第8、12、24周的信心、饮食和运动评分均高于健康教育组(P<0.05)。解决导向组第4周运动评分和第8、12、24周信心、饮食、运动评分均高于第1周(P<0.05);第8、12、24周信心、饮食、运动评分均高于第4周(P<0.05);第12、24周信心、饮食、运动评分均高于第8周(P<0.05);第24周信心、饮食评分均高于第12周(P<0.05)。健康教育组第24周运动评分高于第4周(P<0.05)。解决导向组、健康教育组干预前后体质量、体质指数、腰围比较,差异均无统计学意义(P>0.05)。结论解决导向电话干预对慢性病患者的心理及生活方式有较好的促进作用,而体质量、体质指数及腰围的管理效果尚需更长时间的控制。

Objective To evaluate the effect of telephone-based solution-focused interventions for the management of overweight and obesity in chronic disease residents,enriching the contents of health management services.Methods Sixty-eight Hangzhou chronic disease residents who received treatment in Gongshu District Xiaohehushu Street Community Health Service Center from May 2015 to April 2016 were included and divided into solution-focused group(36 cases receiving telephonebased solution-focused interventions)and health education group(32 cases receiving telephone-based health education)according to the random number table.Interventions of solution-focused group include behavioral change assessment,decision making,construction,and behavioral changes.The improvement in self-confidence in weight loss,dietary intake and physical exercising was assessed by the residents themselves at the end of 1,4,8,12,24 weeks of intervention.Before and after each intervention,body weight and weight circumference were measured,and BMI was calculated.Results Compared with the health education group,the improvement in self-confidence in weight loss,dietary intake and physical exercising scored much higher in the solution-focused group at the end of 8,12,24 weeks of intervention(P<0.05).In the solution-focused group,the 2nd,3rd,4th and 5th measurement scores of improvement in self-confidence in weight loss and dietary intake,as well as the 2nd,3rd,and 4th measurement scores of physical exercising improvement significantly increased successively with the prolongation of interventions(P<0.05).The 5th measurement scores of physical exercising improvement significantly increased successively compared with the 2nd,3rd(P<0.05).However,the health education group only demonstrated higher scores in physical exercising improvement at the last measurement compared with the 2nd measurement(P<0.05).Compared with before intervention,both groups demonstrated minor changes in body weight,BMI,and waist circumference after receiving intervention(P>0.05).Conclusion Compared with telephone-based health education,telephone-based solution-focused interventions could better improve the mental health and lifestyle of patients with chronic diseases.However,for the control of body weight,BMI and waist circumference,much longer intervention is needed.