健康信念模式教育对农村地区颅内动脉瘤介入术后患者按期随访依从性的影响

Health belief model on the adherence to regular postoperative follow-up of patients with intracranial aneurysms in rural areas

目的探讨基于健康信念模式(HBM)的健康教育方法对农村地区颅内动脉瘤(ICA)介入术后患者按期随访依从性的影响.方法采用混合性研究方法,第一阶段目的性抽取样本进行质性访谈,了解该目标人群不依从行为的原因.第二阶段采用非同期对照试验研究,将2015年6月-2016年12月济宁市第一人民医院行ICA介入术的农村患者共312例作为对照组,采用常规健康教育方法.以2017年4月-2018年6月行ICA介入术的农村患者共268例作为观察组,在质性访谈结果基础上采用基于HBM的健康教育方法.统计并对比两组患者按期随访依从性的差异.结果质性研究阶段共提取4个主题,即对ICA介入术后复发的可能性及危害性认识不足、对造影复查的必要性认识不足、对造影复查需住院治疗及住院费用存在顾虑、农村患者健康保健意识差,不重视疾病预防.量性研究阶段经干预后观察组患者按期随访依从性(95.52%)高于对照组(62.82%),差异具有统计学意义(χ^2=89.64, P<0.01).结论基于HBM的健康教育方法对农村地区ICA介入术后患者按期随访起到了良好的促进作用,临床健康教育工作应更注重借助健康教育理论指导.

Objective To explore the effect of health education based on health belief model (HBM) on the adherence to regular postoperative follow-up of patients with intracranial aneurysms (ICA) after surgery in rural areas. Methods A mixed research method was adopted in the study. In the first phase, purposive sampling method was used when conducting qualitative interviews in order to analyze the reasons for the inadherence in the target population. In the second phase, non-synchronous controlled trial was carried out and 312 patients from rural areas who underwent ICA invasive surgery in Ji'ning No.l People s Hospital from June 2015 to December 2016 were selected and put into control group. Routine health education was adopted for the group. A total of 268 patients who underwent ICA invasive surgery in The First People s Hospital of Ji'ning City from April 2017 to June 2018 were selected and assigned into the observation group. Based on the results from the qualitative interview, the HBM health education was applied in the observation group. The two groups were analyzed and compared in terms of their adherence to regular revisit after discharge. Results A total of 4 themes were extracted during the qualitative research phase: there is insufficient understanding of the possibility and harm of recurrence after ICA intervention, insufficient understanding of the necessity of angiographic review, concerns about hospitalization and hospitalization expenses for angiographic review, poor health care awareness and lack of attention to disease prevention. After implementing the intervention, the adherence to timely postoperative follow-up in the observation group (95.52%) was higher than that of the control group (62.82%)with statistical significance ( x^2=89.64, P < 0.01). Conclusions Health education based on HBM can improve the adherence to regular postoperative review among rural patients with intracranial aneurysms. Health belief model should be applied as guidance into clinical health education.