基于健康信念模式的健康教育在慢性阻塞性肺疾病患者吸入剂管理中的应用效果研究

Application Effect of Health Education Based on Health Belief Model in Inhalant Management of Patients with Chronic Obstructive Pulmonary Disease

背景吸入剂治疗被国内外指南推荐为防治慢性阻塞性肺疾病(COPD)等呼吸道疾病的首选给药方式,但错误使用吸入剂又会影响疾病控制效果。目前,COPD吸入剂宣教并无固定模式,更无涉及照顾者的宣教模式。目的探讨基于健康信念模式(HBM)的健康教育在COPD患者吸入剂管理中的应用效果。方法选取2019年6月—2020年6月在连云港市第一人民医院呼吸科就诊的COPD患者140例,采用简单随机法分为对照组和干预组,剔除干预过程中的脱落病例,最终干预组纳入68例、对照组纳入65例。对照组患者给予常规健康教育,干预组患者及其主要照顾者给予基于HBM的健康教育。比较两组患者入组时及入组3、6个月后吸入给药装置使用情况评分、肺功能指标[第1秒用力呼气容积占预计值的百分比(FEV_(1)%)和第1秒用力呼气容积与用力肺活量比值(FEV_(1)/FVC)]、急性发作/加重次数、Morisky用药依从性量表(MMAS-8)评分、简明健康状况调查问卷(SF-36)评分、护理满意度评分,入组3、6个月后临床疗效。结果干预组患者入组3、6个月后吸入给药装置使用情况评分、FEV_(1)%、FEV_(1)/FVC、MMAS-8评分、SF-36评分及护理满意度评分高于对照组,急性发作/加重次数≥2次者所占比例低于对照组(P<0.05)。干预组患者入组3个月后吸入给药装置使用情况评分、FEV_(1)%、FEV_(1)/FVC、临床治疗有效率、MMAS-8评分、SF-36评分及护理满意度评分高于入组时,入组6个月后吸入给药装置使用情况评分、FEV_(1)%、FEV_(1)/FVC、MMAS-8评分、SF-36评分及护理满意度评分高于入组时和入组3个月后(P<0.05)。结论基于HBM的健康教育能有效提高COPD患者吸入剂治疗的依从性及正确率,改善患者肺功能,减少急性发作/加重次数,进而提高患者的临床疗效及生活质量,且患者的护理满意度较高。

Background Inhalant therapy has been recommended as the first choice for the prevention and treatment of chronic obstructive pulmonary disease(COPD)and the other respiratory diseases by domestic and foreign guidelines,but the wrong use of inhalant will affect the effect of disease control.At present,there is no fixed mode of COPD inhalant education,let alone involving caregivers.Objective To explore the application effect of health education based on health belief model(HBM)in inhalant management of COPD patients.Methods A total of 140 COPD patients in the Department of Respiratory of the First People’s Hospital of Lianyungang from June 2019 to June 2020 were selected as the research objects.The patients were divided into control group and intervention group in accordance with a random number table.Finally,68 cases in the intervention group and 65 cases in the control group were included after shedding cases were eliminated.The patients in the control group were given regular health education,the patients and their primary caregivers in the intervention group were given health education based on the HBM.The score of usage of inhalation drug delivery device,pulmonary function indexes[percentage of forced expiratory volume in the first second to predicted value(FEV_(1)%)and ratio of forced expiratory volume in the first second to forced vital capacity(FEV_(1)/FVC)],times of acute attack/exacerbation,Morisky Medication Adherence Scale(MMAS-8),Short Form 36 Health Survey Questionnaire(SF-36)score and nursing satisfaction score were compared between the two groups before intervention,3 and 6 months after intervention,and clinical effect was compared between the two groups 3 and 6 months after intervention.Results The score of usage of inhalation drug delivery device,FEV_(1)%,FEV_(1)/FVC,MMAS-8 score,SF-36 score and nursing satisfaction score in the intervention group were higher than those in the control group 3 and 6 months after intervention(P<0.05);the proportion of patients with more than 2 times of acute attack/exacerbation in the intervention group was lower than that in the control group 3 and 6 months after intervention(P<0.05).In the intervention group,the score of usage of inhalation drug delivery device,FEV_(1)%,FEV_(1)/FVC,effective rate of treatment,MMAS-8 score,SF-36 score and nursing satisfaction score 3 months after intervention were higher than those before intervention,while above indicators 6 months after intervention were higher than those before intervention and 3 months after intervention(P<0.05).Conclusion Health education based on HBM can effectively improve the compliance and correct rate of COPD patients with inhalation therapy,improve the pulmonary function of patients,reduce the number of acute attack/aggravation,and then improve the clinical efficacy and quality of life of patients,and the nursing satisfaction of patients is high.