基于社会生态理论模型的急性缺血性脑卒中患者早期活动影响因素的质性研究

Influencing factors of early activity in patients with acute ischemic stroke based on social ecological model:A qualitative study

目的:急性缺血性脑卒中(acute ischemic stroke,AIS)是中老年人致残的主要原因之一,早期活动对功能恢复具有重要作用。本研究旨在了解AIS患者早期活动实施的影响因素,为促进AIS患者早期活动实施、制订干预策略提供参考依据。方法:采用目的抽样法,选取2021年6月至12月在中南大学湘雅三医院和长沙市第三医院卒中中心就诊的19名AIS患者及其照护者,以及为卒中患者提供医疗保健服务的19名医务人员、医院管理者或社区工作者作为访谈对象,基于社会生态理论模型确定访谈提纲,并进行半结构式访谈,采用Colaizzi七步法对访谈资料进行分析。结果:依据质性访谈结果将AIS患者早期活动的影响因素总结为4个主题、12个亚主题,分别为医务人员因素(知识技能不足、对早期活动认知不足、职责分工不明确)、患者因素(疾病严重程度、知识缺乏、心理压力大、害怕跌倒)、社会环境因素(社会支持不足、人力资源和康复设备紧缺、医保支持力度不够)、证据与规范(早期活动证据有待完善、缺乏规范的早期活动流程)。结论:AIS患者早期活动受到医务人员、患者、社会环境、证据与规范多个层面因素影响,针对以上因素制订综合干预策略有助于促进AIS患者早期活动的实施。

Objective:Acute ischemic stroke(AIS)is one of the main causes of disability in middleaged and elderly people,and early activity plays an important role in functional recovery.This study aims to understand the factors that affect the implementation of early activity in This work was supported by the Natural Science Foundation of Hunan patients with AIS and to provide reference for promoting early activity implementation and developing intervention strategies for AIS patients.Methods:Using purposive sampling,19 AIS patients and their caregivers who visited at Stroke Center in the Third Xiangya Hospital of Central South University and the Third Hospital of Changsha from June to December 2021,as well as 19 medical staff,hospital administrators,or community workers providing medical health services to stroke patients,were selected as interviewes.A semi-structured interview was conducted based on the social ecological theory model,and the Colaizzi seven-step method was used to analyze the interview data.Results:According to qualitative interview results,the factors affecting early activity in AIS patients were summarized into 4 themes and 12 sub-themes:medical staff factors(insufficient knowledge and skills,insufficient knowledge of early activity,unclear division of responsibilities),patient factors(severity of the disease,lack of knowledge,psychological pressure,fear of falling),social environmental factors(lack of social support,shortage of human resources and rehabilitation equipment,insufficient medical insurance support),and evidence and norms(the evidence for early activity needs improvement,lack of standardized early activity procedures).Conclusion:Early activity in AIS patients is impacted by factors at multiple levels,including medical staff,patients,social environment,and evidence and norms.Developing comprehensive intervention strategies to address these factors can promote early activity implementation in AIS patients.