基于健康行为改变整合理论的自我管理方案在非酒精性脂肪肝病患者中的应用研究

Application of self-management intervention scheme in patients with non-alcoholic fatty liver disease based on the integrated theory of health behavior change

目的基于健康行为改变整合理论(integrated theory of health behavior change,ITHBC)构建非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者自我管理干预方案,并评价其在NAFLD患者中的应用效果。方法以ITHBC为理论框架,通过文献分析法初步拟定干预方案初稿。采用专家函询法修改及完善自我管理方案。采用立意抽样法纳入2023年4-5月在乌鲁木齐市某社区卫生服务中心体检的符合NAFLD诊断标准的患者80例,采用随机数字表法分为对照组和观察组各40例。对照组行社区常规护理,观察组行基于ITHBC的自我管理干预;随访4个月,比较2组患者的自我管理能力及临床特征变化。结果(1)3轮专家函询问卷有效回收率分别为100%、85%、85%,专家权威系数为0.833,协调系数分别为0.191、0.254、0.272,均P<0.01。最终干预方案包括一级指标5项,二级指标11项,三级指标17项。(2)随访4个月后,观察组患者干预后自我管理总分、疾病防治管理、日常生活管理、心理认知管理及不良生活方式管理评分均显著高于对照组(P<0.05);而临床指标(腰围、BMI、总胆固醇、三酰甘油及低密度脂蛋白)均低于对照组(P<0.05)。结论基于ITHBC构建的NAFLD患者自我管理干预方案可提高患者自我管理能力,进而改善患者病情,提升NAFLD的预后。

Objective To construct a self-management intervention scheme for patients with non-alcoholic fatty liver disease(NAFLD)based on the integrated theory of health behavior change(ITHBC),and to evaluate its effectiveness.Methods Based on ITHBC as the theoretical framework,and the first draft of intervention program was developed by literature analysis method.Expert correspondence method was used to modify and improve the self-management program.A total of 80 patients with NAFLD in a community physical examination center in Urumqi from April to May 2023 were included by intentional sampling method,and were divided into the control group and the observation group with 40 patients each by random number table method.The control group received community routine nursing,and the experimental group received ITHBC-based self-management intervention.After 4 months of follow-up,the self-management ability and change of clinical characteristics between 2 groups were compared.Results(1)The effective recovery rates of 3 rounds of expert correspondence questionnaires were 100%,85%,and 85%,the expert authority coefficient was 0.833,and the coordination coefficient was 0.191,0.254,and 0.272,respectively,all P<0.01.The final intervention plan included 5 first-level indicators,11 second-level indicators and 17 third-level indicators.(2)After 4 months of follow-up,the total score of self-management,disease prevention and treatment management,daily life management,psychological cognitive management,and adverse lifestyle management of patients in the observation group were significantly higher than those in the control group(P<0.05);The clinical indicators of the observation group,such as waist circumference,BMI,total cholesterol,triglyceride,and low-density lipoprotein were lower than those of the control group(P<0.05).Conclusion The ITHBC-based self-management intervention plan for NAFLD patients can increase the self-management ability of patients,thus improving the condition of patients and improving the prognosis of NAFLD patients.