基于格林模式的健康教育在脑卒中后吞咽障碍患者中的应用

Application of health education based on the PRECEDE-PROCEED model in patients with dysphagia after stroke

目的探讨基于格林模式的健康教育在脑卒中后吞咽障碍患者中的应用效果,为临床制订并实施脑卒中吞咽障碍患者健康教育和管理提供参考依据。方法选取2020年12月―2021年12月在乌鲁木齐市某三级甲等医院神经内科住院的脑卒中吞咽障碍患者94例为研究对象,按照组间基本特征具有可比性的原则分为观察组和对照组,各47例。对照组实行常规吞咽健康教育,观察组实行基于格林模式的吞咽健康教育,干预时间为3个月。比较两组患者入院时、干预后3个月时吞咽生存质量问卷(SWAL—QOL)、自我护理能力测定量表(ESCA)、标准吞咽功能评定量表(SSA)评分。结果完成本次研究的患者共87例,其中对照组44例,观察组43例。入院时,两组患者SSA、SWAL—QOL和ESCA评分的比较,差异无统计学意义(P>0.05)。干预后,观察组患者的SSA评分低于对照组,差异有统计学意义(P<0.05);SWAL-QOL总分及吞咽负担、进食时间、食欲、吞咽症状频率、食物选择、语言交流、进食恐惧、心理健康、社会交往、疲劳、睡眠评分均高于对照组,差异有统计学意义(P<0.05);自我护理能力总分及自我概念、自护责任感、自我护理技能、健康知识水平各维度得分均高于对照组,差异均有统计学意义(P<0.05)。结论对脑卒中吞咽障碍患者运用基于格林模式的健康教育,可促进患者的吞咽功能恢复,提高患者生活质量和自我护理能力。

Objective To explore the application effect of health education based on the PRECEDEPROCEED model in patients with dysphagia after stroke,and to provide a reference for the clinical formulation and implementation of health education and management for stroke patients with dysphagia.Methods A total of 94 stroke patients with dysphagia who were hospitalized in the neurology department of a tertiary Grade A hospital in Urumqi from December 2020 to December 2021 were selected as the study subjects.They were divided into an observation group and a control group,each consisting of 47 patients,based on comparable basic characteristics between the groups.The control group implemented routine swallowing health education,while the observation group implemented swallowing health education based on the PRECEDE-PROCEED model.The intervention period lasted for 3 months.Swallowing-related Quality of Life(SWAL-QOL),Exercise of Selfcare Agency Scale(ESCA)and Standardized Swallowing Assessment(SSA)scores were compared between the two groups of patients at admission and after 3 months of intervention.Results The study was completed with a total of 87 patients,including 44 in the control group and 43 in the observation group.Upon admission,there was no statistically significant difference in scores of SSA,SWAL-QOL,and ESCA between the two groups of patients(P>0.05).After intervention,the SSA scores of patients in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05);patients in the observation group scored higher than those in the control group on SWAL-QOL total score,as well as in swallowing burden,eating duration,appetite,frequency of swallowing symptoms,food selection,communication,eating fear,psychological health,social interaction,fatigue,and sleep,the differences were statistically significant(P<0.05);the observation group showed higher scores than the control group in total scores of self-care ability,as well as in the the dimensions of self-concept,self-care responsibility,self-care skills,and health knowledge level,the differences were statistically significant(P<0.05).Conclusion The application of health education based on the PRECEDEPROCEED model in stroke patients with dysphagia can promote the recovery of patients'swallowing function,and enhance their quality of life and self-care ability.