国内不同健康教育方式对脑出血患者健康行为干预的Meta分析

The intervention effects of different health education methods on health behaviors in patients with cerebral hemorrhage:A meta-analysis

目的系统评价不同健康教育方式对脑出血患者健康行为的干预效果,为脑出血患者术后健康行为干预方式的选择提供佐证依据。方法检索Pubmed、Cochrane library、Embase、Web of science、中国知网、万方及维普网数据库,时限从建库至2023年10月31日。检索健康教育方式干预脑出血健康行为的随机对照试验,按照纳入排除标准进行筛选文献、提取数据后,采用Stata 16.0和Revman 5.4软件进行Meta分析。采用传统Meta及网状Meta分析进行统计分析,以P<0.05为差异有统计学意义。结果按照PICOS原则共检索到688篇文献。按照纳入排除标准筛选后,共纳入10篇文献,共947例脑出血患者。网状Meta分析显示,与常规健康教育相比,多元化健康教育提高患者服药依从性评分最优(SMD=0.27,95%CI:0.05~0.48),基于自我效能感理论健康教育(SMD=2.01,95%CI:1.45~2.57)提高患者合理饮食评分最佳,阶段性饮食教育模式(SMD=1.90,95%CI:1.33~2.46)干预患者运动锻炼效果最好,基于健康信念模式的教育(OR=5.77,95%CI:1.16~28.57)、微信互动健康教育模式(OR=5.77,95%CI:2.49~14.55)下患者遵医率均高于常规健康教育。结论多元化健康教育、基于自我效能感理论、阶段性饮食教育、基于健康信念模式的教育和微信互动健康教育方式在干预脑出血患者的服药依从性、合理饮食、运动锻炼及遵医率上,各具优势。临床上需要根据目的来选择合适的健康教育方式。

Objective To systematically evaluate the intervention effects of different health education methods on the health behaviors of patients with cerebral hemorrhage,and to provide supporting evidence for the selection of health behavior intervention for patients with cerebral hemorrhage after surgery.Methods Pubmed,The Cochrane library,Embase,Web of Science,China Knowledge,Wanfang and VIP databases were searched.The search time was from the date of creation to October 31,2023.Randomized controlled trials about health education intervention for health behaviors in cerebral hemorrhage patients were retrieved.After screening the literature and extracting data according to the inclusion and exclusion criteria,meta-analysis was performed by Stata 16.0 and Revman 5.4.Statistical analyse was performed by traditional meta and network meta-analysis,with P<0.05 indicating statistically significant differences.Results A total of 688 studies were retrieved according to the PICOS(patients,intervention,comparison,outcome and study design) principle.After screening according to the inclusion and exclusion criteria,ten studies with a total of 947patients with cerebral hemorrhage were included.Net meta-analysis showed that diversified health education was optimal for improving patients' medication adherence scores compared with conventional health education(standardized mean difference SMD=0.27,95%CI:0.05-0.48).Self-efficacy theorybased health education(SMD=2.01,95% CI:1.45-2.57) improved patients' rational eating scores best.The staged diet education model(SMD=1.90,95% CI:1.33-2.46) had the best effect of improving patients' exercise.Rate of patient compliance were higher under the health belief-based model of education(OR=5.77,95% CI:1.16-28.57),and the WeChat interactive health education approach(OR=5.77,95% CI:2.49-14.55) than conventional health education.Conclusions Diversified health education,self-efficacy theory-based health education,staged diet education model,the health belief-based model of education and WeChat interactive health education approach each had their own advantages in the intervention of medication adherence,rational diet,exercise and rate of patient compliance with cerebral hemorrhage.It is necessary to choose the appropriate health education method according to the purpose.