社会工作者引导的中老年超重肥胖人群健康行为管理效果评价

Effect evaluation of social worker-led health behavior management among overweight and obese middle aged and elderly adults

目的探讨在社区医师协助下的社会工作者(社工)引导中老年超重肥胖人群健康行为管理效果。方法2016年8-12月选取广州市14个社区,每个社区成立1个由12~15名年龄≥40岁且超重肥胖者组成的健康行为管理小组,随机分为社工组(94人)和社区医生组(83人),社工组由2名社工引导,1名社区医生协助,医生组由2名社区医生引导,分别进行为期6周的小组干预活动。活动结束后1年进行主动随访,评估干预效果。结果纳入研究对象177人中,超重131人,肥胖46人。基线时两组人群一般情况、健康知识知晓、健康行为以及相关代谢指标差异均无统计学意义(χ~2值为0.02~2.38,P值均>0.05),社工组收缩压[(SBP:(134.8±13.9)mmHg]显著低于医生组[(140.5±15.8)mmHg](t=-2.574,P=0.011)。1年主动随访,失访27人,失访率为15.3%,两组失访率差异无统计学意义(χ~2=0.020,P=0.887)。追踪到的160人随访时与基线调查时相比,健康知识得分:社工组提高了(16.8±27.5)分,医生组提高了(11.6±25.1)分(t值为5.440、3.844,P值均<0.05),社工组甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)均显著降低,(t值为2.061~4.153,P值均<0.05);医生组高纤维饮食得分中位数提高了14.3分(Z=2.383,P=0.017),SBP降低(4.0±15.9)mmHg,HDL降低(0.2±15.9)mmol/L(t值为2.094、2.718,P值均<0.05);随访时社工组现在饮酒率(3.8%)显著低于医生组(15.7%)(χ~2=6.315,P=0.012),SBP、DBP和LDL-C均显著低于医生组(t值为2.028~2.791,P值均<0.05)。一般线性模型分析显示,调整年龄、性别、学历和月收入后,社工组TC和LDL-C下降幅度明显高于医生组(F值为9.531、8.940,P值均<0.05)。结论社工引导、社区医生协助下的健康行为管理小组能持续有效改善中老年超重肥胖者健康结局,应鼓励社工积极参与社区健康管理服务。

Objective To evaluate the effect of social worker(SW)-led,community health professional(CHP)assisted health behavior management of overweight and obese middle-aged and elderly adults.Methods From Aug to Dec in 2016,14 communities in Guangzhou were selected.A health behavior management group consisting of 12-15 overweight and obese people aged over 40 years was formed in each community,who were randomly divided into SW group(94 persons)and CHP group(83 persons).The SW group was guided by 2 social workers,assisted by 1 community health professional;while the CHP group was guided by 2 community health professionals.Team intervention was conducted for 6 weeks for both groups.Active follow-up was conducted 1 year after the end of the intervention to evaluate the effect.Results Among the 177 subjects,131 were overweight and 46 were obese.For baseline survey,there were no significant differences in general conditions,health knowledge score,health behavior and related metabolic indexes between groups(χ~2 values were 0.02-2.38,all P>0.05).Systolic blood pressure(SBP:134.8 mmHg±13.9 mmHg)in SW group was significantly lower than that in CHP group(140.5 mmHg±15.8 mmHg)(t=-2.574,P=0.011).After 1 year active follow-up,27 subjects were lost,resulting the lost rate of 15.3%.There was no significant difference in the lost rate between groups(χ~2=0.020,P=0.887).Compared with baseline survey,the health knowledge scores of the 160 subjects tracked at follow-up increased(16.8±27.5)points in SW group and(11.6±25.1)points for CHP group(t=5.440 and 3.844,all P<0.05).In SW group,the triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)decreased significantly(t values were 2.061-4.153,all P<0.05).In CHP group,the median score of high fiber diet increased by 14.3 points(Z=2.383,P=0.017)and SBP decreased by(4.0 m±15.9)mmHg,HDL decreased by(0.2±15.9)mmol/L(t=2.094 and 2.718,all P<0.05).At follow-up,the drinking rate in SW group(3.8%)was significantly lower than that in CHP group(15.7%)(χ~2=6.315,P=0.012);the SBP,DBP and LDL-C were significantly lower than those in CHP group(t=2.028-2.791,all P<0.05).General linear model analysis showed that TC and LDL-C in SW group decreased significantly than CHP group after adjusting age,gender,education and monthly income(F=9.531 and 8.940,all P<0.05).Conclusion The health behavior management team guided by SWs and assisted by CHPs can effectively improve the health outcomes of middle-aged and elderly overweight and obese adults.Social workers should be encouraged to actively participate in community health management services.