双模式健康教育对住院老年患者预防跌倒知、信、行及跌倒效能的影响

发布时间：2018-04-01 20:36

本文选题：跌倒效能　切入点：健康教育　出处：《重庆医科大学》2017年硕士论文

【摘要】：目的:调查住院老年患者预防跌倒知、信、行及跌倒效能的现状,分析二者的影响因素;评价健康信念模式和程序式健康教育模式的双模式健康教育对住院老年患者预防跌倒知识、态度、行为及跌倒效能、预防跌倒行为依从性、跌倒发生率的影响。方法:本研究包含两部分。第一部分:横断面研究。采用便利抽样法对重庆市某三甲医院老年病科、神经内科350例住院老年患者行问卷调查。内容包括社会人口学资料、跌倒史、疾病史、服药情况、是否使用辅具、活动情况、跌倒效能、预防跌倒的知识、态度、行为、是否害怕跌倒等。第二部分:随机对照试验研究。病例来源为第一部分筛选出存在害怕跌倒(Fear of falling,FOF)的住院老年患者,纳入病例104,随机分为两组,各52例。干预组在常规健康教育的基础上结合健康信念模式及程序式健康教育模式行健康教育,分5阶段进行,第一阶段:使患者意识到跌倒严重性及易感性,时间3天;第二阶段:认识预防跌倒健康行为的益处和采取健康行为的障碍,时间3天;第三阶段:让患者自愿采取一定的预防跌倒健康行为,协商制定个性化健康教育方案及预防跌倒的健康行为,时间3天;第四阶段:让患者自觉实践预防跌倒行为,具备预防跌倒的自我效能,时间5天;第五阶段:出院后继续强化健康行为,时间3月。出院第4周、8周、12周、3月行电话或微信随访。各阶段按程序式健康教育五步骤进行,提供个性化健康教育。对照组采用常规健康教育方式,入院健康教育内容和出院随访时间和干预组一致。3月后收集资料进行数据统计。结果:1.研究对象平均年龄为75.01±8.40岁。2.有跌倒史为167名,占总人数的47.7%。3预防跌倒知识维度得分为(45.33±6.16)分,态度维度得分为(25.06±3.69)分,行为维度得分为(24.50±6.20)分,跌倒效能得分为(77.05±39.14)分,4.将影响预防跌倒知、信、行及跌倒效能的单因素结果进入多元线性逐步回归分析,影响跌倒知、信、行的因素为:文化程度、经济来源、经济状况,决定系数为0.301(调整r2)。影响跌倒效能的因素为:助行器、活动锻炼、年龄、跌倒史、文化程度,决定系数为0.452(调整r2)。5预防跌倒知识、态度、行为与跌倒效能进行相关性分析,预防跌倒知识、态度与跌倒效能呈正相关,相关系数知识(r=0.110,p0.05,)态度(r=0.150,p0.01);6干预后,比较两组患者预防跌倒知识、态度、行为得分,干预组明显高于对照组,差异具有统计学意义(p0.01);比较两组跌倒效能得分,干预组(modifiedfallsefficacyscale,mfes)总分高于对照组,差异有统计学意义(p0.01);比较两组患者干预14天前后预防跌倒行为依从性变化,干预组依从性明显高于对照组,差异有统计学意义(p0.01),比较两组患者干预期间跌倒发生率,干预组低于对照组,差异有统计学意义。结论:1.住院老年患者预防跌倒的认知不强,跌倒效能总体水平不高。文化程度、经济来源、经济状况是影响跌倒认知的重要因素;是否使用助行器、活动锻炼、年龄、跌倒史、文化程度是影响住院老年患者跌倒效能的重要因素,活动锻炼、使用助行器对跌倒效能影响较大。2.双模式健康教育可以有效提高住院老年患者跌倒的认知及效能,提高预防跌倒行为的依从性,提高对跌倒的认知度,预防跌倒发生,可以在临床上进行应用。
[Abstract]:Objective: to know the prevention of falls in hospitalized elderly patients, investigation letter, and present fall efficacy, analysis of factors affecting the two; attitude dual mode health education mode of health education and health belief model program evaluation on prevention of falls in hospitalized elderly patients, knowledge, behavior and fall efficacy, fall prevention compliance, falls the rate of effect. Methods: This study consists of two parts. The first part: a cross-sectional study. The Department of Geriatrics, General Hospital of Chongqing city with the convenient sampling method, Department of Neurology, 350 patients in hospital by questionnaire survey. The contents include social demographic data, fall history, disease history, medication, whether the use of assistive devices, activities fall, efficiency, fall prevention knowledge, attitude, behavior, whether the fear of falling. The second part: a randomized controlled trial. All cases were first part were screened for the presence of fear of falling (Fear Of falling, FOF) of the hospitalized elderly patients, included 104 patients, were randomly divided into two groups, 52 cases in each group. The intervention group with the health belief model and the program of health education mode for health education based on routine health education, is divided into 5 stages, the first stage: to make patients aware of the severity and susceptibility to fall time, 3 days; second stages: awareness of fall prevention health behavior benefits and adopt healthy behavior disorder, 3 days; the third stage: let the patients voluntarily take certain fall prevention health behavior, consultation and individualized health education plan and fall prevention health behavior, time of 3 days; the fourth stage: let the patient conscious the practice of fall prevention behaviors, have fall prevention self-efficacy, time of 5 days after discharge; the fifth stage: continue to strengthen the health behavior, the time of March. Discharged fourth weeks, 8 weeks, 12 weeks, March WeChat phone or follow-up. According to each stage of history Order five steps to carry out health education, providing personalized health education. The control group uses the conventional health education, hospital health education content and follow-up time and intervention group consistent.3 months after collecting data for statistical data. Results: 1. subjects with an average age of 75.01 + 8.40 years.2. a history of falls was 167, accounting for the total the number of 47.7%.3 falls prevention knowledge score was (45.33 + 6.16), attitude score was (25.06 + 3.69) points, the behavior score was (24.50 + 6.20) points, scores fall efficacy (77.05 + 39.14) points, 4. will affect the fall prevention knowledge, faith, and single factor fall performance results into multiple linear stepwise regression analysis, influence of fall knowledge, letter, for factors: education, economic resources, economic conditions, the coefficient of determination was 0.301 (adjusted R2). For the factors influencing the effectiveness of the fall: walker, exercise, age, history of fall, The cultural degree, the coefficient of determination was 0.452 (R2).5 fall prevention knowledge, attitude, behavior and fall efficacy correlation analysis, fall prevention knowledge, attitude and fall efficacy was positively related to the correlation coefficient of knowledge (r=0.110, P0.05) (r=0.150, P0.01); attitude 6 intervention, compared two groups of patients fall prevention knowledge, attitude, behavior scores, the intervention group was significantly higher than the control group, the difference was statistically significant between the two groups (P0.01); fall efficacy score, the intervention group (modifiedfallsefficacyscale, MFEs) score higher than the control group, the difference was statistically significant (P0.01); the intervention of two groups were compared before and after 14 days of fall prevention compliance changes, intervention group compliance was significantly higher than the control group, the difference was statistically significant (P0.01), compared between the two groups during the intervention in patients with the incidence of falls, the intervention group was lower than that of the control group, the difference was statistically significant. Conclusions: 1. hospitalized elderly patients Fall prevention awareness is not strong, the overall level of efficiency is not high. The fall culture degree, economic resources, economic situation is an important factor affecting the fall of cognition; whether to use walkers, exercise, age, history of falls, cultural level is an important factor of falls among hospitalized elderly patients, the effectiveness of exercise, use walking aid for larger fall efficacy.2. dual mode of health education can effectively improve the efficiency of cognition and hospitalization falls in elderly patients, improve prevention compliance fall behavior, improve the fall awareness, fall prevention, and can be used in clinic.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

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