基于社区组织理论的空巢老人“SMG”健康管理模式研究

发布时间：2018-05-04 12:21

本文选题：健康管理 + 空巢老人　；参考：《山西医科大学》2017年博士论文

【摘要】：目的:本研究将社区组织理论与健康管理科学融合,构建适宜空巢老人的“SMG”健康管理模式,以山西省空巢老人为例进行实证研究,以期了解空巢老人健康管理特征及影响因素,评价健康管理模式应用效果,从而为应对社会“老龄化”、“空巢化”问题提供新思路,也为提高空巢老人生活质量,更新基层卫生服务模式提供可资借鉴之依据。方法:采用多阶段随机整群抽样的方法,选取山西省11个地市的4901名空巢老人作为研究对象,利用健康促进生活方式量表(HPLP-C)、健康状况调查简表(SF-36)及社会支持评定量表(SSRS)等为研究工具,采用描述性分析进行空巢老人一般人口学特征分析,两独立样本t检验和方差分析比较不同的一般人口学特征下空巢老人在各量表得分上的差异,多元逐步回归对影响因素进行探索。采用分层随机整群抽样的方法,选取太原市三个社区的396名空巢老人作为干预研究对象,分别设置干预组与对照组,在实施为期7个月的“SMG”健康管理后,对模式应用效果进行评价,采用卡方检验比较干预组与对照组的人口学特征差异,两独立样本t检验比较干预组与对照组之间的得分差异,配对样本t检验比较干预前后的得分差异。空巢老人智能健康信息采集系统则基于Windows 2008 Server平台,以B/S为结构,运用PHP语言,采用My SQL数据库完成相关功能及模块的设计与实现。结果:特征及影响因素研究结果显示,本次调查对象年龄分布以60~70岁为主,男性(2546人)与女性(2355人)人数基本相当,生活区域为农村多于城市,居住形式为与配偶同住者最多,75.54%的被调查者属于相对空巢状态。健康促进生活方式方面,本次调查对象的健康促进生活方式总分为105.29±19.68,处于中等水平。在各维度单项均分中,营养得分(2.84)最高,健康责任得分(2.21)最低。除性别(P=0.955)、空巢情况(P=0.539)、现在是否工作(P=0.483)及饮酒频率(P=0.107)四个维度外,其他不同人口学特征的空巢老人健康促进生活方式得分差异均具有统计学意义(P0.001)。经多元回归分析发现,社会活动参与度、社区满意度、文化程度等12个因素为空巢老人健康促进生活方式的主要影响因素。生命质量方面,本次调查对象的SF-36各维度得分与全国65岁及以上人群常模相比,除躯体疼痛(BP)以外(P=0.311),其他各维度的差异均有统计学意义(P0.001)。对不同人口学特征的空巢老人的生命质量进行比较,除空巢情况(PCS P=0.238,MCS P=0.089)与吸烟状况(PCS P=0.091,MCS P=0.241)两个维度差别无统计学意义外,其他不同人口学特征的空巢老人生活质量得分差异均具有统计学意义(P0.001)。经多元回归分析发现,生活自理情况、慢性病患病情况、年龄等16个因素为空巢老人生命质量生理健康状况(PCS)的主要影响因素;而生活自理情况、月收入、三餐规律程度等14个因素为空巢老人生命质量心理健康状况(MCS)的主要影响因素。社会支持方面,本次调查对象的社会支持评定量表得分与全国普通人群常模相比,量表各个维度的差异均具有统计学意义,除客观支持维度低于全国常模外,主观支持、支持利用度以及总得分均高于常模水平。对不同人口学特征的空巢老人的社会支持情况进行比较,除性别(P=0.703)与现在是否工作(P=0.429)外,其他不同人口学特征的空巢老人SSRS得分差异均具有统计学意义(P0.05)。经多元回归分析发现,丧偶、夫妻关系、与子女关系等11个因素为空巢老人社会支持的主要影响因素。模式评价研究结果显示,迎泽区、尖草坪区及晋源区的干预组与对照组研究对象在性别、年龄、文化程度、婚姻状况、居住形式、空巢情况、月收入、社会活动参与度、生活自理能力以及慢性病患病情况方面均无统计学差异(P0.05),研究对象具有同质性。健康促进生活方式方面,实施健康管理后,迎泽区、尖草坪区及晋源区的空巢老人健康促进生活方式均有所提高,总分、健康责任及人际支持维度上的变化最为明显,营养与运动维度有一定提升但部分结果无统计学意义,自我实现与压力管理维度上的变化有限。生命质量方面,实施健康管理后,迎泽区、尖草坪区及晋源区的空巢老人生命质量均有所提高,在SF-36量表的各维度中,心理健康总分(MCS)、情感职能(RE)、社会功能(SF)的变化最为明显,活力(VT)、总体健康(GH)、躯体疼痛(BP)及精神健康(MH)有一定改变但部分结果无统计学意义,生理功能(PF)、生理职能(RP)与生理健康总分(PCS)的变化均无统计学意义。社会支持方面,实施健康管理后,迎泽区、尖草坪区及晋源区的空巢老人社会支持均有所提高,在社会支持评定量表的各维度中,总分、客观支持及对支持的利用度的变化最为明显,主观支持有所改变但部分结果无统计学意义。结论:本项目以空巢老人为研究对象,通过特征与影响因素分析,挖掘了空巢老人的健康特征及危险因素,筛选出健康管理实施过程中的关键环节。在此基础上,将社区组织理论引入健康管理,构建集自我管理、互助管理、团体管理为一体的“SMG”健康管理模式。通过干预研究,证明了社区组织理论在健康管理中的适用性及模式干预方案的有效性。配合自主研发的空巢老人智能健康信息采集系统,“SMG”健康管理模式可有效提升空巢老人的健康状况。研究成果为应对我国“老龄化”、“空巢化”问题提供了有效途径,具有一定的科学价值与现实意义。
[Abstract]:Objective: to integrate community organization theory with health management science, construct a "SMG" health management model suitable for empty nest elderly, take the example of empty nest elderly in Shanxi as an example, in order to understand the health management characteristics and influencing factors of empty nest elderly, and evaluate the application effect of health management model, so as to cope with the social "aging". "Empty nest" problem provides new ideas, and also provides reference for improving the life quality of empty nest elderly and renewing the basic health service model. Method: using multi stage random cluster sampling method, 4901 empty nest elderly in 11 cities of Shanxi province are selected as the research objects, and the Health Promotion Lifestyle Scale (HPLP-C) is used. The health status survey (SF-36) and social support rating scale (SSRS) were used as research tools. Descriptive analysis was used to analyze the general demographic characteristics of empty nesters. Two independent sample t test and variance analysis were used to compare the differences in the scores of the empty nest elderly under the different general demographic characteristics, and the multiple stepwise regression analysis of the influence causes The method of stratified random cluster sampling was used to select 396 empty nest elderly in three communities in Taiyuan city as the intervention research subjects. The intervention group and the control group were set up respectively. After the implementation of the "SMG" health management for 7 months, the effect of the model was evaluated and the chi square test was used to compare the intervention group and the control group. Two independent sample t test compared the score difference between the intervention group and the control group. The paired sample t test compared the scores before and after the intervention. The intelligent health information collection system of the empty nest elderly was based on the Windows 2008 Server platform, B/S as the structure, the PHP language, and the My SQL database to complete the related functions and models. Design and implementation of block. Results: the results of characteristics and influencing factors showed that the age distribution of the subjects was 60~70 years old, the number of male (2546) and female (2355) was basically equal, the living area was more rural than the city, the form of living was the most with the spouse, and 75.54% of the respondents belonged to the relative empty nest state. In terms of lifestyle, the total health promotion lifestyle of the subjects was 105.29 + 19.68, at the middle level. In the single dimension, the nutrition score (2.84) was the highest and the health responsibility score (2.21) was the lowest. Except for sex (P=0.955), the empty nest (P= 0.539), the present work (P=0.483) and the drinking frequency (P=0.107) four dimensions In addition, there were statistically significant differences in the scores of health promotion lifestyles of empty nest elderly with different demographic characteristics (P0.001). Through multiple regression analysis, 12 factors, such as social activity participation, community satisfaction and cultural degree, were the main factors influencing the health promotion of empty nest elderly. The SF-36 dimensions of the subjects were compared with those of the population aged 65 and above, except for somatic pain (BP) (P=0.311), and the differences in other dimensions were statistically significant (P0.001). The quality of life of empty nest elderly with different demographic characteristics was compared, except for empty nest (PCS P=0.238, MCS P=0.089) and smoking status (PCS P=0.091, MCS). P=0.241) there was no statistically significant difference in the two dimensions, and the scores of the quality of life of the empty nest elderly with different demographic characteristics were all statistically significant (P0.001). Through multiple regression analysis, 16 factors, such as life self-care, chronic disease and age, were the main images of the quality of life (PCS) of the empty nesters. The 14 factors such as life self-care, monthly income, and the law degree of three meals were the main factors affecting the mental health status of the empty nest elderly (MCS). In terms of social support, the score of the social support rating scale was compared with the norm of the general population in the country, and the differences in the dimensions of the scale were statistically significant. Besides the objective support dimension is lower than the national norm, the subjective support, the support utilization and the total score are higher than the norm level. The social support of the empty nest elderly with different demographic characteristics is compared. Except for the sex (P=0.703) and the present work (P=0.429), the difference of the SSRS scores of the empty nest elderly with different demographic characteristics is all Statistical significance (P0.05). Through multiple regression analysis, it was found that 11 factors such as widowhood, husband and wife relationship and relationship with children were the main factors affecting the social support of the empty nesters. The results of the model evaluation showed that the subjects of the intervention group and the control group in the Yingze District, the tip lawn area and the Jinyuan area were in sex, age, educational level and marital status. There were no statistical differences in living forms, empty nest conditions, monthly income, social activity participation, life self-care ability and chronic diseases (P0.05). The research objects were homogeneity. After health promotion, the health promotion methods of empty nests in Yingze, the grass area and Jinyuan district were all healthy. The improvement, the total score, the health responsibility and the interpersonal support dimension were the most obvious changes, the nutrition and sports dimension had a certain promotion but the partial results were not statistically significant, the change of self realization and pressure management dimension was limited. The quality of life, the quality of life, after the implementation of health management, the quality of life of the empty nesters in the Yingze District, the tip lawn area and the Jinyuan District In all the dimensions of the SF-36, mental health total score (MCS), emotional function (RE), social function (SF) were most obvious, vitality (VT), overall health (GH), somatomatic pain (BP) and mental health (MH) had some changes but partial results were not statistically significant, physiological function (PF), physiological function (RP) and physiological health total score (PCS) There was no statistical significance in the changes. Social support, after the implementation of health management, the social support of empty nesters in the Yingze District, the tip lawn area and the Jinyuan district had been improved. In all the dimensions of the social support rating scale, the total score, the objective support and the utilization of support were most obvious, the subjective support was changed but some of the results were not unified. Conclusion: this project takes the empty nest elderly as the research object. Through the analysis of the characteristics and influencing factors, the health characteristics and risk factors of the empty nest elderly are excavated, and the key links in the implementation of health management are screened out. On this basis, the community organization theory is introduced into the health management to build a set of self-management, mutual management and group management. "SMG" health management model. Through intervention research, it is proved that the applicability of community organization theory in health management and the effectiveness of model intervention program. With the independent research and development of empty nest elderly intelligent health information collection system, "SMG" health management model can improve the health status of empty nest elderly. In order to deal with the problem of "aging" in China, it provides an effective way to solve the problem of "empty nest" and has certain scientific and practical significance.

【学位授予单位】：山西医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R195.1

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