摘要： 背景 老年慢性病患者記憶力與生活自理能力逐漸下降，僅依靠其個(gè)人力量進(jìn)行疾病的自我管理難以達(dá)到良好效果，需要更多來自他人的幫助。在對老年慢性病患者進(jìn)行健康教育時(shí)不能僅單獨(dú)面向老年人，更需要充分利用患者的社會網(wǎng)絡(luò)，讓其社會網(wǎng)絡(luò)成員參與到老年患者的疾病管理中，以更有效地提高患者的自我管理能力。 目的 探討基于患者社會網(wǎng)絡(luò)的健康教育對社區(qū)老年慢性病患者自我管理能力的影響。 方法 招募2021年3月—2022年6月在北京方莊社區(qū)衛(wèi)生服務(wù)中心、清華長庚醫(yī)院門診、北京醫(yī)院內(nèi)分泌門診就診及紅聯(lián)村社區(qū)的老年慢性病患者，采用電腦生成的隨機(jī)數(shù)字表，將患者按照招募入組的順序各自進(jìn)行編號，奇數(shù)為干預(yù)組，偶數(shù)為對照組，按照1∶1隨機(jī)分為干預(yù)組和對照組，干預(yù)組給予老年患者+其社會網(wǎng)絡(luò)成員健康教育，對照組給予患者健康教育，干預(yù)周期12個(gè)月；在干預(yù)前、干預(yù)第6個(gè)月、干預(yù)第12個(gè)月應(yīng)用慢性病自我管理研究測量表（CDSMS）評估慢性病自我管理的效果，使用Lubben社會網(wǎng)絡(luò)量表簡表（LSNS-6）測評患者社會網(wǎng)絡(luò)水平。 結(jié)果 80例患者入組，其中1例患者（對照組）因研究期間兩次住院退出研究，最終79列患者完成研究：干預(yù)組患者40例+其社會網(wǎng)絡(luò)成員40例，對照組39例。CDSMS自我管理行為分量表的運(yùn)動(dòng)鍛煉維度、認(rèn)知性癥狀管理維度及自我效能分量表的時(shí)間與分組存在交互作用（F交互分別為7.174、8.488、9.939，P<0.05）；時(shí)間在CDSMS兩個(gè)分量表上主效應(yīng)顯著（F時(shí)間分別是13.527、12.188、7.576、5.058，P<0.05）；分組在CDSMS自我管理行為分量表的三個(gè)維度上主效應(yīng)顯著（F分組分別是12.324、7.383、5.927，P<0.05）。干預(yù)第6個(gè)月，干預(yù)組CDSMS運(yùn)動(dòng)鍛煉維度得分高于對照組（t=2.852，P=0.006）；干預(yù)第12個(gè)月，干預(yù)組CDSMS運(yùn)動(dòng)鍛煉維度得分高于對照組（t=4.473，P<0.05）、認(rèn)知性癥狀管理維度得分高于對照組（t=-2.780，P=0.005）、自我效能分量表得分高于對照組（t=2.993，P=0.004）。 結(jié)論 為期12個(gè)月的基于患者社會網(wǎng)絡(luò)的健康教育，可改善老年慢性病患者的部分自我管理行為，提高自我效能水平。

關(guān)鍵詞: 慢性病, 老年人, 健康教育, 社會網(wǎng)絡(luò), 自我管理

Abstract:

Background

The memory and self-care abilities of older adults with chronic diseases are gradually declining, and relying solely on their personal strength for disease self-management is difficult to achieve good results, requiring more help from others. When providing health education to older adults with chronic diseases, it is not only necessary to focus solely on the elderly, but also to fully utilize the patient's social network and involve social network members in the disease management of the patients, to more effectively improve their self-management ability.

Objective

To explore the impact of social network-based health education on the self-management ability of older adults with chronic diseases in community.

Methods

From March 2021 to June 2022, older adults with chronic diseases who visited Beijing Fangzhuang Community Health Service Center, Clinic of Tsinghua Changgeng Hospital and Endocrinology Clinic of Beijing Hospital, Hongliancun Community were recruited. Using a computer-generated random number table, the older adults were assigned numbers in the order of recruitment, with odd numbers being intervention group and even numbers being control group. They were randomly divided into an intervention group and a control group in a 1∶1 ratio. The older adults in the intervention group received health education with their social network members, while those in the control group received health education alone. The Chronic Disease Self-Management Study Scale (CDSMS) was used to evaluate the effectiveness of chronic disease self-management before intervention, at the 6th and 12th months of intervention, meanwhile the Lubben Social Network-6 (LSNS-6) was used to assess their social network level.

Results

Eighty older adults with chronic diseases were enrolled, of which 1 patient (in control group) withdrew from the study due to two hospitalizations during the study period. Finally, 79 older adults completed the study: 40 older adults in the intervention group+40 members of their social network, and 39 older adults in the control group. The exercise dimension, cognitive symptom management dimension of self-management behavior subscale, and self-efficacy subscale of CDSMS had an interactive effect on time and grouping (Finteration-values were 7.174, 8.488, and 9.939, respectively, P<0.05) ; The main effect of time on the two subscales of CDSMS was significant (Ftime-values were 13.527, 12.188, 7.576, 5.058, respectively, P<0.05) ; The main effects of grouping on three dimensions of CDSMS self-management behavior subscale were significant (Fgroup-values were 12.324, 7.383, 5.927, respectively, P<0.05). At the 6th month of intervention, the CDSMS exercise dimension score in the intervention group was higher than that in the control group (t=2.852, P=0.006), the difference was statistically significant. At the 12th month of intervention, the CDSMS exercise dimension score in the intervention group was higher than that in the control group (t=4.473, P<0.05), the score of cognitive symptom management dimension was higher than that in the control group (t=-2.780, P=0.005), the self-efficacy subscale score was higher than that in the control group (t=2.993, P=0.004), the differences were statistically significant.

Conclusion

A 12-month social network-based health education can improve some of the self-management behaviors and self-efficacy with chronic diseases.

Key words: Chronic disease, Aged, Health education, Social network, Self-management

中圖分類號: 

R 36

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