| Hypertension(HTN) is an important public health problem worldwide. In China it was reported that there are more than 2.7 billion people have hypertension and the prevalence rate of hypertension among adult(the people above 15 years old)was 24% and for people above 60 years old reached to 66.9%, almost every two elderly has a hypertension. In China, inadequate control of blood pressure is associated with a significant risk of stroke and vascular death. Hypertension health education is an effective and efficient way to raise the public awareness of hypertension, it has a great significance to control hypertension, reduce the complications of cardiovascular disease, control disease burden and cost and increase health level of public.Objective:The purpose of this study is to identify and explore the effectiveness of community-based health education for the urban elderly hypertensive patients(CBHEUEHP) from the need assessment, process evaluation and outcome measurement perspectives by the example of J province C city.Methods:Mixed method was used. Qualitative and quantitative research methods as follows:(1) Questionnaire SurveyIn the need assessment, we did a survey of 494 elderly hypertensive patients(EHPs) to discover their needs of hypertension health education and evaluate their knowledge, attitude and behavior(KAB) of hypertension health education. Another survey of 228 public health professionals(PHPs) was done to understand their hypertension health education needs and current level of hypertension knowledge.(2) In depth self-interviewIn the process evaluation, we use qualitative research methodology individual in-depth interview to collect data. We interviewed 20 EHPs and 10 PHPs using semi-structured interview guideline to discover what components influence the hypertension health information dissemination process and how the EHPs get hypertension health education in their process of disease.(3) Quasi-experimental designWe did a convenience and purposive sampling, recruited 80 EHPs from two neighborhoods with similar demographic and socioeconomic characteristics, 40 EHPs was in the experimental group and 40 EHPs in control group. The experiment group received intensive 4-stage hypertension health education based on the previous results of study, and the control group received the usual care. Difference-in-difference model was used to estimate the changes of level of the EHPs’ KAB and their self-efficacy before and after intervention to evaluate the effectiveness of health education intervention.(4) SWOTAt last, we did SWOT analysis to discover the strengths, weak, opportunity and threat of CBHEUEHP and then developed recommendations and suggestions to further spread of CBHEUEHP.Results:(1) Need assessmentThe survey results of EHPs showed that 86.9% subjects would like to learn hypertension health education knowledge; 56.3% EHPs choose face to face consultation to get hypertension health education; EHPs wanted to get more hypertension health education knowledge on self-management of hypertension(81.8%), pharmacology instruction(76.7%) and prevention of hypertension(74.7%). For KAB survey: less than 50% participants know the control target of HTN, understand lifestyle change as HTN nonpharmacologic treatment play an important role in hypertension therapy and the amount of daily salt intake, although 81.8% participants take measurement to control their blood pressure, only 59.1% participant performed regular BP measurement, 27.7% participant didn’t know how to use the sphygmomanometer, 71.7% participant didn’t take regular follow up.The survey of the PHPs demonstrated that 100% participant would like to learn hypertension health education knowledge. To improve their HTN health education ability, 90.4% PHPs want to learn modern information and communication technology. PHPs wanted to learn more HTN health education through new mass media; posters and academic journals and books. The current knowledge survey of PHPs showed 58.3% participant knew the healthy blood pressure, 86.9% participant knew the control target of EHP, above 95.0% acknowledged that HTN needs lifelong treatment and healthy lifestyle modification is very important; 100%participant agreed that control of daily salt intake will reduce the blood pressure, only 20.2% think that EHP should take less than 3g everyday. 40.4% participant didn’t know the time interval of follow up for HTN patients.(2) Process evaluationThe results of depth self-interview of EHPs demonstrated that in the process of getting hypertension health education, EHPs experienced 5 phases as denial phase, acceptance phase, over treatment and seeking alternative treatment phase, seeking health care professionals phase and self-management phase.The results of depth self-interview of PHPs showed that as the opinion leaders of CBHEUEHP, their influential power depends on 4 interrelated components: familiar with hypertension health education content and EHPs, their own Credibility and the way and strategies to disseminate the health education.(3) Outcome evaluationThe results of CBHEUEHP intervention:at the baseline the experimental group of hypertensive health education KAB and self-efficacy level were 3.33±0.79,6.72±1.78,6.72±1.81,2.61±0.53 respectively, and the control group were 3.58±0.68,6.87±1.65,6.58±1.45,2.43±0.65 respectively, there was no difference between the two groups; after health educational intervention hypertensive health education knowledge, attitudes, behavior and self-efficacy level of experimental group increased to 4.53±0.85,7.50±1.25,7.28±1.52,4.93±0.97 accordingly.In the 3 month follow up the hypertensive health education knowledge, attitudes, behavior and self-efficacy level continue to increase to 5.06±1.04,7.08±1.23,7.25±1.71 and 6.03±0.64。Difference-in-difference model was used to evaluate the effectiveness of health education intervention. The net effect of knowledge DID model, attitude DID model, behaviors DID model are 1.147(p<0.001), 0.952(p<0.05) and 4.996(p<0.001)respectively; the net effect of self-efficay DID model is 1.061(p<0.001)。CBHEUEHP intervention improved hypertension health education KAB level and self-efficacy level, and is effective.Conclusion:(1) EHPs had high motivation to participate in CBHEUEHP; they wanted to get hypertension health education through face to face consultation with PHPs, their knowledge of hypertension health education is poor and should be strenghthen.(2) PHPs had high mationvation to learn health education of hypertension; they wanted to get more hypertension knowledge by new media. PHPs need to update their knowledge in accordance with the newest Chinese Hypertension Patients Education Guideline.(3) PHPs as the opinion leaders, play an important role in dissemination of CBHEUEHP, their influential power depends on 4 interrelated components: familiar with hypertension health education content and EHPs, their own personal credibility and the way and strategies to disseminate the health education.(4) For EHPs, the process of getting hypertension health education information was influenced by their disease stages. EHPs encountered different problems and their acceptance of health education information was different in different stages of disease.(5) Lastly, based on Adult Learning theory and Self-efficacy theory progressive 4-stage intensive hypertension health education intervention was effective and improved hypertension KAB and general self-efficacy levels of EHPs. |
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