| BackgroundHypertension is the most common chronic disease, is also the most important risk factors for cerebrovascular disease, stroke, myocardial infarction, heart failure and chronic kidney disease and other complications. World Health Organization forecast to2020non-communicable diseases will account for China’s cause of death in79%, cardiovascular disease is the first, Hypertension is the most important risk factors for cardiovascular. China has become one of the most serious dangers of hypertension in the world, our patients with hypertension awareness, treatment, control rate were lower, respectively,30.2%,24.7%,6.1%.Hypertension treatment, including medication and non-drug treatment, Hypertension Prevention Guide2010told that a healthy lifestyle, at any time on any hypertension, are effective treatment can lower blood pressure, controlling for other risk factors and clinical conditions, all patients should be adopted, the main measures include:reducing sodium intake; control of body weight; smoking cessation; reduce the amount of alcohol; sports; maintain mental balance.Self-management including self-efficacy and behavior management, Self-efficacy independent from social cognitive theory, Bandura in1977for the first time to put forwaed the concept of self-efficacy. Evaluation and judgment of the individual in their own ability, that is, whether they have the ability to control their own successful adoption of healthy behaviors and external factors, and to achieve the desired results. Self-efficacy and high, more healthful behaviors proposed may be adopted. Self-behavior management developed a management process to deal with chronic diseases, symptoms, treatment, physiological and psychological changes in society, as well as the ability to make lifestyle changes. Effective self-management is to maintain a satisfactory quality of life, individuals must have the ability to monitor the physical condition, but also changes in management behavior and emotional reactions. At present, the majority of patients the existence of such two cases, one is totally dependent on doctors, medicine to control blood pressure, does not care about their own behavioral risk; another is to ignore the hazards of high blood pressure condition to take a laissez-faire attitude, not trying to change their risk behaviors.The first chronic disease self-management project (CDSMP) designed by the Stanford University Patient Education Research Centeris used self-efficacy theory as the theoretical framework, through a series of measures focused on improving patient management, disease self-confidence throughimprove behavior and emotional control, and ultimately improve the patient’s health status, improve quality of life, to have satisfactory results in self-efficacy, self-management behavior, health outcomes and health resource utilization aspects. At present, chronic disease self-management projects in many countries to promote open to Europe and the United States and other developed countries, self-management approaches for chronic disease prevention and control in the United States, Britain, Australia and other developed countries for over20years of history. United States and Britain have chronic disease self-management health education programs as a regular community services provided to patients and their families willing to participate in government-funded.1998, Fudan University School of Public Health in cooperation with the Shanghai part of the community health service centers to carry out the community hypertension self-management project, the successful implementation and to achieve better results. The project is based on the basic skills and confidence to help patients learn to effectively manage a variety of chronic diseases as the main content, but this mode has not been promoted widely in the country.Motivational Interviewing (MI) is found by helping patients overcome their ambivalence, by PhD Miller, in1983, the study of an abstinence first proposed, the subsequent development of systems theory is increasingly being used in chronic disease management, such as pain control, cardiac rehabilitation, diabetes, weight loss and other areas in changing smoking, diet and activities, treatment compliance has achieved a certain effect. Movement as the main method of a non-drug treatment of hypertensive patients, helps control weight, lower blood lipids, promote metabolism, regulation of mood, have some antihypertensive effect.1983Prochaska and Diclemente proposed the transtheoretical model (TTM), TTM think human behavior change process is divided into five major behavioral change stage, divided into pre-intention stage, intention stage, preparation stage, action stage and maintenance phase. TTM used in the field of health behavior, including the role of two aspects:on the one hand, to change people’s unhealthy behaviors; the other hand, is used to help people develop good and useful healthy behaviors.Objective①to compare control group and intervention group’self-management about elderly hypertensive patients;②to explore a healthy lifestyle and self-management intervention model for community elderly hypertensive patients.Methods1.The object of study:In this study, the method of quasi-experimental design, from early June2011to the end of December2011, randomly selected from the Haizhu District of Guangzhou City, a community hospital, to get in touch with the community hospitals, community health centers to create the file in elderly hypertensive patients, with a computer generate a random number method random sample of170met the inclusion exclusion criteria and willing to participate in the hypertensive patients as subjects.Inclusion criteria:(1) Hypertension Prevention Guide (2009primary Edition) diagnostic criteria of essential hypertension:not with antihypertensive drugs, unusual measurements, systolic blood pressure≥140mmHg and/or diastolic pressure≥90mmHg, a diagnosis of hypertension, patients with a previous history of hypertension, antihypertensive drugs currently in use, blood pressure, although lower than140/90mmHg, also diagnosed with high blood pressure;②The age≥60and≤80years old;③agreed to participate in this study and signed informed consent;④in stable condition with clear minds;⑤taking at least one antihypertensive drug.Exclusion criteria were:①dementia, cognitive impairment, limb movement disorder, language disorder;②The secondary hypertension;③husband and wife, siblings and other immediate relatives while enrolled.2.Two research methods:2.1Research steps:①determine the content of this study, the intervention, intervention, intervention time, data collection methods, and community hospitals to do the preparatory work.②The study included170cases in accordance with the computer-generated random number method were randomly divided into control group and intervention group, single-blind method on the object of study to take control group received routine health education, intervention group Motivational Interviewing and the Transtheoretical model hands-on approach to collect the patient population, intervention before school data and clinical observations indicators baseline information, and patients signed informed consent.③The Community Hospital, a six-month intervention on a patient in the control group using conventional health education at the community hospital, in the control group using a combination of intervention of home visits and community activities.④in the first three months and six months of the intervention to assess the observed indicators, analysis of the intervention effects of two different modes of intervention.2.2The researchIntervention group:The family visit to the combination of visual and community activities, accepted by the community work more than a decade experienced a community medical staff and researchers I have completed the Motivational Interviewing knowledge and knowledge of the transtheoretical model of research.Part I:the home visits part. According to the circumstances of the patient’s baseline data, patients were divided into different behavior change stage, according to the different stages of the development of the interview plan, the telephone booking home visits once a month, every40to60minutes in a continuous six months carried out. Motivational Interviewing and the transtheoretical model of intervention is specific according to the five stages of behavior change:before the stage of intention, the intention stage, preparation stage, action stage and maintenance stage, combined with the Motivational Interviewing approach in implementing the intervention, the contents of the interviews, including patients with medication, exercise, diet, stop smoking, limit alcohol, less oil, salt and hypertension knowledge.Part II:Community activities segment. Patients were divided into different groups, grouping the implementation of the intervention, the telephone booking in advance patients to community hospitals, the use of a centralized approach to health education in a community hospital conference room to complete course is divided into6stages of change according to the patients’self-management behavior, once a month, each60minutes, the intervention within six months of continuous Community intervention in the form of demonstrations, group activities, patients experience sharing.Part III:self-management of everyday life. Issued to each patient hypertension health log to guide patients with medication, exercise, diet, blood pressure, recorded their own daily life. Community Hospital for free blood pressure measurement card issued to each patient, the patient may present the card to community hospitals to free blood pressure measurement, weight, waist.Control group:Focus for intervention in a community hospital, community work personnel and researchers in a community together to complete the research.Part I:Health education programs. Telephone booking in advance patients to community hospitals, implementation of interventions to patients in outpatient health education room. Health education programs developed for patients with hypertension, concentrated at the community meeting room, the curriculum is divided into12times, once every two weeks, every60minutes, intervention within a continuous six months. Specific forms of intervention include:teaching lectures, demonstrations, thematic discussions, consulting interaction and other means.Part II:The same as intervention group.2.3Evaluation Index①general condition of patients questionnaire,②medical indicators:blood pressure, standing height, weight, waist circumference,③the patient’s self-efficacy measured by high blood pressure self-efficacy scale,④patients with self-measurement of behavior management with high blood pressure behavior compliance Scale Lahdenpera design hypertension patients with behavioral compliance Scale (CHPS),⑤hypertension diary.2.4Statistical MethodsThe measurement data use X±s, the indicators was used to compare two independent samples t-test between the two groups, compared intervention and control groups with repeated measurements, before and after intervention between the two groups were compared using two repeated measurements factor analysis of variance;Count data using frequency and percentage (%) between the two groups with the χ2test of the contingency table data;Statistical processing of all data were analyzed using statistical software SPSS13.0, select the inspection level a=0.05, bilateral P<0.05considered results statistically significant.Results1the premise of balanced in the two groups of patients with general demographic data and clinical baseline data, the implementation of different interventions for six months, after the repeated measures analysis of variance results obtained, time main effect of the intervention before and after lifestyle medication each index score, exercise time, vegetable intake, fruit intake, oil intake, salt intake were statistically significant (P<0.05), medication score, exercise time, the intake of vegetables, fruits intake as the intervention in the conduct of an upward trend, oil intake, salt intake with the intervention, the gradual downward trend. Grouping the main effect and time grouping interaction effect shows a significant difference (P<0.05), the intervention group lifestyle indicators are better than the control group.2A baseline data survey in the study population, smoking, alcohol consumption numbers were36cases (23.2%) and48cases (30.9%), six months after intervention the numbers were30cases (19.4%) and43cases (27.7%), the intervention of the study population before and after smoking, alcohol consumption decreased, between the two groups was not statistically significant (P>0.05), in patients with smoking and alcohol consumption, were compared by repeated measures analysis of variance results show that the time main effect of group main effects, interaction effects were statistically significant (P<0.05). The intervention group patients smoking was significantly higher degree of alcohol consumption decreased.3six months after the intervention were compared between patients self-efficacy score, patients with daily life, health behaviors, medication, disease surveillance in four dimension scores were improved self-efficacy in the control group total score of52.59points before the intervention to The intervention group scored52.73points to61.27points, to55.77points, the two groups statistically significant (P=0.036), combined with the interactive effects of contour to come to the intervention group score increased extent than the control group.4Intervention six months after the assessment of patients behavior adherence showed that adherence scale in the two groups of patients with behavior intention, lifestyle, attitude, responsibility, smoking, drinking, drug treatment six entry score were decreased control group score dropped from37.43points to30.15points, the score of the intervention group decreased from37.03points to24.31points, two groups of patients before and after intervention scores by repeated measures analysis obtained a significant difference (P=0.000), combined with the interactive effects of contour The diagram drawn downward trend of the intervention group was significantly better than the control group.5six months after the intervention, elderly hypertensive patients in this study, the BMI index, waist were decreased, BMI decreased from22.70to24.12, waist dropped from82.27to78.21, and the intervention effect of the intervention group was significantly better than the control group, the difference was statistically significant (P<0.05). patients with blood pressure compliance rate improved significantly, before the intervention29(18.7%) to45(29.0%), two different modes of intervention compliance on blood pressure by contingency table data x2draw a significant difference (P=0.025), the control group blood pressure average decline3/2mmHg, the intervention group decreased by an average of7/6mmHg.Conclusion5.1After six months of study, conventional health education interventions and Motivational Interviewing and the Transtheoretical model intervention could improve in elderly hypertensive patients with medication compliance, Motivational Interviewing and cross-the theoretical model of intervention is more effective.5.2Two kinds of intervention can improve the communities in elderly hypertensive patients with exercise time, vegetable intake, fruit intake, while reducing the intake of oil, salt, indicating that the two interventions can promote elderly high blood pressure in patients with a healthy lifestyle, the effect of the intervention group better than the control group.5.3Two kinds of intervention in elderly hypertensive patients to quit smoking, and alcohol intervention effect was not difference, Intervention group to promote smoking, alcohol consumption decrease in patients with smoking and alcohol is better than conventional health education.5.4Two kinds of intervention can reduce the extent of the decline of community elderly hypertensive patients with systolic blood pressure, diastolic blood pressure, BMI, waist circumference.5.5Two forms of intervention can improve self-efficacy and behavior of elderly patients with hypertension, thereby increasing the compliance rate in elderly hypertensive patients with blood pressure, while the effect of intervention group was significantly superior to conventional health education group. |
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