| Objective:The use of evidence-based methods in this study is to explore the most effective and the most extensive fall prevention measures.Then based on evidence-based results,stroke fall risk perception and behavior intention questionnaire is drew up by using Delphi,then investigate the current situation.Finally,a structural equation model is constructed to analyze the influence path of the relevant variables.Methods: Databases including The Cochrane Library,PubMed,CNKI and so on were searched the randomized controlled trials at home and abroad about preventing falls in people after stroke,and studies were selected according to the inclusion and exclusion criteria.Statistical analysis was using RevMan5.3 software.Based on the analysis,the cognitive theory,structured stroke risk perception and behavior intention questionnaire by Delphi,and evaluated its reliability and validity.Selected stroke patients with the convenient sampling method,investigated the current situation of risk perception and behavior intention and construction of structural equation model is used to analyze and evaluate the variable path to explore the efficacy of interpret of antecedent variables of behavior intention on behavior intention and the mediating effect of behavioral intention and self-efficacy variables on executive intention variables at the stage of intention.The data were processed and analyzed by SPSS17.0 and AMOS 17.0.Results:1 22 randomized controlled trials were included.The results of meta analysis showed that,compared with the placebo or routine intervention,comprehensive effect of different forms of interventions for preventing falls inadult after stroke had not a statistical significance in the number of adults who had fallen[OR=0.80,95%CI 0.61-1.05],but the multi-factorial intervention had a significant reduction[OR=0.33,95%CI 0.16-0.68];different time of intervention for preventing falls in adult after stroke was not statistically significant in the number of fallers[OR=1.00,95%CI 0.77-1.30];there were no statistical differences between two groups in the rate of falls[OR=0.79,95%CI 0.39-1.62],and the results were stable and reliable.2 after 2 rounds of expert consultation,Preliminary investigation and formal investigation,fall risk perception and behavior intention questionnaire was established which was consisted of 57 items.Then exploratory factor analysis extracted 10 factors,and the cumulative variance contribution rate was 75.17%.The extracted common factor is consistent with the structure hypothesis which is designed according to the theoretical framework.The 6theoretical variables were risk perception,outcome expectancy,fall self-efficacy,behavior intention,coping intention,coping self-efficacy.The overall Cronbach's a is 0.934,and the Cronbach's a of each variable were0.897,0.822,0.979,0.892,0.929,0.940.Therefore the questionnaire had good internal consistency.3 The modified model about stroke fall risk perception and behavior intention was successfully simulated with the actual data and could be accepted(?2=5.737,P=0.676,?2/df=0.717<2,NFI=0.991,RFI=0.968,IFI=1.004,TLI=1.013,CFI=1.000,RMSEA=0.000<0.08),The model could explain 47% of behavioral intention,41% of action planning,and 51% of the coping planning.Fall self-efficacy and risk perception were determinants of behavioral intention,and there was a direct positive prediction effect.Meanwhile,Coping self-efficacy between self-efficacy and perceived risk and between behavior intention and implementation intention played a mediating role;behavior intention in fall self-efficacy,risk perception and implementation intentions played a full mediating effect.Conclusion:The HAPA theory was applied to fall risk perception and behavior intention questionnaire,which has good reliability and validity,and The questionnaire is consistent with the theoretical framework.The HAPA model can effectively describe,explain,and predict the change process of the fall prevention behaviors. |
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