Application Of Health Empowerment In Self-management Behavior Intervention Of Community Stroke Patients:Based On Trans-theoretical Model

Objective Trans-theoretical model(TTM)was used to evaluate the distribution status of self-management behavior stages in community stroke patients.we evaluate the influence of TTM-based health enpowerment intervention on the changes of self-management behavior,self-efficacy and self-management behavior of community stroke patients,and explore the difference between TTM-based health enpowerment intervention and single health enpowerment intervention on the self-management intervention effect of stroke patients.Methods During August 2018 and March 2019,Using a convenient sampling method,we selected 60 stroke patients who met the inclusion and exclusion criteria in 6 communities affiliated to a community health service center in Nanjing and randomly divided them into TTM-based health enpowerment group(20 cases),single health enpowerment group(20 cases)and conventional control group(20 cases).We used behavior stage assessment questionnaire,chronic disease self-efficacy questionnaire and stroke self-management behavior assessment scale to evaluate the self-management behavior stage,self-efficacy and self-management behavior level of the three groups subjects before intervention,8 weeks of intervention,16 weeks of intervention,and 24 weeks of intervention,respectively.Results A total of 54 subjects were collected in this study,including 19 in the TTM-based health enpowerment group,17 in the health enpowerment group,and 18 in the conventional control group.Self-management behavior stage:8 weeks of intervention,there was no statistical difference in the distribution of self-management behavior stages among the three groups.16 weeks of intervention,the differences between the TTM-based health enpowerment group and the single enpowerment group,and the TTM-based health enpowerment intervention and the conventional control group were statistically significant(P<0.05),while the single health enpowerment group and the conventional control group were not statistically significant.24 weeks of intervention,the differences between the TTM-based health enpowerment group and the single health enpowerment group,and the TTM-based health enpowerment group and the conventional control group were statistically significant(P<0.05),while the differences between the single enpowerment group and the conventional control group were not statistically significant.Self-efficacy:8 weeks of intervention,16 weeks of intervention,and 24 weeks of intervention,the differences in self-management efficacy of the subjects in the three groups were statistically significant(P<0.05).8 weeks of intervention,the difference between the TTM-based health enpowerment group and the conventional control group was statistically significant(P<0.05),while the other groups was not statistically significant.16 weeks of intervention,the differences between the TTM-based health enpowerment group and the conventional control group,the TTM-based health enpowerment group and the single health enpowerment group,and the single health enpowerment group and the conventional control group were statistically significant.24 weeks of intervention,the distribution of the self-management efficacy of the subjects in the TTM-based health enpowerment group and the conventional control group,the TTM-based health enpowerment group and the single health enpowerment group,had statistical significance(P<0.05),while the single health enpowerment group and the conventional control group had no statistical significance.The self-management efficacy scores of the subjects were compared with each other at four time points,The difference between the single health enpowerment group 8 weeks of intervention and other three time point were statistically significant(P<0.0125).There was no significant difference in self-management efficacy scores between the TTM-based health enpowerment group at 24 weeks of intervention and 16 weeks of intervention,but other differences were statistically significant(P<0.0125).Self-management behaviors:8 weeks of intervention,the total scores of disease management,safe drug administration,diet,rehabilitation and exercise management and self-management behaviors in the TTM-based health enpowerment group and the single health enpowerment group were higher than those before the intervention(P<0.0125).The emotional management dimension score of the TTM group was higher than that before the intervention(P<0.0125),and there was no statistical difference between the TTM-based health enpowerment group and the single health enpowerment group.16 weeks of intervention,the total scores of disease management,safe medication management,diet,daily life management,social function and interpersonal management,rehabilitation and exercise management and self-management behavior in the TTM-based health enpowerment group and the single health enpowerment group were higher than those 8 weeks of intervention(P<0.0125).The emotional management dimension score of the TTM group was higher than that of the control group(P<0.0125).The total scores of disease management,safe drug administration,rehabilitation and exercise management and self-management behavior of the TTM group were all higher than those of the control group(P<0.05).24 weeks of intervention,the total scores of disease management,emotional management,social function and interpersonal management,rehabilitation and exercise management,and self-management behavior in the TTM group were higher than 16 weeks of intervention(P<0.0125).There was no significant difference between the scores of administration of safe drugs,diet management and daily life management and the 16 weeks of intervention(positive growth).Can assign a set of social function and interpersonal management score higher than 16 weeks of intervention(P<0.05),eating and living a management scores and 16 weeks of intervention no statistical difference(positive growth),disease management,safe drug use and rehabilitation exercise management scores and 16 weeks of intervention no statistical difference(negative growth),self-management behavior score less than 16 weeks of intervention(P<0.0125),TTM group disease management,safe medication management,emotion management,rehabilitation exercise management,self-management behavior score were higher than control group(P<0.05).Conclusion Both TTM-based health enpowerment intervention and single health enpowerment intervention can effectively promote cerebral apoplexy patients in community self-management behavior,improve the patients' self-efficacy and raise the self-management level.However,the effectiveness of TTM-based health enpowerment intervention is more enormous than the effectiveness of single health enpowerment intervention,especially in long-term effects.As a consequence,TTM-based health enpowerment intervention can be used to improve the compliance of patient's health behavior.This study provides a theoretical reference for future theoretical research and clinical practice on how to develop individualized intervention scheme of self-management for stroke patients.