| ObjectivesThis study investigated and analyzed the current status and relevant influencing factors of health belief,health behaviors and functional exercise compliance of stroke patients with hemiplegia and this study analyzed the promoting factors in the formation of health behaviors of functional exercise in stroke patients with hemiplegia.The purpose of this study was to explore the application and effects of the menu-based nursing intervention based on the Health Action Process Approach Model(HAPA)which applied on stroke patients with hemiplegia.It provided a new theoretical basis for improving the health belief and functional exercise compliance and developing good health behaviors of stroke patients with hemiplegia.It had important significance in expanding the field of the HAPA model and application in further research.MethodsThere were three stages in this study.The first stage:Using the convenient sampling method,a total of 355stroke patients with hemiplegia who were satisfied the inclusion criteria for participation in this study were from the neurology department of three third-grade hospitals in Hengyang since September 6,2017 to June 10,2018.Participants were investigated by the general demographic characteristics questionnaire,Health action stage assessment questionnaire,Champion's health belief model scale,functional exercise compliance scale of stroke patients and health behaviors questionnaire of stroke patients.A total of 350questionnaires were distributed and 322 qualified questionnaires were returned with an effective rate of 92%.The second stage:To compare the sample's heterogeneity,stroke patients with hemiplegia who came from neurology department in a third-grade hospital in Hengyang,Hunan Province were selected based on the age,marital status,diagnosis,health action stage.Researchers developed interview outlines based on the HAPA model.Finally,11 participants were recruited by principle of data saturation for in-depth interviews to investigate the promoting factors of behaviors of functional exercise in stroke patients with hemiplegia.The third stage:Using the convenient sampling method,84 stroke patients with hemiplegia who came from a neurology department of a third-grade hospital in Hengyang since July 5 to December 20,2018 were in accordance with the inclusive criteria and selected as sample of the study.According to the random principle,participants were randomly allocated to the control group(n=42)and the intervention group(n=42).Patients in the control group were given routine health education of stroke knowledge.Patients in the intervention group were given menu-based nursing intervention based on the HAPA model and the routine health education of stroke knowledge.Using the the general demographic characteristics questionnaire,Health action stage assessment questionnaire,Champion's health belief model scale,functional exercise compliance scale of stroke patients and health behaviors questionnaire of stroke patients to evaluate the two groups of patients before intervention and 12 weeks after intervention.And then compared health belief scores,functional exercise compliance scores,health behavior scores and the changes of health action stage between two groups.In the end,2 patients in the control group and 2 patients in the intervention group dropped out this study.Finally,there were 40 stroke patients with hemiplegia in each group.Statistical Package for the Social Sciences(SPSS)22.0 was used to analyze the data,the statistical methods involved descriptive statistics,Pearson correlation analysis,one-way ANOVA,multiple linear regression analysis,t-test,chi-square(?~2)test,etc.Results(1)The total mean score of health belief scale of stroke patients with hemiplegia was(112.34±11.03),items average score was(3.21±0.32),which was at a medium level.Gender,family history,and health action stage were the main influencing factors,which explained 32.8%of the total variation of the regression equation of stroke patients health belief.(2)The total mean score of the functional exercise compliance scale of stroke patients with hemiplegia was(33.19±4.78).13.35%of stroke patients had low functional exercise compliance.82.92%of stroke patients with hemiplegia were at moderate level of functional exercise compliance.Gender,age,and health action stage were the main influencing factors,which explained 36.3%of the total variation of the regression equation of stroke patients functional exercise compliance.(3)The total mean score of the health behavior questionnaire of stroke patients with hemiplegia was(64.02±8.40).Items average score was(2.67±0.35).Standardized scoring rate was 53.35%,which was at a medium level.Gender,age,educational level,and health action stage were the main influencing factors,which explained 34.9%of the total variation of the regression equation of stroke patients health behaviors.(4)There was positive correlation between health belief and health behaviors of stroke patients with hemiplegia(r=0.159,P<0.01).Stroke patients'health belief was positively correlated to the functional exercise compliance(r=0.261,P<0.01).Stroke patients'health behavior was positively correlated to the functional exercise compliance(r=0.334,P<0.01).(5)Qualitative interviews were conducted with 11 stroke patients with hemiplegia who met the inclusion criteria.Five brief themes were refined out:(1)adequate disease-related knowledge;(2)correct risk awareness;(3)appropriate social support;(4)positive outcome expectations;(5)appropriate self-adjustment and actively coping with difficulties.(6)There was no significant difference of the demographic details,health beliefs,functional exercise compliance,and health behaviors between the two groups before the intervention(P>0.05).(7)There was no significant difference of the number of patients in each health action stage between the two groups before the intervention(P>0.05);After intervention,the changes in the health action stage of the intervention group were significantly better than those in the control group(P<0.05).(8)After intervention,stroke patients with hemiplegia in the intervention group had a significant decrease in the total mean health beliefs score,as well as each dimension score(P<0.05).After intervention,scores of stroke patients with hemiplegia in the intervention groups were statistically significant higher on those scores than that those in the control group(P<0.05).(9)After intervention,stroke patients with hemiplegia in the intervention group had a significant increase in the total mean health behaviors score,as well as each dimension score(P<0.05).After intervention,scores of stroke patients with hemiplegia in the intervention groups were significantly higher on those scores than that in the control group(P<0.05).(10)After intervention,the average score of health behaviors in stroke patients with hemiplegia and and its scores of each dimension in the intervention group were significantly higher than that before intervention(P<0.05).After intervention,the average score of health behaviors of stroke patients with hemiplegia and its scores of each dimension in the intervention group were significantly higher than that in the control group(P<0.05).Conclusions(1)The health belief,functional exercise compliance,health behaviors of stroke patients with hemiplegia were at a medium level.And there was a positive correlation among health beliefs,functional exercise compliance and health behaviors in stroke patients with hemiplegia.(2)Stroke patients with hemiplegia had a correct risk perception of this disease after mastered sufficient stroke-related knowledge.Patients with appropriate social support,can establish positive outcome expectations,enhance self-efficacy,and make self-adjustment timely to cope with difficulties actively.It can promote the formation and maintenance of health behaviors of patients'functional exercise.(3)The menu-based nursing intervention based on the HAPA model can effectively improve the health belief level,improve functional exercise compliance,promote the health behavior of stroke patients with hemiplegia. |
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