Development And Application Of Peer Opinion Leaders Intervention Model On Health Management Of Older Adults At High Risk Of Stroke

BackgroundStroke is the main cause of limb dysfunction,cognitive impairment and even death in older adults.In China,older adults at high risk of stroke account for a large proportion,lacking the awareness of health management.Community based health management is limited to go deep into the daily life of older adults at high risk of stroke,requiring the supervision and guidance of peer opinion leaders（POLs）.POLs,active members in similar population,can promote behavior change of surrounding populations.As a potential resource,POLs can spread health knowledge in the community and help alleviate the shortage of medical and health personnel in China.Thus,it is warranted to study the intervention of POLs on health management of older adults at high risk of stroke.Objective1.To develop the POLs intervention model on health management of older adults at high risk of stroke.2.To determine the application effects of POLs intervention model.Methods1.ParticipantsTwo communities were randomly selected from a community healthcare center in Xinxiang City to collect the physical examination data of older adults.The subjects were recruited by using the screening form for population at high risk of stroke.One hundred and twenty-two older adults at high risk of stroke who met the criteria were enrolled in the current study by cluster sampling,including 59 in community A and 53 in community B（The remaining 10 high-risk individuals were POLs）.2.Methods（1）Development of POLs intervention model a)Development of health management manual for older adults at high risk of stroke.Information-motivation-behavioral skills model were applied as the theoretical basis.Based on literature search,first edition of the manual was drafted.After discussions among experts,the manual was modified,forming a health management manual for older adults at high risk of stroke.b)Screening of POLs.POLs were recruited through self or others recommendation.After 6weeks’training and qualification confirmation,10 POLs were screened.c)Development of POLs intervention model.Taking the manual as the core content,the basic framework,personnel organization structure and intervention approaches of POLs intervention model were determined to preliminarily develop POLs intervention model.After discussions among experts,POLs intervention model was modified and finally developed.（2）Application of POLs intervention model Older adults in control group were given conventional health guidance by community healthcare center.Those who came from the POLs intervention group were intervened by POLs based on the conventional health education.The scores of the rating scale of health self-management for adults（AHSMSRS）,self-rated abilities for health practices scale（SRAHP）,health promoting lifestyle profile-Ⅱ,revise（HPLP-ⅡR）and the short-form of the UCLA Lone-liness Scale（ULS-8）were compared between the two groups at baseline（T0）,3 months（T1）,and 6months-follow-up（T2）.The SPSS 25.0 softwere was used to conduct t-test,chi-square test,Wilcoxon rank sum test and repeated measurement analysis of variance respectively according to the data characteristics.Results1.POLs intervention modelAccording to the POLs intervention model,POLs transmitted the health management knowledge of information,motivation and behavior skills to older adults at high risk of stroke through group discussion,collective exercise and face-to-face communication.Either POLs or older adults fed back confused problems to the researchers,who provided support,supervision and knowledge dissemination in the process of intervention.2.Repeated measurement analysis of variance on each index in the two groupsAfter the intervention of POLs,scores of AHSMSRS(F_time=174.194,F_grouping=6.653,F_interaction=55.362),SRAHP(F_time=602.101,F_grouping=67.148,F_interaction=259.826),HPLP-ⅡR(F_time=816.963,F_grouping=243.893,F_interaction=485.463),and ULS-8(F_time=148.411,F_grouping=8.979,F_interaction=69.576)of older adults differed significantly on time effect,grouping effect,and interaction effect between time and grouping（P<0.05）.3.Comparison of the scores on AHSMSRSThe scores of AHSMSRS(t _T1=2.229,t _T2=6.482)and health self-management behavior subscale(t _T1=1.999,t _T2=6.067)differed significantly between two groups at T1 and T2 end points（P<0.05）.For scores of health self-management environment subscale(t _T2=4.271)and health self-management cognition subscale(t _T2=3.456)of older adults,comparison between two groups differed significantly at T2 end points（P<0.05）.4.Comparison of the scores on SRAHPThe scores of SRAHP(t _T1=5.700,t _T2=15.375),nutrition subscale(t _T1=3.140,t _T2=8.474),psychological comfort subscale(t _T1=2.592,t _T2=8.709),motion subscale(t _T1=3.353,t _T2=7.054),and health responsibility subscale(t _T1=2.132,t _T2=7.749)of older adults differed significantly between two groups at T1 and T2 end points（P<0.05）.5.Comparison of the scores on HPLP-ⅡRFor scores of HPLP-ⅡR(t _T1=9.968,t _T2=31.325),health responsibility subscale(t _T1=5.359,t _T2=18.426),interpersonal relationship subscale(t _T1=4.329,t _T2=13.482),nutrition subscale(t _T1=3.735,t _T2=11.971),physical activity subscale(t _T1=4.805,t _T2=17.208),spiritual growth subscale(t _T1=2.068,t _T2=9.559),and stress management subscale(t _T1=3.113,t _T2=10.274)of older adults,comparison between two groups differed significantly at T1 and T2 end points（P<0.05）.5.Comparison of the scores on ULS-8For scores of ULS-8(t _T1=-2.712,t _T2=-7.625)of older adults,comparison between two groups differed significantly at T1 and T2 end points（P<0.05）.ConclusionsThe POLs intervention model on health management of older adults at high risk of stroke was developed,which improved the health self-management ability and health practices ability,ameliorated the health promoting lifestyle,and reduced the loneliness of older adults at high risk of stroke.