Constructing An Intervention Program Based On Cognitive-Behavioral Theory For Compliance Behavior Of Patients With Aortic Dissection And Its Application

ObjectiveTo construct a cognitive behavioral intervention program for compliance behavior of patients after aortic dissection surgery,and to explore its application effects on blood pressure control,compliance behavior,negative emotions and quality of life,so as to provide reference for cognitive behavioral intervention research in patients with aortic dissection.Methods1.Construct the intervention program for postoperative compliance behavior of patients with aortic dissection based on cognitive-behavioral therapy.A comprehensive literature review from PubMed,Web of Science,China Knowledge Network,Wan fang and some other databases to understand the current status of the improvement of blood pressure,postoperative compliance behavior and quality of life in patients with aortic dissection.A preliminary intervention program based on cognitive behavioral theory was constructed on the basis of the literature analysis.Fifteen experts were selected for Delphi expert correspondence to further refined the intervention program according to expert recommendations.Though the preexperiment,the final implementation draft of the cognitive behavioral intervention program could be conducted.2.To evaluate the effect of the intervention program constructed based on cognitive behavioral theory on the application of post-operative compliance behavior in patients with aortic dissection.Patients with post-operative aortic dissection treated in two wards of a tertiary hospital in Henan Province from March 2021 to July 2021 were randomly divided into a control group and an intervention group according to the coin flip method（the control group was given routine health education while the intervention group applied the cognitive behavioral theory-based intervention program on the basis of the control group）.Patients were followed up and assessed before,immediately after,3 months after and 6 months after the intervention.Blood pressure measurement,Morisky medication compliance Scale,the SF-36 Quality of Life Scale and the Negative Mood Scale were used to evaluate the effects of the intervention program on the improvement of blood pressure,postoperative compliance,quality of life and negative mood in patients with aortic dissection.Statistical analysis performed using SPSS 20.0 software and repeated measures analysis of variance were used to compare the differences between the two groups before and after the intervention.Results1.Construction of an intervention program based on cognitive-behavioral theory of compliance behavior of post-operative patients with aortic dissection.The relevant literature retrieved was comprehensively reviewed to understand the current situation of blood pressure improvement,medical compliance behavior,negative emotions and quality of life of patients after aortic dissection surgery,7 papers were finally selected as references to construct the first draft of the intervention program based on cognitive-behavioral theory.After two rounds of expert consultation and preexperiment,the intervention plan was modified on this basis,and the effective recall rate of the two rounds of expert consultation was 100%,and the expert authority coefficient was 0.84,thus forming the final feasible and authoritative clinical cognitive-behavioral intervention administration draft.2.Application of the intervention program for compliance behavior of postoperative aortic dissection patients based on cognitive-behavioral therapy.（1）Baseline data:A total of 68 patients were included,4 cases were lost,the lost rate was 5.9%,the effective sample size was 64 cases,32 cases in the control and intervention groups,respectively.There was no statistical difference between the two groups in terms of gender,age,ethnicity,days of hospitalization,education,marital status,per capita monthly household income,work status,occupation,place of residence,and form of medical payment（P>0.05）.（2）Comparison of blood pressure values:There were no statistically significant differences in systolic and diastolic blood pressure values between the two groups before intervention（P>0.05）.The results of repeated measures showed that the differences between groups were statistically significant(F_SBP=4.336,P<0.05;F_DBP=6.334,P<0.05);Systolic blood pressure and diastolic blood pressure values in the two groups were affected by time factors,and there were significant differences in systolic blood pressure and diastolic blood pressure values at different time points(F_SBP=35.500,P<0.01;F_DBP=9.886,P<0.01).Systolic blood pressure and diastolic blood pressure have interaction between the two groups and time(F_SBP=5.073,P<0.05;F_DBP=2.576,P<0.05);The difference of blood pressure in the intervention group was statistically significant at 3 months and 6 months after intervention（P<0.05）.（3）Scores of Morisky medication compliance scale:there was no statistical significance in scores before intervention between the two groups（P>0.05）.Repeated measures analysis of variance showed that there was an interaction of the scores of medication compliance scales between the two groups and time（F=11.947,P<0.01）,and the differences between the two groups was statistically significant（F=45.588,P<0.01）.According to the comparison of dates within each group,the scores of two groups after the intervention were significantly improved compared with those before the intervention（F=56.252,P<0.05）.The scores of medication compliance in the intervention group were significantly different immediately after intervention,3 months and 6 months after intervention（P<0.05）.（4）Quality of life scores:there was no statistical significance in scores of all dimensions before intervention between the two groups（P>0.05）.Analysis of variance by repeated measures showed that there is an interaction between the two groups of patients in terms of time and space in the total score of quality of life（F=79.236,P<0.01）.The scores as well as total score of all dimensions of quality of life scale in the intervention group were higher than those in the control group,and the difference was statistically significant（F=442.325,P<0.01）.The scores and total score of all dimensions of quality of life scale were affected by time.There were statistically significant differences in the scores and total scores of each dimension at different time points（F=995.050,P<0.01）.The quality of life scores of the intervention group were significantly different immediately after intervention,3 months and 6 months after intervention（P<0.05）.（5）Negative emotion scores:There was no statistical significance in Hamilton Anxiety Scale（HAMA）score analysis and Depression Scale（HAMD）score between two groups before intervention（P>0.05）;repeated measurement analysis of variance showed that HAMA and HAM D scores in the intervention group were more significant than those in the control group just after,3 months and 6 months after the intervention,with statistically significant differences（P<0.01）.Negative emotions were improved more significantly just after and 3 months after the intervention.HAMA scores and HAMD scores of the two groups at each time point had interactive effects between gr oups and time（P<0.01）.Simple effects showed that HAMA and HAMD scores in the intervention group were lower than those in the control group at different time points,with statistical significance（P<0.01）.There were significant differences in HAMA score and HAMD score in the intervention group immediately after intervention,3 months and 6 months after intervention（P<0.05）.ConclusionThe intervention program of compliance behavior for patients after aortic dissection surgery based on cognitive behavior theory can keep the blood pressure of patients after aortic dissection surgery relatively stable,improve compliance behavior,reduce negative emotions,and play a positive role in improving the quality of life of patients.