| BackgroundIn order to optimize the use of medical resources and improve the health level of residents,the state vigorously promoted the grass-roots first diagnosis and graded diagnosis and treatment system,and began to take family doctor contract service as one of the contents of public health services in 2011.In 2018,the National Health Commission issued the Circular on further doing a good job in the key work related to the construction of a graded diagnosis and treatment system,proposing that grass-roots medical and health institutions should steadily promote the signing services of family doctors.Priority should be given to signing services for key groups such as the elderly,pregnant women,children aged 0-6 years,patients with chronic diseases and patients with severe mental disorders,and standardize the health management of patients with chronic diseases.At present,China takes the family doctor team of the community health service center as the core to carry out the lifestyle intervention management model based on health education for the prevention and management of chronic diseases in the community.At present,the community family doctor team in our country mainly faces two problems in carrying out health education.On the one hand,the quantity and quality of the family doctor team can not keep up with the requirements of building a healthy China.On the other hand,the content and form of community health education can not keep up with the people’s growing demand for health knowledge.Some community health education work is still dominated by traditional methods such as health bulletin boards,health manuals and health wall posters.Not only the form of health education is single,not vivid and attractive,but also the content is layered,and the sustainability is poor.Lack of personalization and precision;some communities mostly carry out health education by offline lectures and face-to-face diagnosis and treatment,which requires high human and material resources and low efficiency.With the development of telecommunications and Internet technology,the mode of human communication presents a rich and colorful pattern along with the electronic,networked and intelligent characteristics of information technology.The application of "Internet +" technology to community health education is a good way to break through the current predicament.Internet information dissemination collection of sound,pictures,video,text,multi-contact,vivid display content,has become a cheap and efficient way to obtain health information,and is widely loved by the public.In order to explore innovative models of community health education,this study developed and designed Wechat "Micro-step appointment" Mini Program to build a new platform for health communication between community family doctors and residents,so as to make good use of the Internet to enhance the effectiveness of community health education.This study takes patients with type 2 diabetes mellitus in the community as intervention objects.By building a health education platform based on "Internet +" technology,the purpose of this study is to explore the effect of the new model of health education based on "Internet +" technology on the management of T2 DM patients in the contract service of family doctors in Chongqing,and to provide practical and theoretical basis for the construction of a new model of online health education.ObjectiveUsing the existing telecommunications and Internet resources,this paper constructs a health education platform of the new model of health education based on "Internet +" technology,and discusses the effect of the new model of "Internet + health education" on the management of T2 DM patients in the contract service of family doctors in Chongqing.By building a network communication platform between the family doctor team and the contracted family,we can reduce the working time cost of the family doctor team,improve the work efficiency of the family doctor team,and effectively improve the problems existing in the community health education work of the family doctor team.Methods1.Investigate the current situation of health education in community health service centers,study the functional requirements of health education platform based on "Internet +" technology,and construct the basic framework of the platform;cooperate with the program development network company to develop a new health education model platform based on "Internet +" technology,and optimize the platform through continuous trial testing,and finally determine the main functions,interface and operation mode of the platform.2.Based on the new model platform of health education constructed by the research group,volunteers were recruited to carry out the practice of health education and weight loss activities,and to explore the effect of the new model of health education based on "Internet +" technology on lifestyle behaviors related to weight loss.Combine We Chat group and We Chat Mini Programs for online intervention.3.Taking community T2 DM patients as intervention objects,according to the inclusion and exclusion criteria,600 T2 DM patients were selected from 3 community health service centers in Shapingba District of Chongqing for "multicenter" new health education model intervention based on "Internet +" technology.Using We Chat Mini Programs,Wechat official account and We Chat group,11 family doctor teams from 3 community health service centers in Shapingba District of Chongqing were sent to community T2 DM patients with healthy lifestyle intervention as the core content,to establish knowledge and beliefs,to guide community T2 DM patients to pay attention to their own health and change their bad lifestyle,and finally to achieve effective community T2 DM management.The effect was evaluated by the combination of qualitative research and quantitative research.(1)Qualitative study: face-to-face interviews were conducted with community health service center leaders,family doctor team members and diabetes patients at the end of the intervention.The interview mainly focuses on the health education platform based on "Internet +" technology,the intervention work of the family doctor team and the experience of the project participants.(2)Quantitative study: the project participants were investigated by questionnaire and health-related indicators were measured before and 3 months after intervention.According to the pre-intervention survey results,the project participants were randomly grouped to ensure that the sample balance was comparable.After the intervention,the measurement results of health-related indicators of the two groups were compared,and the intervention effect was evaluated.Results1.The health education platform based on "Internet +" technology has been successfully constructed,with the following functions:(1)The dissemination of health knowledge.Through the popularization of disease-related health knowledge,help community T2 DM patients to learn health knowledge and establish health beliefs.(2)Answer questions online.Realize the online communication between the community family doctor team and the community T2 DM patients,and broaden the patient health consultation channels.(3)Exercise monitoring.The exercise team function allows the family doctor team to keep abreast of the movement of T2 DM patients and facilitate reminder and supervision.(4)Diabetes self-management punch and other functions,according to the self-management test for T2 DM patients with individual disease management short board reminder intervention.2.The research group recruited 7 volunteers to participate in the weight loss project based on "Internet +" technology.after the activity,there were significant differences in body fat rate,waist-to-hip ratio,fat and visceral fat,and the weight loss effect was significant.3.A total of 600 patients with T2 DM were enrolled in the study.After three months of intervention,a questionnaire survey and health-related indicators were conducted again,and a total of 563 people were interviewed.There were 285 patients in the intervention group and278 patients in the control group.(1)Qualitative research results: According to the feedback from 4 community health service center leaders,5 family doctor team members and 12 project participants,the family doctor team uses the new health education model based on "Internet +" technology to manage community T2 DM effectively.Patients’ compliance has been improved,their awareness of their own diseases has been further deepened,their anxiety about the disease has also been greatly reduced,their firm belief and determination to overcome diabetes have been strengthened,and their knowledge and beliefs have been put into action.contributed to a change in lifestyle.(2)Quantitative research results: There was no significant difference in baseline(demographic characteristics and health-related indicators)in the intervention group(P >0.05).After 3 months of intervention,compared with the control group,the waist circumference(P < 0.01)and waist-hip ratio(P < 0.05)were smaller in the intervention group,and the muscle percentage was higher in the intervention group(P < 0.01).Among the related indexes of blood glucose,blood lipid and blood pressure,fasting blood glucose,glycosylated hemoglobin,fasting insulin and triglyceride were lower in the intervention group(P < 0.01).Among the related indexes of physical fitness,the standing time of one foot with eyes closed(left foot)and the standing time of one foot with eyes closed(right foot)were longer in the intervention group(P < 0.01),and the grip strength of the right hand was stronger in the intervention group(P < 0.05).The results suggest that the intervention can help T2 DM patients in three communities to reduce waist circumference,waist-hip ratio,fasting blood glucose,glycosylated hemoglobin,fasting insulin and triglyceride,increase body muscle rate,right hand grip strength,and prolong the standing time of one foot with eyes closed(left foot,right foot).A stratified analysis was carried out according to the community health service center.A Community Health Service Center: fasting blood glucose,total cholesterol,triglyceride,standing time of one foot with eyes closed(left foot,right foot),right hand grip strength were significantly improved;B Community Health Service Center: muscle rate,fasting blood glucose,glycosylated hemoglobin and other indicators significantly improved;C Community Health Service Center: fasting blood glucose,glycosylated hemoglobin and other indicators significantly improved.ConclusionNo matter the overall evaluation or hierarchical evaluation of the three community health service centers,the two indexes of fasting blood glucose and glycosylated hemoglobin were significantly improved,and the blood glucose control was good.It is confirmed that the new health education model of community health service center based on "Internet +" technology has significant effect on community T2 DM.For the T2 DM patients in the community health service center,the application of the new community health education model based on "Internet +" technology in the contract service of family doctors in Chongqing has a better intervention effect than the conventional community health service center T2 DM management model in the aspects of body shape,body composition,blood glucose and blood lipid,physical fitness and so on.It effectively improves the shortage of health education staff and the single content of health education service in the community health service center,reduces the work burden of the family doctor team in the community health service center,improves the work efficiency,enhances the self-management willingness of T2 DM patients in the community health service center,strengthens the T2 DM intervention in the community health service center,and is worth further popularizing in the community health service center.It is applied to the management of other chronic diseases in community health service centers. |
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