Research On The Construction Of Exercise Intervention Program For The Elderly With Sarcopenia In Community Based On The Transtheoretical Model

Objective: Based on the Transtheoretical Model,this study explores the construction of a community-based exercise intervention program for the elderly with sarcopenia,providing scientific guidance for grassroots health practitioners,introducing the program into the community environment under the guidance of the comprehensive framework of implementation research,analyzing the obstacles and promoting factors of implementing the exercise intervention program in community health service centers,and evaluating the feasibility,acceptability and enforceability of the program,so as to provide theoretical basis for community-based intervention.Methods:(1)Using evidence-based nursing method,the first draft of the scheme was drawn up according to the cross-theoretical model,and the final scheme was formed after two rounds of Delphi expert consultation.(2)According to the comprehensive framework of the implementation research,the interview outline was constructed,and the obstacles and promotion factors of the implementation of the program in the community health service center were analyzed through semi-structured interviews.Evaluate the baseline situation of the elderly with sarcopenia in the community by using the change stage questionnaire,self-efficacy scale,decision-making balance scale and change procedure scale,conduct a pre-test,guide the elderly to complete two-week exercise intervention,and analyze the feasibility,acceptability and enforceability of the elderly with sarcopenia in the community through semi-structured interviews.Results:(1)Through literature research,the intervention plan was constructed based on the trans-theoretical model,and the intervention content of 19 items was formed.The plan was finally determined through two rounds of Delphi expert letters.The results show that the expert authority coefficients of the two rounds are 0.87 and 0.94 respectively,and the coefficient of variation of each item in the two rounds of letters is less than 0.25;The Kendall coordination coefficient of importance is 0.146(P=0.002)in the first round and 0.146(P=0.003)in the second round,and the Kendall coordination coefficient of feasibility is 0.292(< 0.001)in the first round and 0.171(< 0.001)in the second round.The experts’ opinions in the two rounds tend to be consistent,forming the final scheme.(2)Through interviews with 10 community medical staff,the analysis results obtained 17 decisive factors covering the four dimensions of CFIR framework,including 11 promoting factors and 6 hindering factors.Among them,the promotion factors include the training needs of community medical staff,the compatibility with the follow-up work of chronic diseases,the interest of the elderly caused by new knowledge,the benefits of the elderly themselves,the better conditions of the elderly,the organizational culture of community medical staff,the need for community medical staff to seek external cooperation,the importance of project publicity,the importance of health education,the establishment of incentive mechanism for the elderly and the high sense of identity of community medical staff for program intervention.Obstacles include the lack of knowledge of sarcopenia among community medical staff,the lack of special sports instruction time in the community,the lack of sports awareness of the elderly,the lack of manpower,material resources and financial resources in community health service centers,the lack of attention to policies and regulations by community medical staff,and the lack of relevant work indicators in community health service centers.(3)Through interviews with 12 elderly people,the results show that there are 10 decisive factors influencing the intervention of the elderly people with sarcopenia in the community,including 6 promoting factors: convenient exercise mode,diagram of resistance exercise to help them remember actions,recognizing the benefits of exercise,providing elastic belt for free,killing time,having the will to keep exercising,and 4 hindering factors:unable to remember actions,inconvenient to complete actions,exercising alone,and lack of interest.The elderly include 3 males and 9 females,aged 65-87,2 in the pre-intention period,1 in the intention period,5 in the preparation period and 4 in the maintenance period.The score of exercise self-efficacy is between 15 and 75,the score of positive effect of decision-making equilibrium is between 33 and 121,the score of negative effect of decision-making equilibrium is between 32 and 55,and the score of stage change is between 51 and 212.Conclusion: Combining with the Transtheoretical Model,the exercise intervention program for the elderly with sarcopenia in community is scientific.The interview outline made by the Consolidated Framework for Implementation Research can identify the obstacles and promoting factors of implementing the sports intervention program in the community environment.This scheme had certain feasibility,acceptability and sustainability..