Construction And Application Of Self-management Scheme For Elderly Patients With Pruritus Based On HAPA Model

Objective1.To construct a self-management programme for elderly patients with Senile pruritus(SP)based on the Healthaction processapproach(HAPA)theoretical model.2.To explore the effectiveness of the self-management programme based on the HAPA model in patients with SP,with a view to providing a new reference basis for the health management of patients with SP.Methods1.The study was guided by the HAPA model,and the first draft of the self-management programme for SP patients was developed through literature review and group discussion.16 experts in the relevant fields were selected for two rounds of correspondence using the Delphi method,and the final draft of the self-management programme was revised by the research team based on the experts’opinions.2.In this study,72 SP inpatients aged≥60 years in the dermatology department of a Grade A hospital in Jining were selected by convenient sampling method from January2022 to December 2022.They were divided into the control group and the test group by random number table method,with 2 cases lost each,and finally 34 cases were included in each group.The control group implemented routine nursing interventions in dermatology,including admission education,medication precautions during hospitalization,skin care,and discharge instructions;the patients in the experimental group implemented a self-management program based on the HAPA model on the basis of the control group,assessing the behavioral stage the patients were in and giving targeted nursing measures.Patients’scores on pruritus severity,anxiety,depression,self-efficacy,and self-management were assessed using the 12-item Pruritus Severity Scale(12-PSS),the General Self-Efficacy Scale(GSES),the Hospital Anxiety and Depression Scale(HADS),and the Self-Care Ability Scale for the Elderly(SASE)before the implementation of the intervention(first day of patient admission),1 month after the implementation of the intervention,and 3 months after the implementation of the intervention.Statistical methods such as ANOVA and t-test SPSS 26.0 software were used for statistical analysis of the data.To evaluate the effectiveness of the self-management program based on the HAPA model in patients with SP.Results1.The two rounds of expert authority coefficients were 0.803 and 0.865,and the Kendall harmonization coefficients were 0.270(χ~2=146.838,p<0.001)and 0.292(χ~2=158.968,p<0.001),respectively,and the two rounds of expert correspondence were used to construct the final draft of the self-management intervention programme,which contained three primary indicators(pre-intentional stage,intentional stage and action stage),10 secondary indicators and 22 tertiary indicators.2.Comparison of baseline data between the two groups of patients before the intervention:the results of pruritus,anxiety and depression,self-efficacy and self-management scores of the two groups showed no statistically significant differences(P>0.05)and were comparable.3.At the end of the 1st month after the intervention,the pruritus condition score and the anxiety and depression score at the end of the 3rd month were lower than those of the control group at the same period.The difference was statistically significant(P<0.05).The between-group effect,time effect and interaction effect were all statistically significant(P<0.001).4.The differences in self-efficacy scores and self-management scores at the end of month 1 after the intervention were not statistically significant(p>0.05),while self-efficacy scores and self-management scores at the end of month 3 after the intervention were higher than those of the control group during the same period,and the differences were statistically significant(p<0.05).There were statistically significant differences in the between-group effect,time effect and interaction effect(p<0.001).ConclusionIn this study,after using a self-management programme based on the HAPA model to intervene in patients with SP,it was possible to effectively reduce the patients’pruritus,alleviate their anxiety and depression,improve their self-efficacy level and enhance their self-management ability.The intervention model is simple,easy to implement and highly operable,and is worthy of clinical promotion.However,the long-term therapeutic effects on patients still need to be studied in depth.