| Background At present,China has entered a period of rapid aging,with high morbidity and large aging population base.In 2020,China’s population aged 60 and above was 264 million,accounting for 18.7% of the total population.Chronic diseases have become the most important health threat to the elderly,and the prevalence rate of chronic diseases among the elderly ≥ 60 years old in China is 71.18%.Due to the coexistence of multiple diseases and interwoven factors,the prevention and control of chronic disease is grim,resulting in the rapid growth of medical expenses and the increasing burden of family economy and care.As the most common chronic disease threatening the health of the elderly,hypertension is one of the main causes of death and loss of body function in the elderly.The prevalence rate of hypertension in the elderly aged ≥ 60 years in China is 53.2%,but the control rate is only 18.2%.The prevention and treatment of hypertension in the elderly has become a major social problem related to thousands of families,affecting the construction of a harmonious society and the realization of "healthy China 2030".Among the many factors affecting the occurrence and development of chronic diseases,bad lifestyle is the most important risk factor.Although the behavioral risk factors of hypertension have been identified,the research on the influencing factors and mechanisms of behavior change is insufficient,the evaluation tools of behavior change are lack,the behavior change assessment tools are lack and the existing health behavior theories do not clearly distinguish the start and maintenance of behavior change.Most of the studies focus on finding out the influencing factors of health behavior in chronic disease population,but less on the sustainability of health behavior promotion and intervention and the mechanism of behavior change.The change of behavior needs to be based on the corresponding theory,integrate the theory with practice,and re-test the theory through practice.However,due to the lack of relevant research on the formulation and effect evaluation of behavioral intervention strategies,the formulation of lifestyle management strategies lacks strong evidence support.Objectives(1)The purpose of this study is to develop the Chinese version of Measuring Change in Restriction of Salt(Sodium)in Diet in Hypertensives(MCRSDH)and the Measuring Change in Physical Activity Questionnaire(MCPAQ)in hypertensives,and to test its reliability and validity,so as to provide an evaluation tool for the scientific evaluation of the health behavior change of hypertensive patients in China.(2)To analyze the current situation of salt restriction diet and physical activity(PA)in elderly patients with hypertension,and analyze its influencing factors.Explore the distribution characteristics of constitution of the elderly with hypertension.(3)Construct the intervention model of health behavior change in elderly patients with hypertension according to the Multi-Theory Model(MTM).(4)To evaluate the effect of this intervention model in controlling the blood pressure,promoting the change of unhealthy behavior and improving the quality of life of elderly patients with hypertension,so as to provide an effective practical guide for the management of lifestyle of elderly patients with chronic diseases(taking hypertension as an example),and also provide a scientific basis for the government and relevant departments to improve and formulate corresponding policies.Methods This study used a combination of qualitative and quantitative research methods.(1)We obtained authorization from the original authors of MCPAQ and MCPAQ,and conducted cross-cultural adaptation.Item differentiation analysis and correlation coefficient method were used to screen the items to form the initial scale of MCPAQ and MCPAQ.The reliability analysis included internal consistency reliability and retest reliability,and the validity analysis included content validity and structural validity,finally form a formal scale.(2)The general condition questionnaire,disease-related questionnaire,MCPAQ and MCPAQ,and four single item questionnaires were used to measure the participants’ general information,disease-related information,change in restriction of salt in diet and PA behavior.T-test,one-way ANOVA and multiple linear regression were used to analyze the influencing factors of behavior change in salt restriction diet and physical activity.(3)According to the MTM,the survey results of health behavior change of the participants,literature analysis,focus group interviews with elderly hypertensive,and expert consultation and panel discussion,the final intervention mode of health behavior change were formed.The model includes two-way conversation,health education,wechat consultation,establishing community mutual aid groups,recording health behavior diaries,seeking family support,etc.(4)Four communities were recruited and matched,and divided into the intervention group and the control group.Compared the baseline data of the two groups and the intervention effect was evaluated by three-level outcomes.The primary outcomes were blood pressure,BMI,waist circumference,daily salt intake and effective exercise days per week.The secondary outcomes included changes in diet and PA behavior.The tertiary outcomes included quality of life and self-health score.Repeated measurement analysis of variance,chi-square test and linear mixed model were used to analyze the intervention effect.Results(1)The correlation coefficient between each item and the total score ranged from 0.327-0.799 and 0.468-0.893 in MCRSDH-INIT and MCRSDH-SUST respectively.The S-CVI was 0.914.Four factors were extracted by EFA and could explain 68.511% of the total variance for MCRSDH-INIT.Three factors were extracted by EFA and could explain 76.558% of the total variance for MCRSDH-SUST.Values of factor loading ranged from 0.541 to 0.926.CFA indicated: χ2/df=2.193,GFI=0.912,CFI=0.967,RMSEA=0.057,NFI=0.944,TLI=0.958 for initiation model and χ2/df=2.173,GFI=0.937,CFI=0.991,RMSEA=0.069,NFI=0.984,TLI=0.981 for sustenance model。The Cronbach’s α coefficient was 0.901 and the retest reliability was 0.917.(2)The correlation coefficient between each item and the total score were 0.350-0.815 and 0.539-0.896 in MCPAQ-INIT and MCPAQ-SUST respectively.The S-CVI was 0.936.EFA showed that the cumulative variance interpretation rate of the four common factors extracted by MCPAQ-INIT was 71.967%,the cumulative variance interpretation rate of the three factors extracted by MCPAQ-SUST was 74.589%,and the factor loading coefficient of each item was 0.492-0.921.CFA indicated: χ2/df=1.847,GFI=0.910,CFI=0.936,RMSEA=0.043,NFI=0.924,TLI=0.898 for initiation model and χ2/df=1.722,GFI=0.942,CFI=0.967,RMSEA=0.021,NFI=0.937,TLI=0.901 for sustenance model 。 The Cronbach’s α coefficient was 0.911 and the retest reliability was 0.898.(3)A total of 712 elderly patients with hypertension were included in this study.The proportion of dietary salt intake >6g/d was 82.3%.Multivariate regression analysis revealed 44.1% of the variance in initiating the consumption of low-salt diets explained by advantages outweighing disadvantages,behavioral confidence,changes in physical environment,women,living conditions and BMI.About 41.8% of the variance to sustain the intake of low-salt diet was explained by emotional transformation,practice for change,changes in social environment,living condition,BMI and other chronic diseases.(4)The proportion of exercise time <5 days/week and <30 minutes/day in elderly patients with hypertension was 76.3%.Multivariate regression analysis showed that 51% of the variance in the PA initiation was explained by advantages outweighing disadvantages,behavioral confidence,changes in physical environment,education level and years of hypertension.About 57.3% of the variance in PA sustenance was explained by emotional transformation,practice for change,changes in social environment,education level and BMI.(5)Hypertension is biased in constitution from high to low in order of qi deficiency,yin deficiency,phlegm dampness and Yang deficiency.(6)Blood pressure and chronic disease risk outcomes:(1)After six months of follow-up,the systolic and diastolic blood pressure of the intervention group decreased 8.20±5.66 and 3.30±2.35 respectively compared with the baseline,and the systolic and diastolic blood pressure of the control group increased 0.22 ± 2.59 and 0.63 ± 2.02 compared with the baseline.There were interaction between the intervention method and time points.The antihypertensive effect of the intervention group was better than that of the control group.Linear mixed effect model analysis showed that intervention could reduce systolic and diastolic blood pressure in elderly patients with hypertension.(2)The BMI and waist circumference of the intervention group decreased 0.30±0.46 and 0.35±1.84 respectively,and the control group increased 0.17±0.30 and 0.26±0.91 compared with the baseline respectively.There were interaction between the intervention method and time points.The intervention method could significantly affect the changes of BMI and waist circumference.(7)Dietary behavior:(1)The daily salt intake of the intervention group decreased 1.23±2.75,and the control group increased 0.17±0.79 compared with the baseline.The daily salt intake of the intervention group was lower than that of the control group.Linear mixed effect model showed that the intervention could reduce the daily salt intake of elderly patients with hypertension.(2)The scores of each structure of MTM of salt restriction behavior in the intervention group were higher than those in the control group,and the difference was statistically significant.(8)Exercise behavior:(1)The weekly effective exercise days in the intervention group increased 1.76±1.72,and the control group decreased 0.11±1.04 compared with the baseline.The weekly effective exercise days in the intervention group were higher than those in the control group.Linear mixed effect model showed that the intervention could increase the weekly effective exercise days in elderly patients with hypertension.(2)The scores of each structure of MTM of PA in the intervention group were higher than those in the control group,and the difference was statistically significant.(9)Quality of life: there are differences in the health index and self-rating health status before and after the intervention,and there is interaction between the intervention method and time points.The effect of the intervention group in improving the quality of life and self-rating health status is better than that of the control group.Conclusions(1)The Chinese version of MCPAQ and MCPAQ are reliable and valid,and can be used as tools to measuring change in salt restriction diet and PA in hypertensives in China.(2)The willingness of the participants to salt restriction diet needs to be improved.The higher the scores of advantages outweighing disadvantages,behavioral confidence and changes in physical environment,women,living with family and normal BMI,the greater the possibility to initiate low-salt diets.The higher the scores of emotional transformation,practice for change,changes in social environment,living with family,normal BMI and having other chronic diseases,the greater the possibility to sustain the intake of low-salt diet.(3)The willingness of the participants to promote their exercise behavior needs to be improved.The higher the scores of advantages outweighing disadvantages,behavioral confidence,changes in physical environment,the higher education,and the course of disease <3 years,the greater the possibility to initiate PA.The higher the scores of emotional transformation,practice for change,changes in social environment,higher education and normal body mass,the greater the possibility to sustain PA.(4)Hypertension is biased in constitution from high to low in order of qi deficiency,yin deficiency,phlegm dampness and Yang deficiency.(5)The health behavior change intervention model based on MTM can effectively control the blood pressure,BMI and waist circumference,significantly reduce the daily salt intake,increase the PA,improve the scores of MCPAQ and MCPAQ,and significantly improve the health-related quality of life.In short,this model is operable and is an effective and popularized method to promote the health behavior of elderly patients with hypertension. |
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