| Objective:1.To develop a Medical Seeking Behavior KAP scale of the Elderly,and evaluate the psychometric properties of MSBKSE.2.to investigate the current situation of the medical seeking behavior of the aged Miao ethnic group in western Hunan.3.Constructing the intervention model of seeking medical treatment for the aged of Miao ethnic group in western Hunan,and to verify the feasibility and effectiveness of this intervention model by pre-experiment.Methods:1.Based on KAP theory,On the basis of Literature Review,semi-tructured interview and Expert Review,to develop a predictive test scale(MSBKSE-Ⅱ);Using MSBKSE-Ⅱ,to test 300 eligible elderly subjects,and using Classical measurement theory(CTT)to screen the items of the scale,Develop a provisional version of the scale(MSBKSE-Ⅲ).August-december 2018,In Xiangxi Tujia and Miao Autonomous Prefecture,668 eligible elderly people were selected for formal testing,form the final version of the MSBKSE,to evaluate the reliability(internal consistency reliability,test-retest reliability)and validity(content validity,construct validity)of the scale.2.Based on Health Belief Model,To Randomselecte 227 elderly Miao people,using General Information Questionnaire,MSBKSE,SDS self-rating depression scale,activities of daily living scale,health education prevalence questionnaire awareness of basic health knowledge and self-rating health seeking behavior questionnaire to survey,to analyze the influencing factors of the medical seeking behavior of the aged Miao ethnic group in western Hunan.3.Based on a cross-sectional survey of 227 elderly people of Miao ethnic group,An in-depth interview on medical seeking behavior of 10 elderly people of Miao ethnic group,after analysis,induction,discussion and summary by the members of the group,to exploration and verification of Amos structural equation model,to form the final edition of the intervention model of knowledge,belief,and practice level for the elderly of Miao ethnic group in seeking medical treatment.4.A randomized controlled trial design was used,to include 134 eligible Hmong Seniors in Xiangxi Tujia and Miao Autonomous Prefecture from January to August 2019,In the control group,68 elderly Miao people were used blank,The intervention group consisted of 66 elderly people of Miao ethnic group(3 months).The feasibility and effect of the intervention program were evaluated by comparing before,after and three months after the intervention.Results:1.The MSBKSE scale is a self-rating scale,It contains 21 items and 6factors,They are knowledge identification,family support identification,consequence identification,clinician trust,decision-making and medicalexpense judgment.The Cronbach,s alpha identification,family support is 0.734,The test-retest Reliability Coefficient is 0.807,The content validity index(S-cvi)is 0.85.The scale can distinguish the elderly with different medical hyperlipidemia,hypertension,family care burden,cardio-cerebrovascular diseases(myocardial infarction,stroke,etc.)(P<0.05);The results of exploratory and confirmatory factor analysis were acceptable.2.The general level of medical seeking behavior of the aged Miao ethnic group in western Hunan was 47.57 ± 5.829,Among them,there were lower scores in the three factors of consequence identification,family support identification and clinician trust.The educational level,social support,anxiety and depression,awareness of basic health knowledge,sourcesof medical expenses,hyperlipemia,hypertension,family care burden,cardiovascular and cerebrovascular diseases(myocardial infarction,stroke,etc.)Can Affect his medical behavior.3.The intervention model of medical seeking behavior of Miao elderly based on health belief model was constructed,The intervention period was 1 month,once a week,60 minutes each time,the intervention was motivational interviewing;The intervention pattern consists of three themes,Theme 1 and Theme 2 correspond to the intervention items of week 1 and Week 2,Topic 3 corresponds to intervention projects in week3and4;Respectively,First,Perception of health and disease susceptibility,second,Medical-seeking behavior and consequence perception of medical-seeking behavior,third,Confidence in medical behavior change.Among them,the intervention of each subject was conducted according to the three processes of interaction(partnership establishment),participation(interview goal setting)and response(health knowledge provision)motivational interview.4.The structural equation model was used to construct the intervention model for the elderly of Miao ethnic group,The intervention experiment was carried out according to the intervention model,Health intervention for the elderly of Miao ethnic group,before intervention,there was no significant difference in the scores of each variable between the two groups(P>0.05),The results showed that the two groups were comparable.After and three months after the intervention,the score of MSBKSE in intervention group was significantly higher than that in control group,the results was statistically significant(P<0.05)Conclusion:1.The MSBKSE scale has good reliability and validity,It provides a reliable and effective evaluation tool for evaluating the medical seeking behavior of the elderly in China.2.In western Hunan,the knowledge,attitude and practice of the aged Miao people in seeking medical treatment were in the middle to lower level,There’s plenty of room for improvement,we can strengthen the health-seeking behavior of the elderly of Miao ethnic group in western Hunan from three aspects: Knowledge,belief and social support.3.It is feasible and effective to improve the health-seeking behavior of the elderly of Miao ethnic group in western Hunan,It can obviously improve the passive medical seeking behavior of the aged in western Hunan,To enhance his aggressive medical care,so as to improve the level of reasonable medical treatment for the elderly of Miao ethnic group in western Hunan.Figure 11,Table 52,References 189. |
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