The Application Of Health Belief Model In The Health Status Of Patients With The Moderate To Severe Chronic Obstructive Pulmonary Disease

Objectives:(1) To develop a scale for measuring COPD patients' health belief and to rectify its reliability and validity; (2) To investigate COPD patients' health belief and to identify its principal factors, so as to provide theory foundation for nursing intervention; (3) To investigate the effect of HBM-based nursing intervention on the patients with COPD, hoping to establish foundation for further clinical study and application.Methods:The primary items was obtained through reviewing literature and semi-structured interviewing with COPD patients; five experts were invited to assess the primary scale and it was modified according to their suggestions. One hundred and sixty subjects were recruited in the first study to finish the questionnaire, and then item analysis were made, including item distribution, Pearson correlation coefficients, exploratory factor analysis. Lastly, analyzing the revised scale's reliability and validity, Reliability includes internal consistency, split-half reliability, test-retest reliability, Validity including content validity and construct validity.In order to identify the factors,157 COPD patients were observed, which include the patients' basic information, HBM Scale, the COPD self efficacy scale, the St George's Respiratory Questionnaire,MMRC, Barthel index and so on. Independent sample t test, single factor variance analysis, chi-square test, rank correlation analysis and multiple regression analysis are used to determine factors affecting the health beliefs and self efficacy.88 cases of inpatient with COPD were chosen by convenient sampling those who hospitalized at Tianjin Medical University Hospital between September in 2009 and November in 2010, they were investigated involving basic information, several questionnaires, six minutes walking distance, body mass index,pulmonary function test when they were in stable state before discharged from the hospital. During the first month after discharge, the patients received telephone interview, at three month and six month, they got home visits and each patient was required to fill out the St George's respiratory questionnaire, HBM Scale, the COPD self efficacy scale, MMRC, Barthel index activities of daily living and 6MWD,the pulmonary function and so on. The control group will get normal respiratory care only; on the other hand, the case group will be given nursing intervention based on HBM. Analyze the data by Independent sample t test, single factor variance analysis chi-square test, variance analysis.Results:1. Eight items were deleted from 35-item primary HBM scale through item analysis. The final scale contained 5 dimensions, which are perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers or costs and cues to action according to the five aspects of HBM. During exploratory analysis, the KMO was 0.774 and the P value<0.05, the scale' was extracted seven common factors which accounted for 62.503%, and the factor burden on items was from 0.414 to 0.873. The Cronbach's a coefficients of the total and sub-scales ranged from 0.696 to 0.874, the Guttmann split-half coefficients were between 0.685 and 0.801, the test-retest correlation coefficients were 0.675 to 0.880.2. The total score of moderate-severe COPD patients' health belief (96.90±9.97),the score of perceived susceptibility was highest,the lowest one is in the dimension of Cues to action,in the sub-scales of self efficacy, the score of negative affect and physical exertion were relatively low, these aspects need to be improve. Stepwise regression analysis revealed that the condition of economic, behavior adherence,FEV1/FVC and condition of occupation were included in the regression equation (F=17.128, P<0.01),these factors can explain 29.30% of total variance, while level of anxiety-depression and social support are important factors that influence self efficacy, which can explain 44.50% of total variance(F=63.508, P<0.01).3. There were no differences between the case group and the control group on the basic and clinical information when they got stable after admission (P>0.05).After nursing intervention, COPD patients' health belief, self-efficacy, healthy behavior adherence,6MWD, MMRC score, Barthel index, physical activity got improved significantly (P<0.05), though it has no significant improvement in FEVi and FEV1/FVC, but FVC increase obviously(P<0.05),what is more, it can decrease score of quality of life significantly(P<0.05),but there is no obvious effect on patients'BMI.4. The exacerbation frequency of disease, hospitalization and health care cost in the treatment group was significantly less than the control group (P<0.05).Conclusions:1. The reliability and validity of HBM scale is satisfactory, it is easy to be understood and the patients would like to accept it, and it can be an evaluative tool for clinical practice.2. Some aspects of the COPD patients' health belief and self efficacy are need to be improve, the factors affecting the health belief are condition of economic, behavior adherence,FEV1/FVC and condition of occupation. The level of anxiety-depression and social support are important factors that influence self efficacy of the patients.3. The nursing intervention based on HBM can enhance COPD patients' health belief and self efficacy, promoting healthy behavior adherence, though it has no positive effect in FEV1 and FEV1/FVC, but FVC increase obviously, what is more, it can decrease patients' dyspnea, enhance exercise tolerance and physical activity, and eventually improve their quality of life, at the same time, it can cut down the exacerbation frequency of disease and hospitalization, and decrease healthcare cost.