The Study Of Self-management Program Applied In Out-patients Of Gastroesophageal Reflux Disease

Background:Gastroesophageal reflux disease(GERD) is a common acid-related disease caused by gastrointestinal dynamic obstacles. Epidemiological surveys demonstrate that the prevalence of GERD varies from7to15percent in western countries,5.77%in Beijing and7.28%in Zhejiang. Outpatient treatment is the main therapy for GERD patients who need to visit repeatedly to maintain drug therapy because of the various symptoms and the easy recrudesce. Lifestyle, eating habits, exercise and psychological intervention has synergy with the treatment of drugs. At present, more and more researchers focus on the non-pharmacological interventions for GERD.Self-management program has become research hotpot in the field of health management. This model encourage patients to participate in self-care process, combining medical measures with self management strategy, to maintain the status and function of health in a satisfactory condition. With the deepening research on etiology and pathogenesis of GERD, Lifestyle changing, diaphragmatic muscle biofeedback, psychological intervention and traditional Chinese medicine has good efficacy in adjunctive therapy. How to combining the targeted interventions with the theory of self-management, providing effective recovery direction, has became the focus of numerous scholars.The study aims to provide reference to develop of self-management program by investigating of the level of self-management behavior and its influencing factors. Furthermore, to provide reference to non-pharmacological interventions by implementing the self-management intervention and exploring the influence of self-management program on self-efficacy, self-management behavior and clinical symptoms, spiritual psychology and the quality of life among GERD patients. Meanwhile, to provide scientific and effective evaluation tool for implement of self-management program, the self-management behavior scale for GERD was also developed.Objective:1. To investigate the status of self-management behavior among GERD patients and analyze its influencing factors.2. To explore the influence of self-management program on self-management behavior, self-efficacy, health outcomes and satisfaction among GERD patients.Materials and Methods:1.280GERD out-patients were tested by self-management behavior scale which was self-designed, then analysis the influencing factors.The self-efficacy and the quality of life among these patients were tested by the self-efficacy scale for managing chronic disease and the Chinese version of the MOS36-item short form healthy survey (SF-36).2. A total of115GERD patients were divided into intervention group(65) and control group(50) by visiting time. Based on conventional drug treatment, the patients in the intervention group received self-management program while the patients in the control group were subjected the routine guidance. The level of self-efficacy, self-management behavior and psychological condition, curative effect and satisfaction between two groups were compared.Results:1. The scale had a high reliability and validity, with a Cronbach’s alpha of0.859, ICC of0.914and CVI of0.837. There was acceptable concurrent validity with correlations between the self-efficacy scale for managing chronic disease and this scale(r=0.377). Confirmation factor analysis revealed a four factor solution accounting for52.11%of the total variance.2. The level of self-management behavior was medium low. Among dimensions compliance of treatment was the best, while disease knowledge was the worst. It demonstrated by multiple stepwise regression analysis that self-efficacy, educational level and work related stress were significant predictors of self-management behavior.3. The clinical symptoms of intervention group improved more effectively than control group (P<0.05) and the total effective rate of intervention group was better than that of control group (P<0.01) after intervention at8weeks and12weeks. The satisfaction was improved obviously after intervention at12weeks(P<0.01).4. The level of self-efficacy, self-management behavior, psychological health and life quality of the intervention group was better than that of the control group (P<0.05).Conclusions:The self-management behavior scale is a valid and reliable instrument in evaluating the behavior in GERD patients. The current situation of self-management among GERD patients is not perfect. Poor disease knowledge is an important influence and self-efficacy is significant predictors of self-management behavior. The self-management program can improve the level of self-efficacy, self-management behavior, psychological health and the quality of life, enhance the treatment effect and satisfaction.