| ObjectivesThe primary aim of this study was to investigate the level of cerebral apoplexy patients’ related knowledge, self-efficacy, self-management behavior as well as the status of subjective well-being during the stage of recovery, and to analyze the influencing factors of self-management behavior and based on the results to formulate and implement self-management intervention plans. In addition, it was to evaluate the effects of self-management interventions and to verify feasible and effective of self-management interventions. The results can provide available suggestions for improving nursing modes for patients with cerebral apoplexy. It is beneficial for patients to enhance their self-efficacy, promote the level of self-management behavior and prevent recurrence of cerebral apoplexy It also can improve patient’s quality of life and subjective well-being in the future.Methods1. Descriptive epidemiology methods were employed to acquire the status of patients with cerebral apoplexy during convalescence and analyze the related influencing factors. This study was conducted at neurology departments of two level 3 General hospitals in Yancheng city, Jiangsu province. From July 2013 to January 2014, a total of 146 initial cerebral apoplexy patients who discharged from the hospital enrolled in this research. The details about participants including the level of related knowledge, self-efficacy, self-management behavior and the status of subjective well-being during their convalescences were collected by self-designed general information questionnaire and cerebral apoplexy knowledge questionnaire, simple intelligence test scale (AMT), activities of daily life scale (ADL), (Barthel index), chronic disease management self-efficacy scale (SSC), cerebral apoplexy patients’ self-management behavior rating scale, social support rating scale (SSRS), stroke impact scale (SIS)and memorial university of Newfoundland scale was happiness (MUNSH).All statistical analyses were performed using SPSS version 20.0. Part of obtained information including patients’knowledge of stroke, self-efficacy, self-management behavior, social support, quality of life and subjective well-being were scored by statistical description such as percentage, mean and standard deviation. The outcome about influencing factors of self-management behavior was analyzed by single factor analysis, correlation analysis and multiple stepwise regression analysis.2. Experimental epidemiological study was conducted to analyze the effects of self-management interventions on knowledge-attitude-practice and subjective well-being of patients with cerebral apoplexy during convalescence. This research was carried out in neurology departments of two level 3 General hospitals in Yancheng city, Jiangsu province. From March 2014 to September 2014, a total of 70 patients with initial stroke were selected for this study, according to include and exclude criteria. Participants were divided into control group and intervention group by dynamic balancing randomization method,35 cases in each group. Control group accepted conventional treatment and care for stroke in the department of neurology. Meanwhile, intervention group accepted the same routine treatment and nursing, combining with a six-month self-management intervention after leaving the hospital. Based on the knowledge-attitude-practice theory and patients’known information in the first chapter including cerebral apoplexy knowledge, self-efficacy, self-management behavior, the status of subjective well-being and influencing factors of self-management behavior, the first draft of the self-management intervention plan was made. Besides, risk factors of stroke and knowledge and skills of rehabilitation function training were also embodied in the first draft. Moreover, nursing specialists and experts in neurological departments were invited to revise and perfect this intervention plan. Eventually, the final draft was performed. The contents of the self-management intervention plan contained guidelines for disease-related knowledge, safety of using medicine, maintaining healthy behavior, daily self-monitoring, skills of rehabilitation training and mental health. Patients’knowledge-attitude-practice, quality of life and subjective well-being in two groups were compared by using knowledge questionnaire of stroke, SSC scale stroke, stroke patients’self-management behavior rating scale, SIS scale and MUNSH scale, respectively before the intervention and 6 months after the intervention. Besides, influencing factors of the self-management intervention on patients’ knowledge-attitude-practice, quality of life and subjective well-being were also analyzed.Results1. The total score of stroke patients’knowledge was 19.52±6.35. The scoring rate of index was 48.8%. The overall level of stroke patients during convalescent period was very low. 64.4% of patients with cerebral apoplexy had a low knowledge level. Besides, patients with intermediate and high level of knowledge accounted for 28.8% and 6.8% respectively. The score of each dimension rating from high to low, in order, mode of behavior(59.7%), risk factors(50.9%), premonitory symptoms (49.4%),safety of medication (38.3%), first aid treatment (35.5%), rehabilitation knowledge (34.3%).The total score of self-efficacy in patients with stroke during convalescence was 5.43±1.76. The low level of self-efficacy in stroke patients made up 64.4%. Meanwhile, only 35.6%of patients located at a high level. The whole self-management behavior score in patients with cerebral apoplexy was 150.55 ± 37.11.The scoring rate of index was 59.0%. The overall level in patients with stroke was middle or slightly low. The percentages among low, medium and high levels were 44.5%, 51.4% and 4.1% respectively. From high to low, the scoring rate of index in each dimension were, in order, drug safety management (71.8%), dietary management (65.4%), management of daily life (64.7%), emotional management (64.0%), social function and personnel management (59.6%), rehabilitation exercise (57.2%) and disease management (42.5%).2. The total score of social support in stroke patients was 39.78 ±10.60. The objective support score, subjective support score and score of utilizing social sustain accounted for 12.0±3.75, 20.44±5.58 and 7.51±1.79 separately. Compared with the domestic norm, all the scores in this study were lower, with statistical significant difference (P< 0.05, P< 0.01).The whole level of stroke patients’quality of life scored 206.46±34.11. The scoring rate of index was 69.99%. The overall score located medium level. From top to bottom in scoring rate of index of each dimension are, in order, communicative competence (86.3%), memory and thought (80.9%), energy (78.8%), hand function (76.4%), emotion (72.85%), ability to act (62.8%), daily life (60.9%), social participation (54.2%).The total score of SWB in patients with cerebral apoplexy during convalescence was 29.47 ± 4.87, and which was in the medium level. Each dimension in SWB scored as follows:positive emotion(6.26±1.19),negative emotion (4.61 ±1.31), positive experience (8.25±1.75) and negative experience (4.43±1.43). Among all the scores, positive emotion, positive experience and the overall scored lower than the national norm, while negative emotion and negative experience scored higher than the domestic norm. All differences had statistical significance (P< 0.01).3. The results of single factor analysis showed that the total score of self-management behavior in patients with cerebral apoplexy had significant differences among different age, occupation, degree of education, types of medical payment, per capita monthly income, complicating disease and Barthel index (P< 0.01). The correlation analysis demonstrated that the total score of self-management behavior had significantly positive relationship with cerebral apoplexy knowledge (r= 0.579, P< 0.579), self-efficacy (r= 0.405, P< 0.01), social support (r= 0.312, P< 0.01), the quality of life (r= 0.567, P< 0.01) and subjective well-being (r= 0.358, P< 0.01) in patients with stroke during the phase of recovery. Meanwhile, scores in each dimension (disease management, safety management, dietary management, management of daily life, emotional management, social function and personnel management, rehabilitation exercise) of self-management behavior also had significant positive correlations with cerebral apoplexy knowledge (r= 0.511-0.579, P< 0.01), self-efficacy (r= 0.314-0.434, P< 0.01), social support (r= 0.312, P< 0.01), the quality of life (r= 0.468-0.598, P< 0.01) and subjective well-being (r= 0.289-0.368,P< 0.01) in patients with stroke during the phase of recovery. Multiple stepwise regression analysis revealed that the main influencing factors which affected on self-management behavior of patients with cerebral apoplexy during convalescence were as follows:the degree of culture, knowledge, social support and self-efficiency, quality of life.4. Comparison of the control group before and after the intervention:significant differences were found in the following aspects:knowledge-attitude-practice, the overall knowledge, management of safe medication, dietary management, daily life management, emotional management and self-management behavior (P< 0.05 or P< 0.01). However, there were no significant differences in the following domains:each dimension’s knowledge, the overall self-efficacy, disease management, social function, personnel management and management of rehabilitation exercise (P>0.05). At the aspect of QOL, there were statistically significant differences in scores of energy, memory and thought, daily activities, ability to act, function of the hands, social participation and the overall domain(P< 0.05 or P< 0.01), while no significant differences were seen in emotion and communicative competence (P> 0.05). In the field of subjective well-being, there were no statistically significant differences in total score as well as scores in each dimension (P> 0.05).5. Comparison of before and after the intervention group:the self-management group had significant improvements compared with the control group in overall score and each dimension of knowledge-attitude-practice and quality of life (P< 0.01). In the field of subjective well-being, compared with before intervention, the self-management group after intervention had statistically significant improvement in positive emotion, positive experience and total score(P<0.01), while the scores of positive emotion and negative experience in experimental group were significant lower than before(P< 0.01).6. Comparison of the two groups after interventions:the intervention group had obvious improvement in the whole score and each dimension’s score in knowledge-attitude-practice and quality of life, with statistically significant differences (P< 0.05 or P< 0.01). In the field of subjective well-being, compared with the control group, the intervention group had statistically significant improvement in positive emotion, positive experience and the total score (P< 0.01), while the scores of positive emotion and negative experience in the intervention group were significant lower (P< 0.01).Conclusions1. The knowledge in patients with cerebral apoplexy during their recovery stages had a low level. The self-efficacy level in stroke patients during their recovery stages was very poor, and the percentage of patients with a low level of self-efficacy is 64.4%. The overall of self-management behavior level located at the medium to low level.2. The total and each dimension’s scores in social support score of patients with cerebral apoplexy were lower than the domestic norm’s. The quality of life and subjective well-being in stroke patients located at a medium level.3. The main influencing factors of management behavior in patients with cerebral apoplexy during convalescence were degree of culture, knowledge, social support and self-efficiency.4. The self-management intervention in patients with stroke can effectively improve their knowledge levels and enhance their self-confidence for disease self-management. Besides, it is effective to promote the establishment of patients’self-management behavior, and it is also beneficial for improving their quality of life and subjective well-being. |
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