Effect Of Self-management Intervention Under Health Action Process Approach Among Elderly Patients With Tuberculosis

Objective: The advantages of the supervised self-management programme under the Health Action Process Approach(HAPA)among elderly patients with tuberculosis(TB)are unclear.If the behavioural belief intervention component of the supervised self-management programme under HAPA was shown to improve self-management capabilities among elderly patients with TB,this programme could serve as method for the management of TB.Method: This trial was designed with experimental study of epidemiology.254 participants were randomly selected through Management System for Patients with TB in the two cities according to the inclusion criteria and on a voluntary basis.Then we assigned all participants 1:1 to intervention group and control group.Participants in the intervention group were provided with the three-period(when patients' treatment started,1 month after their treatment start,and 6 months after their treatment start),two hours each period,supervised self-management program based on HAPA theory,including behavioural belief intervention(TB-related knowledge,policy and standard for TB medical treatment),behaviour plan intervention(assist patients with designing action calendar aimed at improving their medical treatment compliance and non-medical treatment compliance),self-efficacy intervention(strengthen patients' self-efficacy in four fields: health responsibility,nutrition,mental comfort and activity).We used parallel control with a single session of standardized health promotion under DOTS.Each stage of the implementation carried out repeated measures and after one week to collect the two groups of patients with behavioral beliefs score,behavioral scoring and self-efficacy score and other outcome variables.All data were typed into an Epidata 3.1 software database.Then,we used SAS 9.4 software for each analysis and R-Studio v7.2 software to draw the figures.Besides,we applied mixed model analysis and non-parameter test for quantitative evaluation,and case interview in sociology for qualitative evaluation.Results: 1.General information of elderly patients with TB: there were 254 patients in both groups at baseline.The age distribution focused on 65~74 years old,accounting for 90.94%.The gender distribution was mainly male,accounting for 93.31%.The initial treatment was the highest in the treatment group,accounting for 94.49%.Chemotherapy management to the whole process of supervision,accounting for 70.87%.The occupation before retired,workers majored,accounting for 74.02%;before the diagnosis of tuberculosis knowledge to master the situation,accounting for 77.83%.There was no statistically significant difference in the general demographic data between the two groups and no statistically significant difference in the baseline measurement of the two groups.2.Quantitative evaluation of the supervised self-management intervention: the overall effective rate of each subscale intervention was 85.71%,63.63% and 66.67%.After the first intervention,the effective rates of each subscale intervention were 85.71%,45.45% and 33.33%.After the second intervention,the effective rates were 85.71%,36.36% and 66.67%.After the third intervention,the effective rates of each subscale intervention were 85.71%,45.45% and 33.33%.The trend analysis showed that the score of the intervention group was higher than that of the control group(P<0.01).In the behavioral credit subscale,the trend of the intervention group rise first,and remained stable after the second intervention,but the control group is the first rise and then decline;The trend of the intervention group was lower than that of the control group(P<0.01).In the self-efficacy subscale,the trends in the two groups are consistent with their tendency to score in behavioral beliefs.Subgroup analysis showed that the difference in treatment effect between the two groups was not derived from the relevant grouping factors.After a three-phase follow-up,ten patients were lost(five in the first,three in the second,and two in the third period).3.Qualitative evaluation of the supervised self-management intervention: all interviewees of qualitative interview indicated that their own behavior had changed much after self-management,including medical supervision(12/12),family supervision(9/12),self-supervision(10/12),reasonable sleep And activities(11/12).All show a positive mental state,including confidence in treatment(12/12),a positive attitude towards life(11/12),to ensure the required nutrition(12/12),Adhere to daily physical exercise(10/12).All have taken some specific measures to prevent tuberculosis,including developing good social habits(10/12),lifestyle(9/12),adhere to medication(11/12).Conclusions: This study indicated the supervised self-management programme under HAPA are prior to the standardized health promotion under DOTS and have some certain priority in promoting ability of self-management.Therefore we advice anti-tuberculosis workers could add self-management into standardized health promotion under DOTS and combine the self-management of patients with supervision under medical workers can popularize self-management in communities in China according to local conditions,thus providing beneficial support for management of TB of China.