| ObjectivesTo explore the effect of intervention scheme based on meta-cognition strategy on body mass index(BMI),the rate of hypertension control,hypertension treatment attitude and belief and self-management behavior in community elderly patients with hypertension,so as to provide a clinical reference for further improving the disease management of community elderly hypertension and other chronic diseases.MethodsThe two communities were randomly selected from 6 communities in the district of a community health service center in Changsha,and randomly divided into experimental community and control community.According to the strict inclusion and exclusion criteria,43 subjects who had established health files in the two communities were respectively selected and randomly divided into control group and experimental group from March-July 2019.Routine community nursing was carried out in the control group.The experimental group implemented the intervention scheme based on meta-cognition strategy on the basis of the control group:through individualized health education,making personalized goals and plans,keeping diary,telephone follow-up,positive evaluation and so on,nursing intervention was carried out for 12 weeks with 4elements of meta-recognition.At baseline,the 4~thh week and the 12~thh week,to evaluate the efficacy of the intervention,antihypertensive therapy related attitudes and beliefs scale,hypertention patients self-management behavior rating scale and physiological index were assessed.The Rate,composition ratio,mean and standard deviation,median and quartile intervals were used for statistical description,the non-parametric Mann-Whitney U rank sum test,chi-square test,repeated measurement variance analysis,independent sample t test,Bonferroni test and generalized estimation equation were used for statistical inference.The standard?of the test was 0.05.ResultsThis study completed the effective sample size of 80 cases with 6cases withdrawing halfway,and finally 40 cases each in the experimental group and control group.(1)Before intervention,there was no statistical difference between the two groups of the general data,BMI,the rate of hypertension control,the score of anti-hypertensive therapy related attitudes and beliefs and the score of self-management of hypertension(P>0.05).The study data of the two groups were comparable.(2)Comparison of BMI between two groups of elderly patients with hypertension before and after intervention:Before intervention,after4-week intervention and after 12-week intervention,the BMI of the experimental group were(24.44±2.98),(24.39±2.95),(24.10±2.85),and those of the control group were(24.14±3.02),(24.19±3.09),(24.14±2.96);The results of the variance analysis of repeated measurements showed that there was no statistical difference in main effect between groups(F=0.044,P=0.835);The results of pairwise comparison of BMI in experimental group showed that there was no statistically significance between 4-week intervention compared with that before intervention(P>0.05);compared with the baseline,BMI was lower after 12-week of intervention(P<0.05).(3)Comparison of the rate of hypertension control between two groups of elderly patients with hypertension before and after intervention:At baseline,4~thh week and 12~thh week,the rate of hypertension control of the experimental group were 57.5%,80.0%and 90.0%,respectively,and that in the control group were 45.0%,57.5%and 62.5%,respectively;The results of chi-square test showed that compared with the control group,the rate of hypertension control in experimental group was higher at 4~thh week and 12~thh week(P<0.05).The results of pairwise comparison in experimental group showed that the rate of hypertension control at 12~thh week was higher than before(P<0.05).(4)Comparison of the score of anti-hypertensive therapy related attitudes and beliefs between two groups of elderly patients with hypertension before and after intervention:Before intervention,after4-week intervention and after 12-week intervention,the score of anti-hypertensive therapy related attitudes and beliefs of the experimental group were[74.0(69.3,77.8)],[84.0(80.3,88.0)],[91.0(86.3,93.0)],respectively,and that in the control group were[76.5(70.3,78.0)],[78.5(74.5,80.0)],[80.5(76.3,82.0)],respectively.The results of the generalized estimation equation show that there were statistical difference of the total score of the anti-hypertensive therapy related attitudes and beliefs,the score of the treatment and life style related attitudes and beliefs in the intergroup,time and interaction effect(P<0.05).The results of pairwise comparison in the experimental group showed that compared with the baseline,the the score of each dimension and the total score of the anti-hypertensive therapy related attitudes and beliefs were higher at12~thh week,and the difference was statistically significant(P<0.05).(5)Comparison of the score of self-management behavior between two groups of elderly patients with hypertension before and after intervention:Before intervention,after 4-week intervention and after12-week intervention,the score of self-management behavior of the experimental group were[106.0(99.5,110.5)],[120.9(118.2,125.0)],[132.3(128.3,134.0)],respectively,and that in the control group were[107.5(101.0,110.0)],[112.0(103.3,116.8)],[115.0(107.0,119.0)],respectively.The results of the generalized estimation equation show that there were statistical difference of the score of self-management behavior,drug management,condition monitoring,exercise management and emotion management in the intergroup,time and interaction effect(P<0.05).The results of pairwise comparison in the experimental group showed that compared with the baseline,the the score of each dimension and the total score of self-management behavior were higher at 12~thh week,and the difference was statistically significant(P<0.05).ConclusionsThe intervention scheme based on meta-cognition strategy can effectively improve the treatment attitude and belief level and self-management behavioral level of elderly patients with hypertension in the community... |
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