| Objectives A multi-center cross-sectional study using convenience sampling was conducted to investigate thecurrent situation of self-care for patients with chronic heart failure in the community,analyze the influencing factors of self-care ability in patients with chronic heart failure.The purpose of this study is to construct a health management model for patients with chronic heart failure based on health ecology and medical treatment alliance combined with the results of the current situation survey and through the literature method and Delphi expert consultation method,in order to provide reference basis for forming a health management model suitable for Chinese community patients with chronic heart failure and improving the quality of life.Methods1.The Current Investigation:study on the current situation and influencing factors of self-care in patients with chronic heart failure Convenient sampling method was used,guided by the health ecology theory,in terms of individual patients,the self-developed general information questionnaire,Self-care of Heart Failure Index(SCHFI),7-item Generalized Anxiety Disorder Scale(GAD-7),Patient Health Questionnaire-9(PHQ-9)were used as assessment tools,in terms of health care services,"preferred institution for medical treatment","selection basis","satisfaction with medical treatment" were used,which were included in the general information questionnaire,and social environment was assessed using the Social Support Rating Scale(SSRS).Chronic heart failure patients who met the standards of sodium and discharge in the area of four joint community health service center of Affiliated Zhongda Hospitals of Southeast University.Multivariate linear regression was used to analyze the influencing factors of self-care in patients with chronic heart failure.2.The Model building:Construction of health management model for chronic heart failure based on health ecology and medical treatment alliance On the basis of current situation survey and literature method,the framework of health management model of chronic heart failure based on health ecology and medical treatment alliance was preliminarily developed,and the expert letter questionnaire was prepared according to the framework.The Delphi expert consultation method was used to conduct two rounds of expert consultation for 43 qualified experts,the results of letter consultation were analyzed by the positive coefficient of experts and the degree of coordination of expert opinions.The items were added,deleted or revised according to the opinions of experts and relevant indicators such as the average value of item assignment,coefficient of variation,form the final health management mode of chronic heart failure based on health ecology and medical treatment alliance.Results1.The Current Investigation:the current situation and influencing factors of self-care in patients with chronic heart failure(1)A total of 144 patients with chronic heart failure in the community were enrolled in this study,their total self-care scale score was(42.27±14.93)points,which was at a low level.The highest average score of the dimensions was the nursing confidence dimension(49.62 ± 23.43)points,and the lowest was the nursing management dimension(36.67±17.80)points.(2)Among 144 patients,76% preferred 3a hospitals,among which 33%believed that 3a hospitals were highly skilled,31% trusted them,and their satisfaction was higher than that of community health service centers(83%vs73%).(3)The univariate analysis results showed that education level,per capita income,number of comorbidities,disease duration,anxiety,depression and social support level were the influencing factors of self-care in patients with chronic heart failureand the differences were statistically significant(P <0.05).(4)Multiple linear regression analysis showed that education level,per capita income,number of comorbidities,disease duration,anxiety,depression and social support level were independent factors affecting self-care ability of patients with chronic heart failure in the community.2.The Model building:Construction of health management model for chronic heart failure based on health ecology and medical treatment alliance(1)Based on the research results of influencing factors and literature review,the framework of health management model for chronic heart failure based on health ecology and medical treatmentalliance was preliminarily proposed.The following contents were mainly included:1)Individual patient aspect:Focus on health management education research and Form a health management education programme.2)Medical and health services:Focus on establishing a linkage mechanism between Grade III A hospitals and community health service centers.3)Social environment aspect:Focus on peer support and family support for patients with chronic heart failure in the community.(2)Establishment ofthe health management model of chronic heart failure based on health ecology and medical treatmentalliance1)The first draft of the expert letter questionnaire was prepared,including 3first-level items,16 second-level items and 99 third-level items.2)After two rounds of expert letter consultation,a health management model containing 3 first-level items,18 second-level items and 96 third-level items was finally constructed.The effective recovery rates of the two rounds of questionnaires were 100% and 95.6%,and the expert authority coefficients were 0.88 and 0.89,respectively.Expert Kendall’s test of the significance of the harmony coefficient,the results were statistically significant(P<0.05).Conclusions1.The self-care ability of patients with chronic heart failure was at a low level in this study,in a state of "maintenance,low management and low confidence".2.In this study,patients with chronic heart failure generally believed that the medical and health services in 3a hospitals had advantages over those in community health service centers.However,it was also pointed out that there were some disadvantages in 3a hospitals.Therefore,it was necessary to promote hierarchical diagnosis and treatment to provide more convenient and long-term health management for patients with chronic heart failure in community.3.Education level,per capita income,number of comorbidities,disease duration,anxiety,depression and social support level are the main influencing factors of self-care ability of patients with chronic heart failure in the community.4.Based on the health ecology model,this study mainly constructs the health management model of chronic heart failure from three aspects: individual patients,medical and health services and social environment.5.In this study,the health management model of chronic heart failure based on health ecology and medical treatment alliance was established with good enthusiasm and representativeness of experts,which provided a scientific basis for the health management of patients with chronic heart failure in the community. |
