动机访谈式健康教育减盐干预对高血压患者和高危人群知信行及氯化钠摄入量改变效果分析
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摘要
目的了解动机访谈式健康教育减盐干预对高血压患者或高危人群氯化钠摄入量及减盐的知识、态度、行为的改变效果,为减少钠摄入量适宜技术的研究提供良好基础。方法于2014年6月至2016年6月在浙江省临海市随机整群抽取2个农村社区各200例高血压患者或高血压高危人群,随机分为作为减盐组和对照组。对照组采取常规健康教育管理,减盐组采取项目组研制的动机访谈式健康教育等干预措施。在基线和末期均进行体格检查、问卷调查和3日盐调味品称重和实验室测定。采用SPSS 13.0软件进行t检验、独立样本X~2检验和配对X~2检验,采用倍差法分析动机访谈式健康教育减盐干预的干预效果。结果干预后,减盐组饮食油腻程度低于对照组,口味程度清淡比例高于对照组,盐与高血压相关知识知晓率均高于对照组,所处减盐行为改变阶段优于对照组,差异均有统计学意义(P<0.05)。干预后减盐组收缩压、氯化钠摄入量、TC、HDL-C和LDL-C降低,空腹血糖略有升高;对照组收缩压、空腹血糖升高,腰围、TC、HDL-C和LDL-C降低,差异均有统计学意义(P<0.05,P<0.01)。倍差法分析结果显示,随着时间与减盐干预交互作用,收缩压有所下降,交互效应β=-11.78,有统计学意义(P<0.05),即减盐组经过干预收缩压可下降11.78 mmHg。结论动机访谈式健康教育减盐干预技术对高血压患者或高危人群能够有效地提升减盐的认知、信念,并促进减盐行为,对收缩压降低效果更佳。
Objective To evaluate the effects of salt reduction intervention with motivational interview-based health education on the knowledge,attitude and behavior of sodium chloride intake and salt reduction in hypertensive patients or high risk population,and to provide the basis for studying the skill of sodium intake reduce. Methods From June of 2014 to June of 2016,200 subjects with hypertension or high-risk in 2 rural communities were randomly selected from Linhai City,Zhejiang Province,and 200 subjects were randomly divided into the salt reduction group and the control group. The control group adopted routine health education management,and the salt reduction group adopted intervention measures such as salt reduction intervention with motivational interview-based health education developed by the project team. Physical examinations,questionnaires,and 3-day salt dressing weighing and laboratory measurements were performed at baseline and at the end. The t test and X~2 test were used to analyze the data,and the intervention effects of salt reduction intervention with motivational interview-based health education were analyzed by the difference-in-difference method. The used software was SPSS 13.0 software. Results After one year of intervention,the greasy degree of diet in salt reduction group was significantly lower than that in control group,proportion of light taste in salt reduction group was significantly higher than that in control group,the awareness rate of hypertension knowledge in salt reduction group was significantly higher than that in control group,the salt reduction behavior change in salt reduction group was significantly better than that in control group(P <0.05). After intervention,in the salt-reduced group,the systolic blood pressure,sodium chloride intake,TC,HDL-C,and LDL-C significantly decreased,but fasting blood glucose increased slightly;in the control group,the systolic blood pressure and fasting blood glucose significantly increased,waistline,TC,HDL-C and LDL-C significantly decreased,P <0.05,P <0.01. The results of the difference-in-difference analysis showed that the systolic blood pressure decreased with the interaction of time and salt reduction intervention,and the interaction effect β=-11.78(P<0.05),that was,the salt reduction group could reduce the systolic blood pressure by 11.78 mmHg. Conclusion Salt reduction intervention with motivational interview-based health education technology effectively enhanced the awareness,belief of salt reduction and promoted the salt reduction behavior in patients with hypertension or high-risk,and had a better effect on reducing systolic blood pressure.
Objective To evaluate the effects of salt reduction intervention with motivational interview-based health education on the knowledge,attitude and behavior of sodium chloride intake and salt reduction in hypertensive patients or high risk population,and to provide the basis for studying the skill of sodium intake reduce. Methods From June of 2014 to June of 2016,200 subjects with hypertension or high-risk in 2 rural communities were randomly selected from Linhai City,Zhejiang Province,and 200 subjects were randomly divided into the salt reduction group and the control group. The control group adopted routine health education management,and the salt reduction group adopted intervention measures such as salt reduction intervention with motivational interview-based health education developed by the project team. Physical examinations,questionnaires,and 3-day salt dressing weighing and laboratory measurements were performed at baseline and at the end. The t test and X~2 test were used to analyze the data,and the intervention effects of salt reduction intervention with motivational interview-based health education were analyzed by the difference-in-difference method. The used software was SPSS 13.0 software. Results After one year of intervention,the greasy degree of diet in salt reduction group was significantly lower than that in control group,proportion of light taste in salt reduction group was significantly higher than that in control group,the awareness rate of hypertension knowledge in salt reduction group was significantly higher than that in control group,the salt reduction behavior change in salt reduction group was significantly better than that in control group(P <0.05). After intervention,in the salt-reduced group,the systolic blood pressure,sodium chloride intake,TC,HDL-C,and LDL-C significantly decreased,but fasting blood glucose increased slightly;in the control group,the systolic blood pressure and fasting blood glucose significantly increased,waistline,TC,HDL-C and LDL-C significantly decreased,P <0.05,P <0.01. The results of the difference-in-difference analysis showed that the systolic blood pressure decreased with the interaction of time and salt reduction intervention,and the interaction effect β=-11.78(P<0.05),that was,the salt reduction group could reduce the systolic blood pressure by 11.78 mmHg. Conclusion Salt reduction intervention with motivational interview-based health education technology effectively enhanced the awareness,belief of salt reduction and promoted the salt reduction behavior in patients with hypertension or high-risk,and had a better effect on reducing systolic blood pressure.
引文
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[11]韦海英,李先英,吕跃冲,等.动机性访谈对高血压患者行为改变的影响[J].齐齐哈尔医学院学报,2015,36(26):3913-3915.
[12]赵炜,赵焕虎,牟菲,等.运用双重差分模型评价社区跌倒预防的干预效果[J].中国妇幼卫生杂志,2018,9(1):18-21.
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[14] He FJ,Macgregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes[J]. J Hum Hypertens,2009,23(6):363.
[15] He FJ,Macgregor GA. Reducing population salt intake worldwide:from evidence to implementation[J]. Prog Cardiovasc Dis,2010,52(5):363-382.
[16]游凯,张月,王静雷,等.北京市顺义区居民低钠盐和限盐工具使用调查[J].中国公共卫生,2013,29(10):1448-1449.
[17]徐建伟,颜流霞,张梅,等. 2010年我国居民家庭限盐勺和控油壶普及情况分析[J].中国健康教育,2014,30(5):390-392.
[18]陈婷,毛德强,丁贤彬.学校减盐干预对小学生知识态度行为的影响[J].中国学校卫生,2017,38(1):45-47.
[19]刘婷婷.宁阳县“小手拉大手”学生及家长减盐干预模式效果评价[J].中国农村卫生事业管理,2016,36(3):360-364.
[20]徐建伟,董静,刘平,等.山东省餐饮单位人员烹调用盐行为及态度的定性研究[J].中国初级卫生保健,2015,29(7):76-77.
[21] Newson RS,Elmadfa I,Biro G,et al. Barriers for progress in salt reduction in the general population. an international study[J].Appetite,2013,71(4):22-31.
[22]杨廷忠,于文平,黄丽.行为改变的一种策略和方法:行为分阶段转变理论模型介绍[J].中国行为医学科学,2002,11(3):352-353.
[23]李静,潘怡,王卓,等.健康行为阶段改变理论模型综述[J].现代预防医学,2011,38(23):4914-4916.
[24] Zhang J,Xu AQ,Ma JX,et al. Dietary sodium intake:Knowledge,attitudes and practices in Shandong province,China,2011[J]. PloS One,2013,8(3):e58973. DOI:10.1371/journal.pone.0058973.
[25] Land MA,Webster J,Christoforou A,et al. The association of knowledge,attitudes and behaviours related to salt with 24-hour urinary sodium excretion[J]. Int J Behav Nutr Phys Act,2014,11(1):47.
[2]徐建伟,马吉祥,毕振强,等.我国开展减盐行动的SWOT分析[J].中国农村卫生事业管理,2015,35(9):1148-1151.
[3] Lopez AD,Mathers CD,Ezzati M,et al. Global and regional burden of disease and risk factors,2001:systematic analysis of population health data[J]. The Lancet,2006,367(9524):1747-1757.
[4] He FJ,Li J,Macgregor GA. Effect of longer term modest salt reduction on blood pressure:Cochrane systematic review and meta-analysis of randomised trials[J]. BMJ,2013,346:f1325. DOI:10.1136/bmj.f1325.
[5]叶真,丛黎明,丁钢强,等.浙江省城乡居民糖尿病和代谢综合征患病率调查[C].中华医学会第十次全国内分泌学学术会议论文汇编,2011.
[6]张洁,何青芳,王立新,等.浙江省成人高血压合并糖尿病患病率及心血管病风险分析[J].预防医学,2018,30(2):109-112.
[7]徐建伟.我国开展减盐行动的策略研究[D].北京:中国疾病预防控制中心博士论文集,2014:96-98.
[8] Chen J,Gu D,Jaquish CE,et al. Association between blood pressure responses to the cold pressor test and dietary sodium intervention in a Chinese population[J]. Arch Intern Med,2008,168(16):1740-1746.
[9]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].临床荟萃,2015,30(7):10-30.
[10]骆宏,许百华.动机性访谈:一种以咨客为中心的行为改变咨询技术[J].应用心理学,2005,11(1):85-89.
[11]韦海英,李先英,吕跃冲,等.动机性访谈对高血压患者行为改变的影响[J].齐齐哈尔医学院学报,2015,36(26):3913-3915.
[12]赵炜,赵焕虎,牟菲,等.运用双重差分模型评价社区跌倒预防的干预效果[J].中国妇幼卫生杂志,2018,9(1):18-21.
[13] Cook NR,Cutler JA,Obarzanek E,et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes:observational follow-up of the trials of hypertension prevention(TOHP)[J]. BMJ,2007,334(7599):885. DOI:10.1136/bmj.39147.604896.55
[14] He FJ,Macgregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes[J]. J Hum Hypertens,2009,23(6):363.
[15] He FJ,Macgregor GA. Reducing population salt intake worldwide:from evidence to implementation[J]. Prog Cardiovasc Dis,2010,52(5):363-382.
[16]游凯,张月,王静雷,等.北京市顺义区居民低钠盐和限盐工具使用调查[J].中国公共卫生,2013,29(10):1448-1449.
[17]徐建伟,颜流霞,张梅,等. 2010年我国居民家庭限盐勺和控油壶普及情况分析[J].中国健康教育,2014,30(5):390-392.
[18]陈婷,毛德强,丁贤彬.学校减盐干预对小学生知识态度行为的影响[J].中国学校卫生,2017,38(1):45-47.
[19]刘婷婷.宁阳县“小手拉大手”学生及家长减盐干预模式效果评价[J].中国农村卫生事业管理,2016,36(3):360-364.
[20]徐建伟,董静,刘平,等.山东省餐饮单位人员烹调用盐行为及态度的定性研究[J].中国初级卫生保健,2015,29(7):76-77.
[21] Newson RS,Elmadfa I,Biro G,et al. Barriers for progress in salt reduction in the general population. an international study[J].Appetite,2013,71(4):22-31.
[22]杨廷忠,于文平,黄丽.行为改变的一种策略和方法:行为分阶段转变理论模型介绍[J].中国行为医学科学,2002,11(3):352-353.
[23]李静,潘怡,王卓,等.健康行为阶段改变理论模型综述[J].现代预防医学,2011,38(23):4914-4916.
[24] Zhang J,Xu AQ,Ma JX,et al. Dietary sodium intake:Knowledge,attitudes and practices in Shandong province,China,2011[J]. PloS One,2013,8(3):e58973. DOI:10.1371/journal.pone.0058973.
[25] Land MA,Webster J,Christoforou A,et al. The association of knowledge,attitudes and behaviours related to salt with 24-hour urinary sodium excretion[J]. Int J Behav Nutr Phys Act,2014,11(1):47.