慢性阻塞性肺疾病患者系统化健康教育干预研究
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摘要
目的:
1.了解慢性阻塞性肺疾病患者的疾病相关知识、态度、行为以及生活质量的现状,并分析患者生活质量的相关因素,探讨改善患者生活质量的可行护理对策。
2.探讨系统化健康教育干预对慢性阻塞性肺疾病患者知识、态度、行为以及生活质量的影响。
方法:
本研究采用问卷调查法,通过自行设计的调查问卷及COPD生活质量评分量表等研究工具,对206例慢性阻塞性肺疾病患者的一般人口社会学情况、疾病相关知识、态度、行为以及生活质量等进行了调查分析。并对其中120例患者随机分为干预组和对照组进行了系统性健康教育干预研究。
结果:
1.COPD患者的KAP水平及教育需求。患者对疾病危险因素和康复方面的知识掌握较好,平均正确率分别为79.05%、78.76%,而对长期家庭氧疗和药物治疗的认知较差,平均正确率分别为25.89%、41.70%;69.66%的患者有积极正确的信念和态度;仅18%能坚持经常做呼吸功能锻炼,51%坚持经常全身性的体育锻炼。94.2%的患者希望获得疾病相关知识,需求内容主要集中在预防(52.4%)、治疗(64.1%)和保健康复(71.4%)几个方面。经多组秩和检验显示不同文化程度COPD患者的知识、态度、行为得分无统计学差异(P>0.05)。
2.COPD患者生活质量及相关因素分析。患者的生活质量总分及日常生活能力、社会活动、抑郁症状、焦虑症状4个维度的得分分别为:64.70±14.78、69.23±25.64、61.90±23.81、66.67±33.33、66.67±33.33。COPD患者生活质量的主要相关因素是住院次数、健康行为、婚姻状况、病程、受教育程度(P<0.01)。
3.健康教育干预效果。干预组6个月后的生活质量总分及多个维度得分较干预前有改善(P<0.05);与对照组比较,生活质量总分及各维度得分也有统计学差异(P<0.05)。干预组的知识、态度、行为得分均较干预前有改善(P<0.05);与对照组比较,知识和行为得分也优于后者(P<0.05);对照组KAP得分自身前后比较无统计学差异。6个月后干预组的吸氧人数较前增多(P<0.05),与对照组比较,吸氧时间优于后者(P<0.01);对照组吸氧人数和吸氧时间自身前后比较无统计学差异。
结论:
1.从本组资料看出,COPD患者在疾病的知识、信念和行为方面还存在诸多不足且有获取知识的愿望。COPD患者生活质量较差,尤其是那些病程长、受教育程度低、健康行为缺乏、无配偶以及反复多次住院者是我们应该关注的重点。COPD的健康教育的内容应有重点和针对性,尤其要强调健康行为的形成,如戒烟、锻炼、合理用药、必要的家庭氧疗等。
2.系统性、个体化的健康教育可以促进患者及家属了解更多疾病相关知识,改善负性心理,建立健康的生活行为习惯,提高疾病的自我应对能力,进而改善生活质量。
OBJECTIVE:
1. To investigate the knowledge-attitude-practice (KAP) and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD). And analyze the factors associated with QOL in order to explore feasible nursing strategies.
2. To test the hypothesis that the systematic and individualized health education (HE) have advantage over random health education in improving the KAP and QOL in COPD patients.
METHODS:
206 COPD patients were enrolled and their KAP and QOL were investigated by questionnaire, including demographic information, disease-related knowledge-attitude-practice, and QOL scale. 120 patients among those subjects were then randomly divided into two groups, 54 subjects as intervention group have gotten systematic and individualized health education while 45 subjects as control group have gotten random health education. These two kinds of HE methods’outcomes were investigated by KAP questionnaire and QOL scale 6 months later.
RESULTS
1. Among these subjects, the average correct rate of knowledge about risk factors and rehabilitation were 79.05% and 78.76% respectively, while long-term domiciliary oxygen therapy (LTDOT) and medication treatment were 25.89% and 41.70% respectively. There were 69.66% COPD patients who had correct belief and attitude regarding their disease. And only respectively 18% and 51% subjects who can regularly insist breath training and physical exercise. In respect of the need of disease-related knowledge, 94.2% of subjects said yes. The investigation also showed their need mainly concentrated on prevention (52.4%), treatment (64.1%) and rehabilitation (71.4%). No statistical significance were observed in KAP scores among different education level of those patients (P>0.05).
2. The total score of QOL in these patients was (64.70±14.78), and its 4 dimensionalities, namely activity of daily living, society activity, depressed mentality, anxious mentality were (69.23±25.64), (61.90±23.81), (66.67±33.33) and (66.67±33.33) respectively. There was statistically significant correlation between the quality of life and frequency of hospitalization in the past 2 years, marriage, education, course of disease by stepwise multiple regression analysis (P<0.01).
3. Six months later, the QOL total score and most of its dimensionalities in intervention group were better than before(P<0.05), and they were superior to control group(P<0.05). The scores of knowledge, attitude and practice in intervention group were all better than before(P<0.05), and by contrast with control group, the scores of knowledge and practice were increased significantly(P<0.05). The scores of KAP in control group were not statistically significant difference before and after health education. We also founded, the number of subjects accepting LTDOT was more than before in intervention group(P<0.05), and by contrast with control group, the time of using it was increased significantly(P<0.01). Meanwhile, both the number of subjects accepting LTDOT and the time of using it were not statistically significant difference in control group before and after health education.
CONCLUSION:
1. According to these data, the health-related KAP level is not enough in COPD patients, and most of them desire for knowledge. The quality of life in COPD patients is poor,especially in those who are spouseless, with longer disease history, lower education degree, frequently hospitalized and insufficient of healthy behavior. Health education should focus on prevention,treatment and rehabilitation, especially on improving health behavior, such as smoking cessation, exercise training, correct medication using, LTDOT and so on.
2. The systematic and individualized health education can help COPD patients increasing knowledge, improving mental health and forming health behavior. Ultimately, it enhances patients' capability of control over their ordinary life and medicine conditions thus improve QOL of them.
1.了解慢性阻塞性肺疾病患者的疾病相关知识、态度、行为以及生活质量的现状,并分析患者生活质量的相关因素,探讨改善患者生活质量的可行护理对策。
2.探讨系统化健康教育干预对慢性阻塞性肺疾病患者知识、态度、行为以及生活质量的影响。
方法:
本研究采用问卷调查法,通过自行设计的调查问卷及COPD生活质量评分量表等研究工具,对206例慢性阻塞性肺疾病患者的一般人口社会学情况、疾病相关知识、态度、行为以及生活质量等进行了调查分析。并对其中120例患者随机分为干预组和对照组进行了系统性健康教育干预研究。
结果:
1.COPD患者的KAP水平及教育需求。患者对疾病危险因素和康复方面的知识掌握较好,平均正确率分别为79.05%、78.76%,而对长期家庭氧疗和药物治疗的认知较差,平均正确率分别为25.89%、41.70%;69.66%的患者有积极正确的信念和态度;仅18%能坚持经常做呼吸功能锻炼,51%坚持经常全身性的体育锻炼。94.2%的患者希望获得疾病相关知识,需求内容主要集中在预防(52.4%)、治疗(64.1%)和保健康复(71.4%)几个方面。经多组秩和检验显示不同文化程度COPD患者的知识、态度、行为得分无统计学差异(P>0.05)。
2.COPD患者生活质量及相关因素分析。患者的生活质量总分及日常生活能力、社会活动、抑郁症状、焦虑症状4个维度的得分分别为:64.70±14.78、69.23±25.64、61.90±23.81、66.67±33.33、66.67±33.33。COPD患者生活质量的主要相关因素是住院次数、健康行为、婚姻状况、病程、受教育程度(P<0.01)。
3.健康教育干预效果。干预组6个月后的生活质量总分及多个维度得分较干预前有改善(P<0.05);与对照组比较,生活质量总分及各维度得分也有统计学差异(P<0.05)。干预组的知识、态度、行为得分均较干预前有改善(P<0.05);与对照组比较,知识和行为得分也优于后者(P<0.05);对照组KAP得分自身前后比较无统计学差异。6个月后干预组的吸氧人数较前增多(P<0.05),与对照组比较,吸氧时间优于后者(P<0.01);对照组吸氧人数和吸氧时间自身前后比较无统计学差异。
结论:
1.从本组资料看出,COPD患者在疾病的知识、信念和行为方面还存在诸多不足且有获取知识的愿望。COPD患者生活质量较差,尤其是那些病程长、受教育程度低、健康行为缺乏、无配偶以及反复多次住院者是我们应该关注的重点。COPD的健康教育的内容应有重点和针对性,尤其要强调健康行为的形成,如戒烟、锻炼、合理用药、必要的家庭氧疗等。
2.系统性、个体化的健康教育可以促进患者及家属了解更多疾病相关知识,改善负性心理,建立健康的生活行为习惯,提高疾病的自我应对能力,进而改善生活质量。
OBJECTIVE:
1. To investigate the knowledge-attitude-practice (KAP) and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD). And analyze the factors associated with QOL in order to explore feasible nursing strategies.
2. To test the hypothesis that the systematic and individualized health education (HE) have advantage over random health education in improving the KAP and QOL in COPD patients.
METHODS:
206 COPD patients were enrolled and their KAP and QOL were investigated by questionnaire, including demographic information, disease-related knowledge-attitude-practice, and QOL scale. 120 patients among those subjects were then randomly divided into two groups, 54 subjects as intervention group have gotten systematic and individualized health education while 45 subjects as control group have gotten random health education. These two kinds of HE methods’outcomes were investigated by KAP questionnaire and QOL scale 6 months later.
RESULTS
1. Among these subjects, the average correct rate of knowledge about risk factors and rehabilitation were 79.05% and 78.76% respectively, while long-term domiciliary oxygen therapy (LTDOT) and medication treatment were 25.89% and 41.70% respectively. There were 69.66% COPD patients who had correct belief and attitude regarding their disease. And only respectively 18% and 51% subjects who can regularly insist breath training and physical exercise. In respect of the need of disease-related knowledge, 94.2% of subjects said yes. The investigation also showed their need mainly concentrated on prevention (52.4%), treatment (64.1%) and rehabilitation (71.4%). No statistical significance were observed in KAP scores among different education level of those patients (P>0.05).
2. The total score of QOL in these patients was (64.70±14.78), and its 4 dimensionalities, namely activity of daily living, society activity, depressed mentality, anxious mentality were (69.23±25.64), (61.90±23.81), (66.67±33.33) and (66.67±33.33) respectively. There was statistically significant correlation between the quality of life and frequency of hospitalization in the past 2 years, marriage, education, course of disease by stepwise multiple regression analysis (P<0.01).
3. Six months later, the QOL total score and most of its dimensionalities in intervention group were better than before(P<0.05), and they were superior to control group(P<0.05). The scores of knowledge, attitude and practice in intervention group were all better than before(P<0.05), and by contrast with control group, the scores of knowledge and practice were increased significantly(P<0.05). The scores of KAP in control group were not statistically significant difference before and after health education. We also founded, the number of subjects accepting LTDOT was more than before in intervention group(P<0.05), and by contrast with control group, the time of using it was increased significantly(P<0.01). Meanwhile, both the number of subjects accepting LTDOT and the time of using it were not statistically significant difference in control group before and after health education.
CONCLUSION:
1. According to these data, the health-related KAP level is not enough in COPD patients, and most of them desire for knowledge. The quality of life in COPD patients is poor,especially in those who are spouseless, with longer disease history, lower education degree, frequently hospitalized and insufficient of healthy behavior. Health education should focus on prevention,treatment and rehabilitation, especially on improving health behavior, such as smoking cessation, exercise training, correct medication using, LTDOT and so on.
2. The systematic and individualized health education can help COPD patients increasing knowledge, improving mental health and forming health behavior. Ultimately, it enhances patients' capability of control over their ordinary life and medicine conditions thus improve QOL of them.
引文
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[1] 陈炼,张国林,林少姗等.健康教育对稳定期慢性阻塞性肺部疾病患者肺功能和生活质量的影响[J].中华流行病学杂志,2005,26(10):808~810.
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[7] Ortega F, Toral J, Cejudo P, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med. 2002,166(5):669~674.
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[9] 张建华,刘惠俐,富丽芳.呼吸康复训练对老年慢性阻塞性肺部疾病病人生活质量的影响[J].中华护理杂志,2004,39(7):504~506.
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[1] 陈炼,张国林,林少姗等.健康教育对稳定期慢性阻塞性肺部疾病患者肺功能和生活质量的影响[J].中华流行病学杂志,2005,26(10):808~810.
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[3] Kawane H.Prevention of chronic obstructive pulmonary disease (primary prevention and secondary prevention)[J]. Nippon, Rinsho. 2003, 61(12):2071~2076.
[4] Sahebjami H, Sathianpitayakul E. Influence of body weight on the severity of dyspnea in chronic obstructive pulmonary disease[J]. Am J Respir Crit.2000, 161(3):886~890.
[5] Brug J, Schols A, Mesters I. Dietary change, nutrition education and chronic obstructive pulmonary disease [J]. Patient Educ Couns, 2004, 52(3):249~257
[6] Rochester CL.Exercise training in chronic obstructive pulmonary disease [J].J Rehabil Res Dev, 2003, 40 (5 Suppl 2):59~80.
[7] Ortega F, Toral J, Cejudo P, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med. 2002,166(5):669~674.
[8] 周玉兰,刘翱,刘枢晓.慢性阻塞性肺疾病康复期患者呼吸肌功能锻炼临床观察[J].中国康复理论与实践,2005,11(10):848~849.
[9] 张建华,刘惠俐,富丽芳.呼吸康复训练对老年慢性阻塞性肺部疾病病人生活质量的影响[J].中华护理杂志,2004,39(7):504~506.
[10] Ringback TJ,Viskum K,Lange P,et al.Does long-term oxygen therapy reduce hospitalization in hypoxaemic chronic obstructive pulmonary disease?[J]Eur Respir J,2002,20(1):38~42.
[11] Clini E,Costi S,Lodi S,et al.Non-pharmacological treatment for chronic obstructive pulmonary disease[J].Med Sci Monit,2003,9:RA300~305.
[12]周旭玲,吴燕红.慢性阻塞性肺病病人家庭氧疗依从性调查分析[J].护理研究,2005,19(6)下半月版:1045~1046.
[13]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南[J].中华结核和呼吸杂志,2002,25(8):453~460.
[14] Ninot G, Brun A, Queiras G, Segi A, Moullec G, Desplan J. Psychosocial support for pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease[J].Rev Mal Respir. 2003,20(4):549~557.
[15] 杨晶,杨萍,高媛.慢性阻塞性肺疾病患者社会支持状况及影响因素的调查[J].现代护理,2005,11(3):165~167.
[16] 张大良,张萍.无创机械通气医院家庭治疗慢性阻塞性肺疾病所致呼吸衰竭的研究[J].中国呼吸与危重监护杂志2003,2(4):219~221.
[17] Bourbeau J,Nault D,Dang-Tan T.Self-management and behaviour modification in COPD[J]. Patient Educ Couns. 2004,52(3):271~277.
[18] 王超.应用护理程序对慢性阻塞性肺部疾病病人实施系统健康教育[J].护理研究,2005,19(6)下半月版:1051~1052.
[19] 于海云,张承英,尹丹.循征护理对慢性阻塞性肺疾病缓解期患者抑郁状态的作用[J].中国临床康复,2005,9(16):208.
[20] 杨晶,高媛.慢性阻塞性肺疾病患者健康教育需求的调查分析与对策[J]. 现代康复,2001,5(12):71.
[21] 张珍祥.慢性阻塞性肺疾病社区人群综合干预的研究[J].中华结核和呼吸杂志,2005,28(7):435~436.
[22] Jones PW,Quirk FH,Baveystock CM,et al.A self-complete measure of chronic airflow limitation-the St George,s Respiratory Questionnaire[J].Am Rev Respir Dis,1992,145(6):1321~1327.
[23] 蔡映云,李倬哲,方宗君.慢性阻塞性肺疾病患者生存质量评估[J].中华全科医师杂志,2004,3(4):225~227.