对慢性乙型肝炎患者家属实施连续健康教育的效果研究
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摘要
【目的】通过对慢性乙型肝炎患者的家属实施连续健康教育,探讨该方法对家属的知识水平、健康行为、焦虑、抑郁、生活质量和肝功能方面的影响以及在预防慢性乙型肝炎家庭内传播中的作用。
【方法】本研究采用随机对照试验的研究方法,将2007年1月至2007年7月到天津市武警医学院附属医院肝病门诊就诊的符合入选条件的慢性乙型肝炎患者的家属共103例,随机分为实验组和对照组,其中实验组53例,对照组50例。研究者于干预前收集两组家属的有关资料,包括自行设计的慢性乙型肝炎健康教育调查表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、健康调查简表(SF-36)。
两组均给予常规护理教育,实验组同时还接受了由研究者设计并实施的连续健康教育。该连续健康教育的内容包括:1.于患者就诊当天向家属发放由研究者设计的《慢性乙肝健康教育手册》,并向家属详细讲解乙肝的有关知识,主要包括:乙肝的病因、治疗效果、用药知识、预后情况、并发症的预防、疾病的传播途径、预防知识、家庭护理常识、消毒隔离知识等;2.与家属互留电话,保持联系,及时解答家属的疑问;3.分别于第一次干预后2个月、4个月、6个月的月末进行家访,检查指导家属相关知识的掌握情况和健康行为的依从性;4.于干预后6个月两组家属再次填写慢性乙型肝炎健康教育调查表、SAS、SDS以及SF-36,同时对家属进行乙肝病毒标志物和肝功能的实验室检查。全部数据采用SPSS10.0软件进行处理。
【结果】1.干预前实验组和对照组的焦虑和抑郁水平明显高于国内常模(P＜0.05),其生活质量除躯体疼痛(BP)、生理职能(RP)外其余六个维度的得分明显低于正常人群(P＜0.05).
2.实验组在干预前、干预后2个月、4个月、6个月四次知识得分的比较差异均有统计学意义(P＜0.05),并呈递增趋势,对照组干预6个月后知识得分高于干预前得分(P＜0.05);干预6个月后实验组知识得分高于对照组(P＜0.05)。
3.实验组患者在干预6个月后健康行为依从得分高于干预前(P＜0.05);对照组患者干预6个月后与干预前健康行为依从得分比较差异无统计学意义(P＞0.05)。
4.实验组在干预前、干预后2个月、4个月、6个月四次健康行为依从性得分的比较差异均有统计学意义(P＜0.05),并呈递增趋势;对照组干预前和干预6个月后健康行为依从得分比较差异无统计学意义(P＞0.05)。
5.实验组干预6个月后健康教育态度得分高于干预前得分(P＜0.05);对照组干预前与干预6个月后健康教育态度得分比较差异无统计学意义(P＞0.05)。
6.干预6个月后实验组焦虑和抑郁得分均低于干预前(P＜0.05);干预6个月后对照组焦虑和抑郁得分与干预前比较差异均无统计学意义(P＞0.05);实验组干预6个月后焦虑和抑郁得分仍低于国内常模(P＞0.05)。
7.干预6个月后实验组生活质量除躯体疼痛、生理职能外,在生理机能、总体健康、精力、社会功能、情感职能、精神健康六个维度得分高于干预前(P＜0.05);干预6个月后对照组生活质量各个维度的得分与干预前比较差异均无统计学意义(P＞0.05)。实验组干预6个月后在生理职能、精力、精神健康与正常人群比较差异无统计学意义(P＞0.05),其余五项仍低于正常人群(P＜0.05)。
8.实验组干预6个月后和干预前肝功能检查中r—谷氨酰转酞酶(GGT)、直接胆红素(DBIL)、总胆红素(TBIL)、间接胆红素(IBIL)、碱性磷酸酶(ALP)五个项目值比较差异无统计学意义(P＞0.05);对照组干预6个月后和干预前肝功能检查中只有ALP比较差异无统计学意义(P＞0.05)。
【结论】慢性乙型肝炎患者家属干预前焦虑和抑郁水平较高,其生活质量六个维度的得分低于正常人群。对慢性乙型肝炎患者的家属实施连续健康教育能够提高家属对乙肝知识的认知水平;提高患者和家属生活中健康行为的依从性;提高家属的生活质量水平;降低家属的焦虑和抑郁水平。连续健康教育是促进家属肝功能稳定的一个重要因素。
Objective
To explore the effects of a continuous health education intervention designed by the investigator for the families of the Chronic Hepatitis B (CHB) patients, which included the families' knowledge related to the CHB, health behavior, anxiety, depression, quality of life and liver function. To explore the effect of the continuous health education intervention on preventing the families infected by the CHB patients.
Methods:
103 families of the CHB patients who met the inclusion criterion were invited in this study since they visited the out-patient department of Affiliated Hospital of Armed Police Force Medical College of Tianjin since January 2007 to July 2007. The families were randomly assigned into the study group and the control group. 53 families were in the study group and the other 50 families were in the control group. All the families were asked to fill the questionnaires of CHB health education, SAS, SDS, and SF-36 for getting the baseline data (the first evaluation). The families in the control group received routine health education only, and the families in the study group received the routine health education and a continuous health education intervention which designed by the investigator. The intervention included: providing the families the health handbook at the day when they accompanied the CHB patients to see the doctor, explaining the information of CHB, keeping in touch with the families during the six months of follow up, answering the families' CHB related questions, following up for home visit in the end of the second month (the second evaluation ), the end of the fourth month (the third evaluation), and the end of the sixth month (the fourth evaluation) after the first interview with the families. The follow up included the HBV knowledge improvement, and the improvement of the health behavior related HBV. After six months, all the families were asked to fill in the same questionnaires. At the same time, all the families had the laboratory examination on liver function and HBV marker. Data were analyzed with SPSS 10.0.
Results:
1. The level of the families' anxiety and the depression before intervention was higher than that in the normal crowd (P<0.05); Except BP, RP, the scores of the other domains were lower than those in the normal crowd (P<0.05) in SF-36.
2. Compared the knowledge scores of the four times in the study group, there were significant differences between the each two times comparison (P<0.05). There was not significant difference between the two scores before the intervention and six months after the intervention in the control group (P>0.05). The score of the study group was higher than that of the control group after the intervention (P<0.05).
3. The health behavior score of the patients in the study group after the intervention was higher than that before the intervention (P<0.05). There was not significant difference between the two health behavior scores before and after the intervention for patients in the control group (P>0.05).
4. Compared with the health behavior scores of four times for the study group, the differences were significant (P<0.05). The scores increased continously when evaluated each time during the six months follow up. There was not significant difference between the two health behavior scores before and after the intervention for the control group (P>0.05).
5. The score of attitude to health education in the study group after the intervention was higher than that before the intervention (P<0.05). There was not significant difference between the two scores of attitude to health education before and after the intervention for the control group (P>0.05).
6. In the study group, the scores of SAS and SDS after the intervention were lower than those before the intervention (P<0.05). In the control group, the differences of SAS and SDS scores before and after the intervention were not significant. The differences of SAS score and SDS score before and after the intervention for the study group were significant P<0.05). The scores of SAS and SDS for the study group were lower than those the normal crowd( P<0.05).
7. The scores of PF, GH, VT, SF and RE after the intervention were higher than those before the intervention for the study group( P<0.05). The score was not different significantly for each domain of SF-36 before and after the intervention for the control group (P>0.05). The scores of PF, BP, GH, SF, RE domains after the intervention for the study group were lower than the normal crowd (P<0.05).
8. The differences of the GGT, DBIL, TBIL, IBIL and ALP between the times of before and after the intervention for the study group were not significant (P>0.05). The ALP before and after the intervention was not significant different for the control group(P>0.05).
Conclusion:
Compaired with the normal crowd, the families of CHB patients had higher level of anxiety and depression, and lower level of six domains of SF-36 before the intervention. The continuous health education could elevate the cognition of HBV knowledge for the CHB patients' families. According to this study, it could elevate the health behavior, improve the quality of life, decrease the level of anxiety and depression for the CHB patients' families by the continuous health education. The continuous health education might be an effective factor for keeping the families' liver function stable.
【方法】本研究采用随机对照试验的研究方法,将2007年1月至2007年7月到天津市武警医学院附属医院肝病门诊就诊的符合入选条件的慢性乙型肝炎患者的家属共103例,随机分为实验组和对照组,其中实验组53例,对照组50例。研究者于干预前收集两组家属的有关资料,包括自行设计的慢性乙型肝炎健康教育调查表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、健康调查简表(SF-36)。
两组均给予常规护理教育,实验组同时还接受了由研究者设计并实施的连续健康教育。该连续健康教育的内容包括:1.于患者就诊当天向家属发放由研究者设计的《慢性乙肝健康教育手册》,并向家属详细讲解乙肝的有关知识,主要包括:乙肝的病因、治疗效果、用药知识、预后情况、并发症的预防、疾病的传播途径、预防知识、家庭护理常识、消毒隔离知识等;2.与家属互留电话,保持联系,及时解答家属的疑问;3.分别于第一次干预后2个月、4个月、6个月的月末进行家访,检查指导家属相关知识的掌握情况和健康行为的依从性;4.于干预后6个月两组家属再次填写慢性乙型肝炎健康教育调查表、SAS、SDS以及SF-36,同时对家属进行乙肝病毒标志物和肝功能的实验室检查。全部数据采用SPSS10.0软件进行处理。
【结果】1.干预前实验组和对照组的焦虑和抑郁水平明显高于国内常模(P＜0.05),其生活质量除躯体疼痛(BP)、生理职能(RP)外其余六个维度的得分明显低于正常人群(P＜0.05).
2.实验组在干预前、干预后2个月、4个月、6个月四次知识得分的比较差异均有统计学意义(P＜0.05),并呈递增趋势,对照组干预6个月后知识得分高于干预前得分(P＜0.05);干预6个月后实验组知识得分高于对照组(P＜0.05)。
3.实验组患者在干预6个月后健康行为依从得分高于干预前(P＜0.05);对照组患者干预6个月后与干预前健康行为依从得分比较差异无统计学意义(P＞0.05)。
4.实验组在干预前、干预后2个月、4个月、6个月四次健康行为依从性得分的比较差异均有统计学意义(P＜0.05),并呈递增趋势;对照组干预前和干预6个月后健康行为依从得分比较差异无统计学意义(P＞0.05)。
5.实验组干预6个月后健康教育态度得分高于干预前得分(P＜0.05);对照组干预前与干预6个月后健康教育态度得分比较差异无统计学意义(P＞0.05)。
6.干预6个月后实验组焦虑和抑郁得分均低于干预前(P＜0.05);干预6个月后对照组焦虑和抑郁得分与干预前比较差异均无统计学意义(P＞0.05);实验组干预6个月后焦虑和抑郁得分仍低于国内常模(P＞0.05)。
7.干预6个月后实验组生活质量除躯体疼痛、生理职能外,在生理机能、总体健康、精力、社会功能、情感职能、精神健康六个维度得分高于干预前(P＜0.05);干预6个月后对照组生活质量各个维度的得分与干预前比较差异均无统计学意义(P＞0.05)。实验组干预6个月后在生理职能、精力、精神健康与正常人群比较差异无统计学意义(P＞0.05),其余五项仍低于正常人群(P＜0.05)。
8.实验组干预6个月后和干预前肝功能检查中r—谷氨酰转酞酶(GGT)、直接胆红素(DBIL)、总胆红素(TBIL)、间接胆红素(IBIL)、碱性磷酸酶(ALP)五个项目值比较差异无统计学意义(P＞0.05);对照组干预6个月后和干预前肝功能检查中只有ALP比较差异无统计学意义(P＞0.05)。
【结论】慢性乙型肝炎患者家属干预前焦虑和抑郁水平较高,其生活质量六个维度的得分低于正常人群。对慢性乙型肝炎患者的家属实施连续健康教育能够提高家属对乙肝知识的认知水平;提高患者和家属生活中健康行为的依从性;提高家属的生活质量水平;降低家属的焦虑和抑郁水平。连续健康教育是促进家属肝功能稳定的一个重要因素。
Objective
To explore the effects of a continuous health education intervention designed by the investigator for the families of the Chronic Hepatitis B (CHB) patients, which included the families' knowledge related to the CHB, health behavior, anxiety, depression, quality of life and liver function. To explore the effect of the continuous health education intervention on preventing the families infected by the CHB patients.
Methods:
103 families of the CHB patients who met the inclusion criterion were invited in this study since they visited the out-patient department of Affiliated Hospital of Armed Police Force Medical College of Tianjin since January 2007 to July 2007. The families were randomly assigned into the study group and the control group. 53 families were in the study group and the other 50 families were in the control group. All the families were asked to fill the questionnaires of CHB health education, SAS, SDS, and SF-36 for getting the baseline data (the first evaluation). The families in the control group received routine health education only, and the families in the study group received the routine health education and a continuous health education intervention which designed by the investigator. The intervention included: providing the families the health handbook at the day when they accompanied the CHB patients to see the doctor, explaining the information of CHB, keeping in touch with the families during the six months of follow up, answering the families' CHB related questions, following up for home visit in the end of the second month (the second evaluation ), the end of the fourth month (the third evaluation), and the end of the sixth month (the fourth evaluation) after the first interview with the families. The follow up included the HBV knowledge improvement, and the improvement of the health behavior related HBV. After six months, all the families were asked to fill in the same questionnaires. At the same time, all the families had the laboratory examination on liver function and HBV marker. Data were analyzed with SPSS 10.0.
Results:
1. The level of the families' anxiety and the depression before intervention was higher than that in the normal crowd (P<0.05); Except BP, RP, the scores of the other domains were lower than those in the normal crowd (P<0.05) in SF-36.
2. Compared the knowledge scores of the four times in the study group, there were significant differences between the each two times comparison (P<0.05). There was not significant difference between the two scores before the intervention and six months after the intervention in the control group (P>0.05). The score of the study group was higher than that of the control group after the intervention (P<0.05).
3. The health behavior score of the patients in the study group after the intervention was higher than that before the intervention (P<0.05). There was not significant difference between the two health behavior scores before and after the intervention for patients in the control group (P>0.05).
4. Compared with the health behavior scores of four times for the study group, the differences were significant (P<0.05). The scores increased continously when evaluated each time during the six months follow up. There was not significant difference between the two health behavior scores before and after the intervention for the control group (P>0.05).
5. The score of attitude to health education in the study group after the intervention was higher than that before the intervention (P<0.05). There was not significant difference between the two scores of attitude to health education before and after the intervention for the control group (P>0.05).
6. In the study group, the scores of SAS and SDS after the intervention were lower than those before the intervention (P<0.05). In the control group, the differences of SAS and SDS scores before and after the intervention were not significant. The differences of SAS score and SDS score before and after the intervention for the study group were significant P<0.05). The scores of SAS and SDS for the study group were lower than those the normal crowd( P<0.05).
7. The scores of PF, GH, VT, SF and RE after the intervention were higher than those before the intervention for the study group( P<0.05). The score was not different significantly for each domain of SF-36 before and after the intervention for the control group (P>0.05). The scores of PF, BP, GH, SF, RE domains after the intervention for the study group were lower than the normal crowd (P<0.05).
8. The differences of the GGT, DBIL, TBIL, IBIL and ALP between the times of before and after the intervention for the study group were not significant (P>0.05). The ALP before and after the intervention was not significant different for the control group(P>0.05).
Conclusion:
Compaired with the normal crowd, the families of CHB patients had higher level of anxiety and depression, and lower level of six domains of SF-36 before the intervention. The continuous health education could elevate the cognition of HBV knowledge for the CHB patients' families. According to this study, it could elevate the health behavior, improve the quality of life, decrease the level of anxiety and depression for the CHB patients' families by the continuous health education. The continuous health education might be an effective factor for keeping the families' liver function stable.
引文
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