【作者】 郭玉；

【导师】 李忠玉； 赵飞骏；

【作者基本信息】 南华大学 ， 护理（专业学位）， 2025， 硕士

【摘要】 目的本研究旨在了解当前生殖道沙眼衣原体(CT)、解脲脲原体(UU)感染育龄妇女的相关需求;构建基于信息-动机-行为技巧(IMB)模型的生殖道CT、UU感染育龄妇女护理干预方案;评价该方案对相关患者身心健康、疾病认知、自我效能和生活质量的影响。为临床开展生殖道CT、UU感染育龄妇女的护理干预提供参考依据。方法(1)采用目的抽样选取在衡阳市某三甲医院妇科门诊就诊的20名生殖道CT、UU感染育龄妇女开展半结构式深入访谈以了解患者的相关需求,并使用Colaizzi 7步分析法进行资料分析和主题提炼。(2)结合文献回顾与质性研究结果,通过小组讨论形成护理干预方案初稿。选取15名专家开展2轮专家函询,采用专家积极性、专家权威程度以及专家意见协调程度对函询结果的可靠性、可信度与稳定性进行综合评判。随后在临床选取10名目标人群开展预试验,依据反馈结果对专家函询拟定的干预方案予以完善,形成《生殖道CT、UU感染育龄妇女护理干预方案》终稿。(3)采取便利抽样方法,选取80名符合纳排标准的患者为研究对象,利用随机数字表法分为对照组(40名)与干预组(40名)。干预组在常规健康教育的基础上接受基于IMB模型的生殖道CT、UU感染育龄妇女护理干预方案,对照组接受医院门诊常规健康教育。干预前及干预3个月后,通过病例资料收集研究对象的感染情况和白带清洁度指标、通过《医院焦虑抑郁量表(HAD)》《生殖道CT、UU感染IMB问卷》《自我护理自我效能量表(SCSES)》《皮肤病生活质量指数(DLQI)》了解患者的身心状况、疾病认知、自我效能与生活质量现状。比较干预前后组内与组间的各指标变化以评判干预方案有效性。结果(1)质性研究共归纳出6个主题,分别为信息需求、生理需求、心理需求、动机需求、社会需求和行为技巧需求。(2)经两轮专家函询和预试验后形成包含3个一级指标、13个二级指标、30个三级指标的生殖道CT、UU感染育龄妇女护理干预方案。首轮函询(3个一级条目,12个二级条目,25个三级条目)有9位专家提出13条建议,合并2个二级条目,增加2个二级条目和5个三级条目,修改11个三级条目。第二轮函询(3个一级条目,13个二级条目和30个三级条目)有1位专家提出1条建议,修改2个三级条目。两轮函询问卷的有效回收率均为100%,两轮专家函询后专家权威系数为0.94,肯德尔和谐系数为0.513,各指标重要性赋值均>4.0,变异系数均<0.25。预试验后对2个三级条目予以修订,形成干预方案终稿。(3)由于对照组失访2例,最终共78例患者完成了本项研究。干预前两组患者一般资料、生殖道感染情况、白带清洁度、各问卷和量表总分及各维度得分差异均无统计学意义(P>0.05),具有可比性。干预3月后,干预组呈现多维改善:(1)生理状况:干预组生殖道CT、UU感染率(P=0.001)及白带清洁度异常患者构成比(P=0.001)明显低于对照组。(2)心理状况:组内比较干预组HAD总分及各维度得分较干预前显著降低(P<0.05)。组间比较干预组焦虑维度得分较对照组更低,差异有统计学意义(P<0.05),干预组抑郁维度得分低于对照组,但差异无统计学意义(P>0.05)。(3)疾病认知:干预组《CT、UU感染IMB问卷》总分、知识维度、动机维度、行为技巧维度得分较干预前显著增加(P<0.05),且显著高于对照组(P<0.05)。(4)自我效能:干预组SCSES得分较干预前显著提升(P<0.001),且显著高于对照组(P<0.001)。(5)生活质量:干预组DLQI得分较干预前显著降低(P<0.001),且显著低于对照组(P=0.001)。结论(1)当前生殖道CT、UU感染育龄妇女在信息获取、个人动机、行为技巧、身心维护以及社会支持方面的需求普遍未能得到满足。(2)本研究构建了一个包含3个一级指标、13个二级指标和30个三级指标的生殖道CT、UU感染育龄妇女护理干预方案,具有科学性和实用性。(3)基于IMB模型的生殖道CT、UU感染育龄妇女护理干预方案能够有效改善患者身心状况、提升疾病认知水平、增强患者自我效能,改善生活质量。更多还原

【Abstract】 ObjectiveThe aim of this study is to explore the current needs of women of reproductive age with genital tract Chlamydia trachomatis(CT)and Ureaplasma urealyticum(UU)infections,construct a nursing intervention plan for these women based on the Information-motivation-behavioral skills(IMB)model,and evaluate the impact of the program on the physical and mental health,disease awareness,self-efficacy,and quality of life of relevant patients.To provide reference for clinical nursing interventions for genital tract CT and UU infection in women of reproductive age.Methods(1)Using purposive sampling,20 women of reproductive age with genital tract CT and UU infections who visited the gynecology clinic of a tertiary hospital in Hengyang City were invited to participate in semi-structured in-depth interviews to explore their needs.Data were analyzed using Colaizzi’s seven-step thematic analysis method to identify key themes.(2)Based on literature review and qualitative research results,a preliminary nursing intervention plan was developed through group discussions.Fifteen experts were selected to conduct 2 rounds of expert inquiry,and the reliability,credibility,and stability of the inquiry results were comprehensively evaluated based on their enthusiasm,authority,and coordination of opinions.Subsequently,10 subjects were selected for pilot clinical trials.Based on the feedback,the intervention plan formulated through expert inquiries was improved to form the final draft of the"Genital Tract CT and UU Infection Nursing Intervention Plan for Women of Reproductive Age".(3)Using the convenience sampling method,80 patients who met the inclusion and exclusion criteria were selected as the research subjects.They were randomly divided into a control group(40 patients)and an intervention group(40 patients)using the random number table method.The intervention group received a nursing intervention plan for women of reproductive age with genital tract CT and UU infections based on the IMB model on the basis of routine health education,while the control group received routine health education in the hospital outpatient department.Before and 3 months after the intervention,the infection status and vaginal cleanliness index of the research subjects were collected through case data,and the physical and mental status,disease cognition,self-efficacy,and quality of life of the patients were evaluated through the Hospital Anxiety and Depression Scale(HAD),Genital Tract CT and UU Infection IMB Questionnaire,Self Care Self Efficacy Scale(SCSES),and Dermatology Life Quality Index(DLQI).The changes in various indicators within and between groups before and after the intervention were compared to evaluate the effectiveness of the intervention plan.Results(1)Qualitative research has identified 6 themes:informational needs,physiological needs,psychological needs,motivational needs,social needs,and behavioral skills needs.(2)After two rounds of expert consultation and preliminary experiments,a nursing intervention plan for women of reproductive age with genital tract CT and UU infections was developed,which includes 3primary items,13 secondary items,and 30 tertiary items.In the first round of inquiry(3 primary items,12 secondary items,25 tertiary items),9 experts proposed 13 suggestions.As a result,2 secondary items were merged,2 secondary items and 5 tertiary items were added,and 11tertiary items were modified.In the second round of inquiry(3 primary items,13 secondary items,and 30 tertiary items),one expert proposed one suggestion to modify 2 tertiary items.The effective response rate of both rounds of inquiry questionnaires was 100%.After two rounds of expert inquiry,the expert authority coefficient was 0.94,the Kendall’s W was 0.513,and the importance values of each indicator were all>4.0,with a coefficient of variation<0.25.After the pilot clinical trials,the researchers revised the two tertiary items to form the final version of the intervention plan.(3)After excluding 2 lost follow-up cases in the control group,a total of 78 patients completed this study.Before intervention,there were no statistically significant differences(P>0.05)between the two groups in general information,genital tract infection status,vaginal discharge cleanliness,total scores of questionnaires/scales,and scores of each dimension,indicating comparability.After 3 months of intervention,the intervention group showed multidimensional improvements:(1)Physiological condition:The intervention group had significantly lower rates of genital tract CT and UU infections(P=0.001)and a lower proportion of patients with abnormal vaginal discharge cleanliness(P=0.001)compared to the control group.(2)Psychological condition:The intervention group’s HAD total score and all subscale scores significantly decreased compared to baseline(P<0.05).The intervention group had lower anxiety dimension scores than the control group(P<0.05),while depression dimension scores were lower but not statistically significant(P>0.05).(3)Disease cognition:The intervention group’s total score on the"CT and UU Infection IMB Questionnaire,"as well as its knowledge,motivation,and behavioral skills subscales,significantly increased compared to baseline(P<0.05)and were higher than the control group’s(P<0.05).(4)Self-efficacy:The intervention group’s SCSES score significantly increased compared to baseline(P<0.001)and was significantly higher than the control group’s(P<0.001).(5)Quality of life:The intervention group’s DLQI scores significantly decreased compared to baseline(P<0.001)and were lower than the control group’s(P=0.001).Conclusions(1)The unmet needs of women of reproductive age with genital tract CT and UU infections in information acquisition,personal motivation,behavioral skills,physical and mental well-being,and social support are generally evident.(2)This study developed a nursing intervention plan for genital tract CT and UU infections in women of reproductive age,which includes 3primary items,13 secondary items,and 30 tertiary items.The plan is scientific and practical.(3)The nursing intervention plan for genital tract CT and UU infections in women of reproductive age based on the IMB model can effectively improve patients’physical and mental health,enhance their disease awareness and self-efficacy,and elevate their quality of life.更多还原