【作者】 胡蓉芳；

【导师】 姜小鹰； 陈晓春；

【作者基本信息】 福建医科大学 ， 老年医学， 2004， 硕士

【摘要】 目的:调查研究社区中老年人骨质疏松症相关知识、信念和行为;探讨以社区为基础,以健康信念模式为理论框架,以健康教育为手段的原发性骨质疏松症社区护理干预模式的可行性和有效性,以期建立适合我国国情、文化背景、具有指导护理实践意义的理论模式,为发展社区健康促进工作提供科学依据。方法:本研究由二个部分组成,第一部分汉化修订《骨质疏松症健康信念量表》和《骨质疏松症自我效能量表》,为干预研究提供评价工具。随机抽取304名分布在福州市三个社区和一个老年公寓35-80岁的中老年人作为被试对象。第二部分是社区干预试验,由三个阶段组成:第一阶段通过基线调查,进行社区健康教育诊断,制定干预计划;第二阶段实施连续六个月的以健康教育为主要手段的原发性骨质疏松症一级预防干预;第三阶段干预后调查了解目标人群骨质疏松症相关知识、信念和行为的变化,评价干预效果。采用类实验设计,选取浦下社区作为试验社区,按地理位置确定2个居委会为干预区,2个居委会为对照区,从各区按居民健康档案随机抽取原则,分别抽取200名年龄为35-80岁的中老年人作为干预前后的调查对象。干预前实际调查374名中老年人,干预区200名,对照区174名,干预后实际获取280名调查对象应答,干预区160名,对照区120名。结果:(1)《骨质疏松症健康信念量表》总量表同质性信度克伦巴赫а系数为0.83,各维度α系数在0.60～0.85之间;重测相关系数为0.73(P<0.05);因子分析结果有六个公因子被提取,累计方差百分比为55.75%。《骨质疏松症自我效能量表》克伦巴赫α系数为0.94,重测相关系数0.80(P<0.01);因子分析结果有二个公因子被提取:锻炼自我效能、食钙自我效能,累计方差百分比为67.45%。(2)基线调查:调查人群骨质疏松症知晓率低,调查人群骨质疏松症相关知识、信念和行为状况较差。主要表现为对骨质疏松症危险因素和严重后果认识不足,调查人群认为易患骨质疏松症的这种信念较弱。(3)干预效果显著,干预人群骨质疏松症相关知识、信念和预防行为(饮食行为、锻炼行为)均有显著改善。干预后,干预组总知识得分指标增加23.2%,干预组知识得分显著高于对照组;干预组感知疾病易患性、健康动机、自我效能方面的得分均有显著增加,食钙障碍、锻炼障碍得分均有明显下降;干预组在疾病易患性、健康动机、锻炼效能、食钙效能六方面得分显著高于对照组,锻炼障碍和食钙障碍得分显著低于对<WP=4>照组;干预组有38.8%调查对象每天食用至少1标准量(约相当于220毫升牛奶)乳制品,比干预前显著增加11.2%;23.8%调查对象每天食用豆制品,比干预前显著增加5.8%;89.6%调查对象经常进行锻炼,增幅12.6%,30.6%调查对象锻炼后无明显感觉,降幅8.4%,合理锻炼比例由干预前27.6%增至41.9%,增幅14.3%,但每周至少锻炼3次和每次锻炼至少30分钟的比例没有显著改变。对照组除了感知食钙利益的得分有显著降低,知识得分、健康信念其余方面、饮食及锻炼行为均无显著改变。结论:(1)汉化修订的《骨质疏松症健康信念量表》和《骨质疏松症自我效能量表》具有良好的信度和效度,基本能真实和稳定地反映骨质疏松症相关信念和自我效能,能为研究者和骨质疏松症健康教育者提供新的工具。(2)干预效果显著,今后需要继续加强干预,提高和巩固干预效果。(3)围绕原发性骨质疏松症危险因素,以健康信念模式为理论框架,以社区为基础,以健康教育为手段的干预模式能够有效指导社区护理、健康促进工作,本研究方法可推广应用于心血管疾病等慢性病预防控制的健康促进工作中。(4)健康教育是社区护理干预的主要手段。社区护士应寻求健康教育可持续发展的途径。更多还原

【Abstract】 OBJECTIVE: The purposes of this study were to determine knowledge, health belief and prevention behaviors on osteoporosis, to evaluate the feasible and effectiveness of a community-based primary osteoporosis prevention program for community-dwelling middle and old aged people to determine if osteoporosis prevention program participants (intervention group) increased their knowledge of osteoporosis, health belief, calcium intake and exercise; to develop a model for health education on basis of theoretical framework of Health Belief Model to promoting the development of community nursing in China and to provide scientific evidences for choosing effective ways in health promotion . DESIGN: This research included two parts. The first part is about revision of the Chinese versions of Osteoporosis Health Belief Scale and Osteoporosis Self-Efficacy Scale. A sample of 304 subjects ages 35 to 80, were randomized selected from three communities and one senior residential apartment, and received the test of OHBS and OSE for psychometric evaluation.The second part is about community intervention trial,which is made up of three stages, the first stage is about the community health education diagnosis which is to find the conditions of the konwledge,attitude,belief and behavior(KABP),then make a intervention plan according to the findings.The second stage is to perform the educational intervention, which was available to the intervention group for 6 months. At last stage, We evaluate effectiveness of the intervention by the change of KABP on osteoporosis pre-intervention and post-intervention.Randomly selected intervention group and control group in Puxia community in Fuzhou City. At baseline survey, 374 adults aged 35 to 80 years were randomly invited from intervention group (n=200) and control group(n=174) At posttest,160 subjects from intervention group and 120 subjects from control group receive the KAP survey on osteoporosis.<WP=6>RESULTS:(1) For OHBS, the test-tested reliability coefficient were 0.73,the Cronbach’s alphas were in 0.60~0.85,factor analysis of responses to the health belief items revealed a logical, theoretically meaningful six-factor structure.For OSE, the test-tested reliability coefficient were 0.80,the Cronbach’s alphas were in 0.94,factor analysis of responses to the self-efficacy items revealed a logical, theoretically meaningful two-factor structure.(2)The main findings of the baseline assessment demonstrate that osteoporosis is unfamiliar to community-dwelling middle and old aged people, The KABP of them is poor. Few people are aware of the susceptiblity and seriousness of osteoporosis and believe that they had a good chance of osteoporosis.(3) The results showed the intervention is effective, it demonstrated that the intervention group have significantly improved in the KABP than the control group. Comparisons between the 2 groups revealed: the knowledge of intervention group have been improved markly, the score index increase by 23.2%, significantly increased 5.86 scores compared with control, the scores of susceptibility ,health motivation and self-efficacy of intervention group are significantly increased,and the scores of calcium barrier and exercise barrier of intervention group are significantly decreased. For intervention group, the rate of exercise increased from 77 % to 89.6%(P<0.05), the rate of reasonable exercise increased from 27.6% to 41.9%(P<0.05),the exercise intensity increased significantly, the rate of intake at least one standard of dairy products(which is correspond to 220 milliliter milk) each day increased from 27.6% to 38.8%(P<0.05),the rate of intake of bean each day increased from 18% to 23.8%(P<0.05),while the KABP of the control group have not significantly changed.CONCLUSION: (1)The Chinese version of OHBS and OSE have psychometrically acceptable reliability and validity, and can be used in Chinese adult population for health promotion.(2)These findings suggest that a education program have an impact on knowledge ,belief and behaviors that may help t更多还原