【作者】 杨帆；

【导师】 杨富国；

【作者基本信息】 青岛大学 ， 护理学， 2024， 硕士

【摘要】 目的本研究以信息框架效应为基础,结合自我效能理论和知信行理论,构建冠心病PCI术后患者自我管理干预方案,并验证该方案的可行性和有效性,以改善其自我管理行为,为方案的广泛推广奠定基础。方法1.基于信息框架效应的冠心病PCI术后患者自我管理干预方案的构建:系统检索冠心病PCI术后患者自我管理相关指南、文献,将符合纳入标准的指南、文献等进行质量评价,对内容进行分析、证据进行分级、推荐强度进行划分,整合形成最佳实践证据,为干预方案的构建提供循证依据。根据最佳实践证据,经小组讨论,以信息框架效应为基础,结合自我效能理论和知信行理论,拟定接受PCI手术的冠心病患者自我管理干预方案初稿,筛选符合纳入函询标准的专家进行干预方案函询,结合专家意见完善方案,选择冠心病PCI术后患者进行预实验,形成冠心病PCI术后自我管理干预方案的终稿。2.基于信息框架效应的冠心病PCI术后患者自我管理干预方案的应用:选取2023年6月至2023年8月在潍坊市某三甲医院心内科接受治疗的90例冠心病PCI术后患者为研究对象。信息框架效应分为积极和消极2种,为明晰不同框架效应的干预效果,将研究对象随机分为积极信息框架组、消极信息框架组和对照组,分别接受积极信息框架的干预、消极信息框架的干预和常规信息干预。每组均为30例。在基线时收集人口学资料,并在干预前和12周干预结束后,收集冠心病自我管理行为量表、冠心病自我效能量表及冠心病知识问卷,使用SPSS25.0软件对数据进行整理分析。分析比较三组患者的自我管理行为、自我效能及知识水平。结果1.基于信息框架效应的冠心病PCI术后患者自我管理干预方案的构建:本研究纳入10篇有效文献,纳入文献的质量较高,汇总形成疾病知识获得、生活习惯管理、吸烟饮酒等不良嗜好管理、疾病症状管理、服用药物依从性、情绪及社会支持6个方面,15个条目。两轮专家的积极度均在90%以上,专家的权威系数(Cr)分别为0.86、0.87,均大于0.8,协调系数分别为0.346和0.600(P<0.05),专家意见较统一,结合预实验的反馈,最终形成终稿,并将干预方案的内容制成了相应短视频。2.基于信息框架效应的冠心病PCI术后患者自我管理干预方案的应用:本研究共纳入90例研究对象,干预过程中失访3例,其中积极效应框架组失访1例,失访率为3%,消极信息框架组失访2人,失访率为6%。三组患者的一般人口学资料、冠心病知识水平、自我效能及冠心病自我管理行为的基线资料均衡可比。干预后结果如下:(1)冠心病知识水平:组内比较结果显示,三组患者知识水平较干预前得分均显著升高(P<0.05)。组间比较结果显示,积极信息框架组与对照组及消极信息框架组差异无统计学意义。与对照组相比,消极信息框架组患者干预后的知识总分水平显著提高(P<0.05)。(2)冠心病自我效能:组内比较结果显示,积极信息框架组和消极信息框架组患者自我效能得分较干预前均显著升高(P<0.05),对照组较干预前无明显变化(P>0.05)。组间比较结果显示,与对照组比,积极信息框架组和消极信息框架组干预后的自我效能水平均显著升高(P<0.05)。与积极信息框架组相比,消极信息框架效应组干预后的自我效能水平显著升高(P<0.05)。(3)冠心病自我管理行为:组内比较结果显示,积极信息框架组和消极信息框架组患者自我管理行为得分较干预前均显著升高(P<0.05),对照组较干预前无明显变化(P>0.05)。组间比较结果显示,与对照组相比,积极信息框架组和消极信息框架组患者自我管理行为得分均显著升高(P<0.05)。与消极信息框架组患者相比,积极信息框架组患者干预后自我管理水平仅有数值上的升高(P>0.05)。结论1.以信息框架效应为基础,结合自我效能理论和知信行理论,构建的接受PCI手术的冠心病患者自我管理干预方案具有较高的科学性和良好的可行性。2.基于信息框架效应的冠心病PCI术后患者自我管理干预方案可有效改善患者的知识水平、自我效能及自我管理水平。两种框架效应的影响不同,积极框架效应对自我管理能力的影响更全面,消极框架信息对自我效能及冠心病知识水平的影响更有效。更多还原

【Abstract】 ObjectiveBased on the information frame effect and combined with self-efficacy theory and knowledge belief theory,this study formulated personalized health information representation for patients with coronary heart disease after PCI,conducted behavioral intervention for patients to improve their self-management behavior.Methods1.Construction of self-management intervention plan for patients with coronary heart disease after PCI based on information framework effect:A systematic search of guidelines and literatures of the self-management for patients with CHD after PCI.The guidelines and reference that meet the inclusion criteria were evaluated,according to the content-analysis,evidence classification and the recommendation intensity clivision.The best practice evidence were formed to provide an evidence-based basis for the construction of the intervention scheme.Based on the best practice evidence and group discussion and the information framework effect,combined with the self-efficacy theory and the theory of knowledge and action,the draft self-management intervention plan for patients with coronary heart disease undergoing PCI was prepared.15 experts in relevant fields who met the criteria for inclusion in the consultation with experts were selected for consultation with intervention plans,and the questionnaires,suggestions and suggestions for modification were collected in time.Combine expert opinions to improve the scheme.Five patients with coronary heart disease after PCI were selected according to the exclusion criteria of the study subjects.After obtaining the consent of the patients,intervention video recordings were played to them,and the viewing feelings and targeted modification comments or suggestions were truthfully recorded and fed back to form the final self-management intervention plan for coronary heart disease after PCI.2.Application of self-management intervention program for patients with coronary heart disease after PCI based on information framework effect:From June 2023 to August 2023,90 cases of coronary heart disease PCI were treated as research objects in 90 cases of coronary heart disease PCI were treated in the cardiac hospital in Weifang City.They were randomly divided into experimental group and control group.The experimental group was divided into active intervention group and passive intervention group according to different ways of receiving information,and the control group received ordinary information intervention,with 30 cases in each group.Video interventions were performed every 2 weeks for 12 weeks after discharge.Demographic data were collected at baseline,and the CHD self-management behavior Scale,CHD self-efficacy scale and CHD knowledge questionnaire were collected at baseline and after the 12-week intervention.SPSS25.0 software was used to organize and analyze the data.The self-management behavior,self-efficacy and knowledge level of the two groups were analyzed and compared.Results1.Construction of self-management behavior intervention program for patients with coronary heart disease after PCI based on information frame effect: In this study,10 valid literatures were included,and the quality of the literatures was high.They were summarized into 15 items in 6 aspects,namely,acquisition of disease knowledge,management of lifestyle habits,management of bad habits such as smoking and drinking,management of disease symptoms,compliance with intervention,emotion and social support.The enthusiasm of two rounds of experts is more than 90%.The authoritative coefficient(CR)of the two-wheeled experts(CR)is 0.86 and 0.873,respectively,both greater than 0.8,and the coordination coefficients are 0.346 and 0.600(P<0.05).Combined with the feedback of the pre-experiment,the final draft was finally formed,and the content of the intervention plan was made into corresponding short videos.2.Application of self-management behavior intervention program in patients with coronary heart disease after PCI based on information frame effect: This study was included in a total of 90 research objects,and 3 cases were lost during the intervention.The rate is 3%,the negative information framework group has 2 people out of 2 people,and the outdoor rate is 6%.The baseline data of the three groups of patients is equivalent.(1)Knowledge level of CHD: 12 weeks after intervention,compared with the control group,knowledge level scores of patients in the positive information frame group and the negative information frame group were significantly increased,and the difference was statistically significant(P<0.05).Compared with patients in the positive information frame group,the total knowledge level of patients in the negative information frame group after intervention was significantly increased,and the difference was statistically significant(P<0.05).(2)CHD self-efficacy: 12 weeks after intervention,compared with the control group,the self-efficacy scores of patients in the information frame groups were significantly increased,and the difference was statistically significant(P<0.05).Compared with patients in the positive information frame group,the self-efficacy level of patients in the negative information frame group after intervention was significantly increased,and the difference was statistically significant(P<0.05).(3)CHD self-management behavior: 12 weeks after intervention,compared with the control group,the self-management behavior scores of patients in the information framework groups were significantly increased,and the difference was statistically significant(P<0.05).Compared with patients in the negative information frame group,the self-management level of patients in the positive information frame group after intervention was only increased numerically,and the difference was not statistically significant(P>0.05).Conclusions1.Based on the information frame effect and combined with the self-efficacy theory and the knowledge,belief and action theory,the self-management intervention program for patients with coronary heart disease undergoing PCI is highly scientific and feasible.2.This study innovatively introduced the information frame effect,and developed the self-management intervention program for CHD patients undergoing PCI surgery,which can effectively improve the self-management level of CHD patients after PCI.The positive and negative framing effects have different impacts on self-management and self-efficacy in patients with coronary heart disease after PCI.The positive framing effect has a more comprehensive impact on self-management ability,while the negative framing information has a more effective impact on self-efficacy and knowledge level of CHD.更多还原