本文選題：跌倒效能　切入點：健康教育　出處：《重慶醫(yī)科大學》2017年碩士論文

【摘要】：目的:調查住院老年患者預防跌倒知、信、行及跌倒效能的現(xiàn)狀,分析二者的影響因素;評價健康信念模式和程序式健康教育模式的雙模式健康教育對住院老年患者預防跌倒知識、態(tài)度、行為及跌倒效能、預防跌倒行為依從性、跌倒發(fā)生率的影響。方法:本研究包含兩部分。第一部分:橫斷面研究。采用便利抽樣法對重慶市某三甲醫(yī)院老年病科、神經內科350例住院老年患者行問卷調查。內容包括社會人口學資料、跌倒史、疾病史、服藥情況、是否使用輔具、活動情況、跌倒效能、預防跌倒的知識、態(tài)度、行為、是否害怕跌倒等。第二部分:隨機對照試驗研究。病例來源為第一部分篩選出存在害怕跌倒(Fear of falling,FOF)的住院老年患者,納入病例104,隨機分為兩組,各52例。干預組在常規(guī)健康教育的基礎上結合健康信念模式及程序式健康教育模式行健康教育,分5階段進行,第一階段:使患者意識到跌倒嚴重性及易感性,時間3天;第二階段:認識預防跌倒健康行為的益處和采取健康行為的障礙,時間3天;第三階段:讓患者自愿采取一定的預防跌倒健康行為,協(xié)商制定個性化健康教育方案及預防跌倒的健康行為,時間3天;第四階段:讓患者自覺實踐預防跌倒行為,具備預防跌倒的自我效能,時間5天;第五階段:出院后繼續(xù)強化健康行為,時間3月。出院第4周、8周、12周、3月行電話或微信隨訪。各階段按程序式健康教育五步驟進行,提供個性化健康教育。對照組采用常規(guī)健康教育方式,入院健康教育內容和出院隨訪時間和干預組一致。3月后收集資料進行數(shù)據統(tǒng)計。結果:1.研究對象平均年齡為75.01±8.40歲。2.有跌倒史為167名,占總人數(shù)的47.7%。3預防跌倒知識維度得分為(45.33±6.16)分,態(tài)度維度得分為(25.06±3.69)分,行為維度得分為(24.50±6.20)分,跌倒效能得分為(77.05±39.14)分,4.將影響預防跌倒知、信、行及跌倒效能的單因素結果進入多元線性逐步回歸分析,影響跌倒知、信、行的因素為:文化程度、經濟來源、經濟狀況,決定系數(shù)為0.301(調整r2)。影響跌倒效能的因素為:助行器、活動鍛煉、年齡、跌倒史、文化程度,決定系數(shù)為0.452(調整r2)。5預防跌倒知識、態(tài)度、行為與跌倒效能進行相關性分析,預防跌倒知識、態(tài)度與跌倒效能呈正相關,相關系數(shù)知識(r=0.110,p0.05,)態(tài)度(r=0.150,p0.01);6干預后,比較兩組患者預防跌倒知識、態(tài)度、行為得分,干預組明顯高于對照組,差異具有統(tǒng)計學意義(p0.01);比較兩組跌倒效能得分,干預組(modifiedfallsefficacyscale,mfes)總分高于對照組,差異有統(tǒng)計學意義(p0.01);比較兩組患者干預14天前后預防跌倒行為依從性變化,干預組依從性明顯高于對照組,差異有統(tǒng)計學意義(p0.01),比較兩組患者干預期間跌倒發(fā)生率,干預組低于對照組,差異有統(tǒng)計學意義。結論:1.住院老年患者預防跌倒的認知不強,跌倒效能總體水平不高。文化程度、經濟來源、經濟狀況是影響跌倒認知的重要因素;是否使用助行器、活動鍛煉、年齡、跌倒史、文化程度是影響住院老年患者跌倒效能的重要因素,活動鍛煉、使用助行器對跌倒效能影響較大。2.雙模式健康教育可以有效提高住院老年患者跌倒的認知及效能,提高預防跌倒行為的依從性,提高對跌倒的認知度,預防跌倒發(fā)生,可以在臨床上進行應用。
[Abstract]:Objective: to know the prevention of falls in hospitalized elderly patients, investigation letter, and present fall efficacy, analysis of factors affecting the two; attitude dual mode health education mode of health education and health belief model program evaluation on prevention of falls in hospitalized elderly patients, knowledge, behavior and fall efficacy, fall prevention compliance, falls the rate of effect. Methods: This study consists of two parts. The first part: a cross-sectional study. The Department of Geriatrics, General Hospital of Chongqing city with the convenient sampling method, Department of Neurology, 350 patients in hospital by questionnaire survey. The contents include social demographic data, fall history, disease history, medication, whether the use of assistive devices, activities fall, efficiency, fall prevention knowledge, attitude, behavior, whether the fear of falling. The second part: a randomized controlled trial. All cases were first part were screened for the presence of fear of falling (Fear Of falling, FOF) of the hospitalized elderly patients, included 104 patients, were randomly divided into two groups, 52 cases in each group. The intervention group with the health belief model and the program of health education mode for health education based on routine health education, is divided into 5 stages, the first stage: to make patients aware of the severity and susceptibility to fall time, 3 days; second stages: awareness of fall prevention health behavior benefits and adopt healthy behavior disorder, 3 days; the third stage: let the patients voluntarily take certain fall prevention health behavior, consultation and individualized health education plan and fall prevention health behavior, time of 3 days; the fourth stage: let the patient conscious the practice of fall prevention behaviors, have fall prevention self-efficacy, time of 5 days after discharge; the fifth stage: continue to strengthen the health behavior, the time of March. Discharged fourth weeks, 8 weeks, 12 weeks, March WeChat phone or follow-up. According to each stage of history Order five steps to carry out health education, providing personalized health education. The control group uses the conventional health education, hospital health education content and follow-up time and intervention group consistent.3 months after collecting data for statistical data. Results: 1. subjects with an average age of 75.01 + 8.40 years.2. a history of falls was 167, accounting for the total the number of 47.7%.3 falls prevention knowledge score was (45.33 + 6.16), attitude score was (25.06 + 3.69) points, the behavior score was (24.50 + 6.20) points, scores fall efficacy (77.05 + 39.14) points, 4. will affect the fall prevention knowledge, faith, and single factor fall performance results into multiple linear stepwise regression analysis, influence of fall knowledge, letter, for factors: education, economic resources, economic conditions, the coefficient of determination was 0.301 (adjusted R2). For the factors influencing the effectiveness of the fall: walker, exercise, age, history of fall, The cultural degree, the coefficient of determination was 0.452 (R2).5 fall prevention knowledge, attitude, behavior and fall efficacy correlation analysis, fall prevention knowledge, attitude and fall efficacy was positively related to the correlation coefficient of knowledge (r=0.110, P0.05) (r=0.150, P0.01); attitude 6 intervention, compared two groups of patients fall prevention knowledge, attitude, behavior scores, the intervention group was significantly higher than the control group, the difference was statistically significant between the two groups (P0.01); fall efficacy score, the intervention group (modifiedfallsefficacyscale, MFEs) score higher than the control group, the difference was statistically significant (P0.01); the intervention of two groups were compared before and after 14 days of fall prevention compliance changes, intervention group compliance was significantly higher than the control group, the difference was statistically significant (P0.01), compared between the two groups during the intervention in patients with the incidence of falls, the intervention group was lower than that of the control group, the difference was statistically significant. Conclusions: 1. hospitalized elderly patients Fall prevention awareness is not strong, the overall level of efficiency is not high. The fall culture degree, economic resources, economic situation is an important factor affecting the fall of cognition; whether to use walkers, exercise, age, history of falls, cultural level is an important factor of falls among hospitalized elderly patients, the effectiveness of exercise, use walking aid for larger fall efficacy.2. dual mode of health education can effectively improve the efficiency of cognition and hospitalization falls in elderly patients, improve prevention compliance fall behavior, improve the fall awareness, fall prevention, and can be used in clinic.

【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473

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