Faculty of Nursing and Social Welfare Science, Fukui Prefectural University, Eiheiji, Japan.
J Epidemiol. 2012;22(2):103-12. doi: 10.2188/jea.je20110036. Epub 2011 Dec 31.
Current health education programs for osteoporosis prevention are not strictly evidence-based. We assessed whether distribution of an evidence-based guideline improved such programs at municipal health centers.
This randomized controlled trial evaluated 100 municipal health centers throughout Japan that were randomly selected from those that planned to revise osteoporosis prevention programs. The implementation status of educational items recommended by the guideline was assessed before and after the intervention by evaluators blinded to the allocation. After the pre-intervention assessment, centers were randomly allocated in a 1:1 ratio to intervention and control groups by a minimization method defining region and city/town as stratification factors. Centers in the intervention group were given copies of the guideline; centers in the control group were instructed to use any information except the guideline. Analyses were performed on an intention-to-treat basis.
The guideline was used by 50% of the intervention group. Before the intervention, there was no significant difference in the evidence-based status of health education between the groups. The post-intervention assessment showed that the implementation rates of health education on dietary calcium intake for postmenopausal women and exercise for elderly persons were higher in the intervention group. Specific advice on intakes of calcium and vitamin D and exercise became more evidence-based in the intervention group.
The findings suggest that the guideline helped healthcare professionals to improve health education programs by making them more evidence-based. However, the improvements seemed to be limited to items that the professionals felt prepared to improve.
目前的骨质疏松症预防健康教育计划并非严格基于证据。我们评估了在市立保健中心分发基于证据的指南是否可以改善这些计划。
本随机对照试验评估了日本 100 家市立保健中心，这些中心是从计划修订骨质疏松症预防计划的中心中随机选择的。在干预之前和之后，评估员对教育项目的实施情况进行了评估，评估员对分配情况不知情。在进行预干预评估后，采用最小化方法，将区域和市/镇作为分层因素，按照 1:1 的比例将中心随机分配到干预组和对照组。干预组的中心获得了指南的副本；对照组的中心被指示使用除指南以外的任何信息。分析采用意向治疗。
50%的干预组使用了指南。干预前，两组健康教育的循证状况无显著差异。干预后的评估显示，绝经后妇女饮食钙摄入和老年人运动的健康教育实施率在干预组更高。干预组在钙和维生素 D 摄入以及运动方面的具体建议更加循证。
这些发现表明，该指南通过使医疗保健专业人员的健康教育更加循证，帮助他们改进了健康教育计划。然而，这些改进似乎仅限于专业人员认为有准备改进的项目。
