University of Tasmania, MS1 UTAS, Private Bag 23, Hobart, TAS 7000, Australia.
BMC Fam Pract. 2012 Jun 13;13:55. doi: 10.1186/1471-2296-13-55.
Adoption and maintenance of healthy behaviours is pivotal to chronic disease self-management as this influences disease progression and impact. This qualitative study investigated health behaviour changes adopted by participants with moderate or severe chronic obstructive pulmonary disease (COPD) recruited to a randomised controlled study of telephone-delivered health-mentoring.
Community nurses trained as health-mentors used a patient-centred approach with COPD patients recruited in general practice to facilitate behaviour change, using a framework of health behaviours; 'SNAPPS' Smoking, Nutrition, Alcohol, Physical activity, Psychosocial well-being, and Symptom management, through regular phone calls over 12 months. Semi-structured interviews in a purposive sample sought feedback on mentoring and behaviour changes adopted. Interviews were analysed using iterative thematic and interpretative content approaches by two investigators.
Of 90 participants allocated to health-mentoring, 65 (72%) were invited for interview at 12-month follow up. The 44 interviewees, 75% with moderate COPD, had a median of 13 mentor contacts over 12 months, range 5-20. Interviewed participants (n=44, 55% male, 43% current smokers, 75% moderate COPD) were representative of the total group with a mean age 65 years while 82% had at least one additional co-morbid chronic condition. Telephone delivery was highly acceptable and enabled good rapport. Participants rated 'being listened to by a caring health professional' as very valuable. Three participant groups were identified by attitude to health behaviour change: 14 (32%) actively making changes; 18 (41%) open to and making some changes and 12 (27%) more resistant to change. COPD severity or current smoking status was not related to group category. Mentoring increased awareness of COPD effects, helping develop and personalise behaviour change strategies, even by those not actively making changes. Physical activity was targeted by 43 (98%) participants and smoking by 14 (74%) current smokers with 21% reporting quitting. Motivation to maintain changes was increased by mentor support.
Telephone delivery of health-mentoring is feasible and acceptable to people with COPD in primary care. Health behaviours targeted by this population, mostly with moderate disease, were mainly physical activity and smoking reduction or cessation. Health-mentoring increased motivation and assisted people to develop strategies for making and sustaining beneficial change.
ACTR12608000112368.
采用和维持健康行为对于慢性疾病自我管理至关重要，因为这会影响疾病的进展和影响。本定性研究调查了参加电话式健康指导随机对照研究的中重度慢性阻塞性肺疾病（COPD）患者所采用的健康行为变化。
社区护士接受健康指导培训，以患者为中心，在普通诊所招募 COPD 患者，通过健康行为框架“SNAPPS”（吸烟、营养、酒精、身体活动、心理社会健康和症状管理），在 12 个月内通过定期电话进行行为改变。在有目的的样本中进行半结构化访谈，以获取有关指导和采用的行为变化的反馈。访谈由两名研究人员使用迭代主题和解释性内容方法进行分析。
在分配给健康指导的 90 名参与者中，有 65 名（72%）在 12 个月的随访中被邀请进行访谈。44 名接受访谈的参与者（75%为中度 COPD）在 12 个月内平均接受了 13 次指导，范围为 5-20 次。接受访谈的参与者（n=44，55%为男性，43%为当前吸烟者，75%为中度 COPD）代表了总人群，平均年龄为 65 岁，而 82%至少有另一种合并的慢性疾病。电话交付方式非常受欢迎，能够建立良好的关系。参与者将“被关心的健康专业人士倾听”评为非常有价值。通过对健康行为改变的态度，确定了三个参与者群体：14 人（32%）积极改变；18 人（41%）愿意并采取一些改变；12 人（27%）更抗拒改变。COPD 严重程度或当前吸烟状况与群体类别无关。指导提高了对 COPD 影响的认识，帮助制定和个性化行为改变策略，即使是那些没有积极改变的人。43%（98%）的参与者针对身体活动，14 名（74%）当前吸烟者针对吸烟，其中 21%的人报告戒烟。导师的支持增加了维持改变的动力。
电话式健康指导在初级保健中对 COPD 患者是可行且可接受的。该人群针对的健康行为主要是身体活动和减少或戒烟，主要是中重度疾病患者。健康指导增加了动机，并帮助人们制定和维持有益的改变策略。
ACTR12608000112368。
