Wang Qiong, Dong Lini, Jian Zaijin, Tang Xianghua
Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
BMC Cardiovasc Disord. 2017 Oct 16;17(1):262. doi: 10.1186/s12872-017-0698-8.
One of the most important challenges in public health is to improve the quality of life in patients with chronic heart failure (CHF). Depression, self-care capacity, and quality of life interact each other in these patients. It's difficult to treat with general education programs and conventional therapy. PRECEDE model is a comprehensive and exclusive theory-based education programs. Its effectiveness for reducing depression and increasing quality of life has been demonstrated in patients with coronary artery bypass grafting, type 2 diabetes, and the elderly. It has not been used in elderly patients with CHF. Thus, this study aims to investigate the effects of this model on self-care behaviors, depression, and quality of life in these patients.
Patients who met the inclusion criteria were randomly assigned to the intervention or control group. All the patients received conventional medical care. The patients in the intervention group also received 9 sessions of education intervention based on the PRECEDE model and then followed up for 3 months after the intervention. Data were collected before and 3 months after the intervention using 4 questionnaires, namely a PRECEDE-based questionnaire to evaluate predisposing, reinforcing, and enabling factors; the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9); the 9-item Personal Health Questionnaire (PHQ-9); and the Minnesota Living with Heart Failure Questionnaire (MLHFQ).
No significant differences were found in the mean scores for the predisposing, enabling, and reinforcing factors, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ before the intervention between the intervention and control groups. After the intervention, the scores for the predisposing, reinforcing, and enabling factors increased significantly, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ decreased significantly in the intervention group. In addition, these scores significantly differed from those of the control group. Furthermore, the MLHFQ score significantly correlated with the EHFScBS-9 and PHQ-9 scores.
This study demonstrates a trend that PRECEDE model of health education promotion is effective in relieving depression symptoms, enhancing self-monitoring, and improving the quality of life of elderly patients with CHF.
Trial registration number: ChiCTR-IOR-17012779 ; Trial registry: Chinese Clinical Trial Registry; Date registered: 22 Sep 2017; Retrospectively registered.
公共卫生领域最重要的挑战之一是提高慢性心力衰竭（CHF）患者的生活质量。在这些患者中，抑郁、自我护理能力和生活质量相互影响。采用一般教育项目和传统疗法难以进行有效治疗。PRECEDE模型是一种全面且基于独特理论的教育项目。其在冠状动脉搭桥术患者、2型糖尿病患者及老年人中降低抑郁水平和提高生活质量方面的有效性已得到证实。但尚未应用于老年CHF患者。因此，本研究旨在探讨该模型对这些患者自我护理行为、抑郁和生活质量的影响。
符合纳入标准的患者被随机分为干预组或对照组。所有患者均接受常规医疗护理。干预组患者还接受了基于PRECEDE模型的9次教育干预，干预后随访3个月。在干预前和干预后3个月使用4份问卷收集数据，即一份基于PRECEDE的问卷，用于评估诱发因素、强化因素和促成因素；9项欧洲心力衰竭自我护理行为量表（EHFScBS - 9）；9项个人健康问卷（PHQ - 9）；以及明尼苏达心力衰竭生活问卷（MLHFQ）。
干预组和对照组在干预前诱发因素、促成因素、强化因素的平均得分以及EHFScBS - 9、PHQ - 9和MLHFQ的平均总分方面均未发现显著差异。干预后，干预组的诱发因素得分、强化因素得分和促成因素得分显著提高，EHFScBS - 9、PHQ - 9和MLHFQ的平均总分显著降低。此外，这些得分与对照组的得分存在显著差异。而且，MLHFQ得分与EHFScBS - 9和PHQ - 9得分显著相关。
本研究表明，健康教育促进的PRECEDE模型在缓解老年CHF患者的抑郁症状、增强自我监测以及提高生活质量方面具有显著效果。
试验注册号：ChiCTR - IOR - 17012779；试验注册机构：中国临床试验注册中心；注册日期：2017年9月22日；回顾性注册。
