Eren Fidanci Berna, Akbayrak Nalan, Arslan Filiz
1PhD, RN, Assistant Professor, Gülhane School of Nursing, University of Health Sciences, Ankara, Turkey; 2PhD, RN, Professor, School of Nursing, SANKO University, Gaziantep, Turkey; 3PhD, RN, Associate Professor, School of Nursing, Yeditepe University, Istanbul, Turkey.
J Nurs Res. 2017 Dec;25(6):436-446. doi: 10.1097/JNR.0000000000000238.
Studies of childhood obesity have shown that fostering healthy life behaviors is more important than losing weight. However, studies reporting this result did not use a theoretical nursing model, which offers a systematic approach and scientific basis for studying the concepts and principles of nursing practice.
The aim of this study was to determine the effects of an intervention that is based on Nola J. Pender's Health Promotion Model (HPM) on the healthy life behaviors and self-confidence of obese children.
This quasi-experimental study enrolled 86 obese children and their parents (48 in the experimental group and 38 in the control group) as participants. The data collection tool was composed of an adaptation of a Pender's model-based evaluation form and the "Piers-Harris Self Confidence Scale." The experimental group received HPM-based individual and group education, whereas the control group received routine follow-up only. Whereas qualitative data were analyzed using content analysis, quantitative data were analyzed using a paired t test and Mann-Whitney U or Wilcoxon test.
At the end of the education and follow-up program, experimental group participants showed a significant increase in healthy eating habits such as noting food portions (Z = 5.231, p < .001) and choosing water instead of sugary drinks (Z = 4.130, p < .001) and spent significantly less time per day in front of a television or computer (Z = 5.085, p < .001). Furthermore, after the intervention, experimental group participants had reduced their total body mass index standard deviation score (Z = 6.031, p < .001) and had an average self-confidence score that differed significantly from the control group (Z = 3.796, p < .001) and that was significantly higher than the average preintervention score (Z = 5.971, p < .01).
Health professionals must recognize the physical, psychological, and social risks of obesity in children and focus on these problems to identify appropriate solutions. It is recommended that education and nursing follow-up programs be developed based on nursing models. This study found that patient education based on Pender's HPM increased healthy life behaviors (e.g., healthy nutrition and increased exercise time) and decreased sedentary activity substantially in the experimental group. This study further suggests that, although Pender's HPM has not been tested on obese children, this model offers effective guidelines for nursing activities that are targeted on developing healthy life behaviors in children.
儿童肥胖研究表明，培养健康的生活行为比减肥更重要。然而，报告这一结果的研究并未使用理论护理模型，而理论护理模型可为研究护理实践的概念和原则提供系统方法和科学依据。
本研究旨在确定基于诺拉·J·彭德健康促进模型（HPM）的干预措施对肥胖儿童健康生活行为和自信心的影响。
这项准实验研究招募了86名肥胖儿童及其父母作为参与者（实验组48名，对照组38名）。数据收集工具由一份基于彭德模型的评估表改编版和“皮尔斯 - 哈里斯自信心量表”组成。实验组接受基于HPM的个体和小组教育，而对照组仅接受常规随访。定性数据采用内容分析法进行分析，定量数据采用配对t检验以及曼 - 惠特尼U检验或威尔科克森检验进行分析。
在教育和随访项目结束时，实验组参与者在健康饮食习惯方面有显著改善，如注意食物份量（Z = 5.231，p <.001）和选择喝水而非含糖饮料（Z = 4.130，p <.001），并且每天花在电视或电脑前的时间显著减少（Z = 5.085，p <.001）。此外，干预后，实验组参与者的总体体重指数标准差得分降低（Z = 6.031，p <.001），平均自信心得分与对照组有显著差异（Z = 3.796，p <.001），且显著高于干预前的平均得分（Z = 5.971，p <.01）。
健康专业人员必须认识到儿童肥胖的身体、心理和社会风险，并关注这些问题以确定合适的解决方案。建议基于护理模型制定教育和护理随访项目。本研究发现，基于彭德HPM的患者教育增加了实验组的健康生活行为（如健康营养和增加运动时间），并大幅减少了久坐活动。本研究进一步表明，尽管彭德HPM尚未在肥胖儿童中进行测试，但该模型为旨在培养儿童健康生活行为的护理活动提供了有效的指导方针。
