Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, 72074 Tübingen, Germany.
Research Centre for Occupational and Social Medicine (FFAS), 79098 Freiburg, Germany.
Int J Environ Res Public Health. 2021 Apr 15;18(8):4179. doi: 10.3390/ijerph18084179.
: To overcome the problem of a high prevalence of undiscovered or untreated arterial hypertension in people of working age, the effects of behavioral change counseling in occupational health (OH) services should be investigated. The technique of motivational interviewing (MI) to support health-related lifestyle changes by physicians and/or occupational nurses ('health coach') has been shown to be successful in patients with chronic diseases. In 2010, we planned a randomized controlled trial (RCT) with employees who suffer from mild arterial hypertension. A preliminary feasibility study was performed in a large manufacturing company in Germany. : All employees with elevated blood pressure measured by the OH-service were invited to undergo validation by 30 self-measurements. Persons with validated elevated values and without medical treatment received either usual hypertension counseling (control group, CG) or intensified MI-counseling (intervention group, IG) by the occupational health physician. Subsequently, the IG received MI-support from the 'health coach' in four telephone counseling sessions. Assessed feasibility factors included organizational processes, the acceptance of the validation procedure and the MI-counseling, and as primary outcome for an RCT the extent to which participants made health-related changes to their lifestyles. : Initially, 299 individuals were included in Study Part A (screening). At the end of Study Part B (intervention), out of 34 participants with validated and non-treated mild hypertension, only 7 (IG) and 6 (CG) participants completed the intervention including documentation. The high drop-out rate was due to the frequent lack of willingness to perform the 30 self-measurements at home with their own equipment. Acceptance was little higher when we changed the method to two repeated measurements in the OH service. MI-counseling, especially by the health coach, was evaluated positively. : Despite the promising counseling approach, the feasibility study showed that an RCT with previous screening in the operational setting can only be implemented with high financial and personnel effort to reach an appropriate number of subjects. This substantial result could only be achieved through this comprehensive feasibility study, which investigated all aspects of the planned future RCT.
为了克服工作年龄段人群中未发现或未经治疗的动脉高血压高发的问题，应研究职业健康（OH）服务中行为改变咨询的效果。通过医生和/或职业护士（“健康教练”）进行动机访谈（MI）以支持与健康相关的生活方式改变的技术已被证明对患有慢性病的患者有效。2010 年，我们计划在患有轻度动脉高血压的员工中进行一项随机对照试验（RCT）。在德国的一家大型制造公司进行了初步可行性研究。
所有通过 OH 服务测量血压升高的员工均被邀请进行 30 次自我测量以验证。经验证血压升高且未经治疗的人员接受常规高血压咨询（对照组，CG）或由职业健康医生进行强化 MI 咨询（干预组，IG）。随后，IG 通过四次电话咨询获得“健康教练”的 MI 支持。评估的可行性因素包括组织流程、验证程序和 MI 咨询的接受程度，以及作为 RCT 的主要结果，参与者在多大程度上改变了与健康相关的生活方式。
最初，有 299 人参加了研究 A（筛查）。在研究 B（干预）结束时，在 34 名经验证且未经治疗的轻度高血压患者中，只有 7 名（IG）和 6 名（CG）参与者完成了包括文件记录在内的干预措施。高退出率归因于经常不愿意在家中使用自己的设备进行 30 次自我测量。当我们将方法更改为在 OH 服务中进行两次重复测量时，接受度略高。MI 咨询，特别是由健康教练提供的咨询，得到了积极评价。
尽管咨询方法很有前景，但可行性研究表明，只有通过大量的财务和人员投入，才能在操作环境中进行具有先前筛查的 RCT，以达到适当数量的受试者。只有通过这项全面的可行性研究，才能得出这一实质性结果，该研究调查了计划未来 RCT 的所有方面。
