Shi Lulu, Wu Bei, Liu Xiaoshen, Ren Yinxia, Zhang Chen, Wang Xiaoyan, Wang Lina
School of Medicine, Huzhou Key Laboratory of Precise Prevention and Control of Major Chronic Diseases, Huzhou University, Zhejiang 313000, China.
Rory Meyers College of Nursing, New York University, New York, NY 10010, USA.
Int J Nurs Stud. 2025 Feb;162:104961. doi: 10.1016/j.ijnurstu.2024.104961. Epub 2024 Nov 19.
Low awareness and misconceptions surrounding mild cognitive impairment highlight the urgent need for effective health education. Reluctance to seek intervention and poor adherence to management strategies make behavior-oriented health education essential.
To assess the effectiveness and clinical significance of a trans-theoretical model-based health education program on cognitive-behavioral outcomes in older adults with mild cognitive impairment.
A two-arm and assessor-blinded randomized controlled trial.
100 community-dwelling older adults with mild cognitive impairment in Huzhou, China.
Participants were randomly assigned to a trans-theoretical model-based health education program (weekly 45-60 min sessions for 8 weeks, followed by 12 weeks of unsupervised practice) or a wait-list control group receiving standard health education. Disease knowledge, behavioral stage, and adherence to health management behaviors were assessed at baseline, 8-week, and 20-week. Effects were evaluated at the group level via generalized estimating equation and at the individual level using reliable and clinically significant change.
The trans-theoretical model-based health education program demonstrated significant effects over the wait-listed control. Generalized estimating equation analyses showed statistically significant effects on behavioral stage (β = 1.04, 95%CI = 0.34-1.75; β = 1.72, 95%CI = 0.95-2.49), disease knowledge (β = 1.14, 95%CI = 0.26-2.02; β = 1.78, 95%CI = 0.87-2.69), and adherence to health management behaviors (β = 6.20, 95%CI = 2.03-10.37; β = 10.74, 95%CI = 6.47-15.01) at both measured intervals. Additionally, global cognitive function (β = 0.60, 95%CI = - 0.18-1.38; β = 2.42, 95%CI = 1.64-3.20), Purdue Pegboard Test Assembly and Bimanual Tasks (β = 0.16/0.38, 95%CI = - 0.21-0.53/-0.18-0.94; β = 0.96/1.80, 95%CI = 0.57-1.35/1.17-2.43) improved significantly over time. Reliable and clinically significant change analyses at 8 weeks indicated significant improvements in the intervention group: 57 % of participants improved in disease knowledge (22 % clinically significant), 90 % in adherence to health management behaviors (17 % clinically significant), and 61 % in global cognitive function (10 % clinically significant). By 20 weeks, these rates increased to 63 % (29 %), 100 % (25 %), and 78 % (27 %). However, non-significant improvements in depression symptoms and sleep quality were found at individual-level assessment.
This study shows that the trans-theoretical model-based health education program effectively enhances cognitive-behavioral health outcomes in older adults with mild cognitive impairment, with benefits persisting for 12 weeks. Future research should further explore the potential mechanisms underlying the cognition and behavior-enhancing effects of this program.
ChiCTR1900028351.
对轻度认知障碍的认知度低和存在误解凸显了开展有效健康教育的迫切需求。不愿寻求干预以及对管理策略的依从性差使得以行为为导向的健康教育至关重要。
评估基于跨理论模型的健康教育项目对轻度认知障碍老年人认知行为结局的有效性和临床意义。
双臂、评估者盲法随机对照试验。
中国湖州100名社区居住的轻度认知障碍老年人。
参与者被随机分配到基于跨理论模型的健康教育项目组（每周进行45 - 60分钟课程，共8周，随后进行12周无监督练习）或接受标准健康教育的等待名单对照组。在基线、8周和20周时评估疾病知识、行为阶段以及对健康管理行为的依从性。通过广义估计方程在组水平评估效果，在个体水平使用可靠且具有临床意义的变化进行评估。
基于跨理论模型的健康教育项目相对于等待名单对照组显示出显著效果。广义估计方程分析表明，在两个测量时间点，对行为阶段（β = 1.04，95%CI = 0.34 - 1.75；β = 1.72，95%CI = 0.95 - 2.49）、疾病知识（β = 1.14，95%CI = 0.26 - 2.02；β = 1.78，95%CI = 0.87 - 2.69）以及对健康管理行为的依从性（β = 6.20，95%CI = 2.03 - 10.37；β = 10.74，95%CI = 6.47 - 15.01）均有统计学显著影响。此外，整体认知功能（β = 0.60，95%CI = - 0.18 - 1.38；β = 2.42，95%CI = 1.64 - 3.20）、普渡钉板测试组装和双手任务（β = 0.16/0.38，95%CI = - 0.21 - 0.53/-0.18 - 0.94；β = 0.96/1.80，95%CI = 0.57 - 1.35/1.17 - 2.43）随时间显著改善。8周时可靠且具有临床意义的变化分析表明干预组有显著改善：57%的参与者疾病知识改善（22%具有临床意义），90%的参与者对健康管理行为的依从性改善（17%具有临床意义），61%的参与者整体认知功能改善（10%具有临床意义）。到20周时，这些比例分别增至63%（29%）、100%（25%）和78%（27%）。然而，在个体水平评估中，抑郁症状和睡眠质量改善不显著。
本研究表明基于跨理论模型的健康教育项目可有效改善轻度认知障碍老年人的认知行为健康结局，且益处持续12周。未来研究应进一步探索该项目认知和行为增强效果的潜在机制。
ChiCTR1900028351。
