Factors influencing health behaviour, blood pressure control, and disability in hypertensive ischaemic stroke patients after a comprehensive reminder intervention

• Published in: Journal of advanced nursing Vol. 76; no. 6; pp. 1384 - 1393
• Main Authors: Zhang, Xiao‐Pei, Pan, Jun‐Hao, Wan, Li‐Hong, Liu, Zhu‐Yun, Mo, Miao‐Miao, Wang, Meng‐Yao, Li, Li‐Li
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2020
• Subjects: Adult; Aftercare - psychology; Aftercare - statistics & numerical data; Aged; Aged, 80 and over; Blood pressure; Brain Ischemia - rehabilitation; China; Clinical trials; Cohort analysis; Cohort Studies; Disability; Disabled Persons - psychology; Disabled Persons - statistics & numerical data; Female; Health Behavior; health behaviour; Health belief model; Health beliefs; Health education; Health Education - methods; Health Education - statistics & numerical data; Health information; Higher education; Humans; Hypertension; Hypertension - drug therapy; Hypertension - psychology; Intervention; Ischemic Stroke; Male; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Middle Aged; nurse; Nurses; Nursing; Prospective Studies; reminder system; Reminder Systems - statistics & numerical data; Stroke; Structural equation modeling; structural equation modelling; Surveys and Questionnaires; China; structural equation modelling; reminder system; nurse; health behaviour; nursing; hypertension; stroke
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.14340

Aims To test prospective pathways of a Comprehensive Reminder System based on the Health Belief Model (CRS‐HBM), stroke knowledge, health belief in health behaviour, blood pressure (BP) control, and disability in hypertensive ischaemic stroke patients at 6‐month postdischarge. Design A nested cohort study design. Methods Data were derived from a randomized controlled trial evaluating the effects of the intervention (N = 174, performed during February 2015 ‐ March 2016). Data were collected by questionnaires and analysed in structural equation modelling in Mplus software. Results The proposed model provided a good fit to the data. This model accounted for 51.5% of the variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6‐month postdischarge. The CRS‐HBM had: (a) direct positive effect (β = .391, p < .001) and indirect positive effects (β = .186, p = .002) on health behaviour; (b) direct positive effect (β = .356, p < .001) and indirect positive effects (β = .183, p = .009) on BP control; and (c) indirect negative effect (β = −.146, p = .008) on disability. Being female was linked to better health behaviour. Higher education predicted higher level of stroke knowledge and health belief. Conclusions The CRS‐HBM can not only directly but also indirectly improve patients' health behaviours by improving their health knowledge or health belief. Better health behaviour can improve patients' BP control and reduce disability. Therefore, nurses need to pay more attention to not only patients' health knowledge but also their health belief when providing education. Impact The CRS‐HBM intervention accounted for 51.5% of variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6‐month postdischarge. This research can help nurses improve health education strategies in postdischarge and community contexts to achieve better health results. 目的 检验高血压缺血性脑卒中患者出院后6个月的基于健康信念模式的综合提醒系统(CRS‐HBM)、脑卒中知识、健康行为方面健康信念、血压(BP)控制和残疾的前瞻性路径。 设计 采用巢式队列研究设计。 方法 数据来源于一项评估干预效果的随机对照试验(N=174,于2015年2月至2016年3月开展)。通过问卷调查收集数据,并在Mplus软件中进行结构方程建模分析。 结果 所建模型与数据拟合良好。出院后6个月,该模型占健康行为变化的51.5%,血压控制的34.1%,改良的Rankin量表评分的5.7%。基于健康信念模式的综合提醒系统:对健康行为有(a)直接积极影响(β= .391,p < .001)和间接积极影响(β= .186,p = .002);对血压控制有(b)直接积极影响(β= .356,p < .001)和间接积极影响(β= .183,p = .009);对残疾有(c)间接负面影响(β= −.146,p = .008)。女性性别与更好的健康行为有关。高等教育对脑卒中知识和健康信念的预测水平较高。 结论 基于健康信念模式的综合提醒系统可通过提高患者的健康知识或健康信念,直接或间接地改善患者的健康行为。良好的健康行为有助于改善患者的血压控制,降低残疾发生率。因此,护士在进行健康教育时,不仅要多多关注患者的健康知识,更要重视病人的健康信念。 影响 出院后6个月,基于健康信念模式的综合提醒系统干预占健康行为变化的51.5%,血压控制的34.1%,改良的Rankin量表得分的5.7%。本项研究可帮助护士在患者出院后及社区环境中改进健康教育策略,以取得更好的健康结果。