动机访谈对社区中老年慢性病患者自我效能和健康行为改变的效果评价

目的了解动机访谈对社区中老年慢性病患者自我效能和健康行为改变的效果，为社区中老年慢性病患者健康行为管理提供依据。方法采用澳大利亚和中国专家共同设计的美好生活俱乐部调查问卷，以随机整群抽样方法，对部分社区287名中老年人进行问卷调查，了解人口学资料、慢性病患病情况和健康相关指标，以及中老年人自我健康评价、心理压力测量、生活满意度量表、行为改变阶段评估。共回收有效问卷265份，有效率为92．3％。结果经过动机访谈干预后的慢性病患者自报症状、生活满意度得分高于干预前（F=8．527，7．697；P〈0．05），心理压力量表、行为改变阶段得分低于干预前（F=229．483，91．613；P〈0．01），在身体状况自评、功能状态和社会功能评价这两个指标中的得分均差异无统计学意义（F=0．222，2．084；P〉0．05）。经过干预后，认为自己的健康程度在比较好及以上的从102人上升到114人、生活满意度中等及以上的人数从255人增加到265人；心理压力高度危险的从5人降低至1人；行为改变阶段中，处于行动期的人数从1人增加到20人、处于准备期的人数从138人上升到215人。结论动机访谈技术能明显加强社区中老年慢性病患者自我效能，促进健康行为改变。但由于行为改变阶段的渐进、分阶段、螺旋式的复杂发展过程，有必要对社区中老年慢性病患者提供持续的动机访谈支持，巩固其行为改变的成果。

Evaluation of motivational interviewing in self-efficacy and health behavior change in elderly patients with chronic diseases in community

Objective To explore the effects on self-efficacy and health behavior change in elderly pa- tients with chronic diseases in community by motivational interviewing and to provide the basis for the health be- havior management of elderly patients with chronic diseases in community. Methods The study was based on a cross-section investigation by random cluster sampling which included a sample of 287 elderly patients. The ques- tionnaire was localized good life club questionnaire of Australia, including demographic data, prevalence of chronic diseases, health-related indicators, self- health assessment, psychological pressure measurement, life satisfaction scale and assessment of behavior change stage .A total of 265 valid questionnaires were effective, and the effective rate was 92.3%. Results The scores of self-reported symptoms and life satisfaction of patients with chronic disea- ses after motivational interviewing were significantly higher than before （F= 8.527,7.697 ; P〈 0.05 ） , the scores of stress scale and behavior change stages were significantly lower than before （F= 229.483,91.613; P〈 0.01 ）. The score differences with health self-assessment, functional status and social function evaluation were not statistically significant （F= 0.222,2.084, P〉0.05）.The number of patients who believed their health are better rose from 102 to 114, the number of patients whose life satisfaction were moderate and above rose from 255 to 265, and the number of high risk of psychological stress reduced from 5 to 1.In the stages of behavior change, the number of people in the action stage rose from 1 to 20,and the number of people in the preparation stage rose from 138 to 215 after the intervention. Conclusion Motivational interviewing can strengthen the self-efficacy in elderly patients with chronic diseases in community significantly and promote healthy behavior change.It is necessary to provide ongoing support for motivational interviewing to consolidate its behavior change outcomes, because of the complexity of the develop- ment process of behavior change stages.