突破行为改变的瓶颈——澳大利亚的美好生活俱乐部及其对中国社区卫生服务的启示

包括糖尿病在内的大多数慢性疾病,需要患者通过改变自身行为来更好地管理疾病.国际研究经验表明,各种改变行为的活动都能明显地改善患者的健康,如改善饮食、降低体质量、增加锻炼、戒烟、降低压力、监测血糖、监测足部和溃疡、按医嘱服药等.不过,即便患者已经有了足够的健康知识,他们也很难改变自己的行为,这在老年人身上表现得尤其明显.澳大利亚政府支持的美好生活俱乐部项目,采用健康教练服务的方式,帮助患者有效地改变行为,更好地管理糖尿病.现在澳大利亚很多慢性疾病管理服务中都采用了这种教练方式.美好生活俱乐部的主要参与者是生活在墨尔本市东部的澳大利亚本地和华裔人群,白马市的全科医学分会以及各社区服务中心和全科医生是该项目的合作伙伴,Monash大学和澳大利亚心理学会提供技术支持.美好生活俱乐部的设计采用行为改变阶段理论,教练采用心理学的动机谈话技术帮助患者发现内心矛盾、制定行动策略、促进行为改变.对该项目的评价结果表明,糖尿病患者的生活质量得到了显著和稳定的改变,更积极地参与包括走路在内的身体锻炼,加强了对自身血糖的管理,并能有效地监测糖尿病症状.本文讨论美好生活俱乐部的设计逻辑以及对该项目的主要评价结果,为中国社区的慢性疾病管理提供有益的借鉴.

Breaking the Bottleneck of Behaviour Change:Experience of Australia's Good Life Club and Implication for Chinese Community Health Services

Many illnesses including diabetes require the patient to modify their behaviour to manage their illness better.Knowing from international research that various actions will frequently result in major improvements in the health and well-being of the patient,such as change in diet (reducing fatty food,increasing fibre),lose weight,increasing physical activity and exercise,stop smoking,reduce stress,monitor blood sugar,monitor feet for sores and ulcers,and take prescribed medication.However,for most patients especially adult and elders,changing behaviour is enormous difficulty,although they have been well educated in patient education program.The Good Life Club was one of several chronic illness self-management programs funded by the Australia Government under the national Sharing Health Care initiative.It used clinical coaches to help patients effectively change their behaviours and better manage their diabetes.Many health services in Australia now routinely use this approach in chronic illness management.The key participants in the Good Life Club were patients with diabetes living in the east of Melbourne and were from Australian and Chinese backgrounds.The Club was a partnership between the Whitehorse Division of General Practice and various community health centres and private doctors.Monash University and Australian Psychological Society provided expert technical support to the Club.The Good Life Club used stages of change in the program design.Health coaches helped patients in motivational interviewing,a psychological technique that has been used internationally in managing people with chronic illness.The Club was closely monitored in order to validate effects of coaching.The participants demonstrated significant sustained positive changes in quality of life,and demonstrated a sustained involvement in walking exercise over the program and improved their management of blood sugar levels,and monitoring of diabetes symptoms.This article discusses logic and design of the Good Life Club and explores opportunity and implication for China′s community.