某社区慢性病自我管理健康教育对自我效能的影响

[目的 ]　评价社区慢性病自我管理健康教育项目对改变患者自我效能的效果。　 [方法 ]　按照社区随机对照试验研究设计 ,将 2 97名患有高血压病、心脏病、关节炎、中风、哮喘、糖尿病、慢性阻塞性肺病 (COPD )等疾病并自愿参加该项目的慢性病人 ,随机分为干预组和对照组。采用协方差的秩检验 ,比较有基线和 6个月后两次问卷调查数据的 12 8名干预组病人和 12 7名对照组病人于项目实施 6个月之后在自我效能方面的变化。　 [结果 ]　干预组病人的症状管理自我效能和疾病共性管理自我效能评分 6个月的增加值 ,分别比对照组高出 1.0 8分和 1.0 7分 (P值均 <0 .0 1)。　 [结论 ]　慢性病自我管理项目实施 6个月后改善了参加者对疾病管理的自我效能     

上海慢性病自我管理项目实施效果的评价

目的：评价上海慢性病自我管理项目实施6个月后的效果。方法：按照以社区为基础的随机对照试验研究设计，将954名患有高血压病、心脏病、关节炎、中风、哮喘、糖尿病、慢性阻塞性肺病（COPD）等疾病自愿参加该项目的慢性病人，随机分为干预组和对照组。采用协方差的秩和检验，比较了有基线和6个月后2次问卷调查数据的430名干预组病人和349名对照组病人在项目实施6个月后在自我管理行为、自我效能、健康状况和卫生服务利用等方面的变化。结果：与对照组比较，干预组在一种自我管理行为方面明显提高：6个月内认知性病状、管理方法实践评分，干预组平均多增加了0．33分；症状管理自我效能和疾病共性管理自我效能评分6个月的增加值，分别比对照组高出0．69分和0．63分；干预组在健康状况的9个方面（整体分离自评、健康担忧、疲劳、气短、疼痛、失能、疾病对病人生活影响、情绪低落及社会活动／角色受限），明显好于对照组（P均＜0．05）；干预组6个月内看急诊次料平均比对照组少0．01次（P＝0．02）；干预组6个月内住院次数平均比对照组减少了0．12次（P＝0．01）。结论：上海慢性病自我管理项目6个月后可改善参加者的自我管理行为、自我效能、部分健康状况、减少看急诊次数和住院次数。     

上海浦东慢性病自我管理项目实施效果评价研究

目的：评上海浦东区慢性病自我管理项目实施6个月之后的效果。方法：按照以社区为基础的随机的机对照试验研究设计，将297名 高血压病，心脏病，关节炎，中风， 哮喘，糖尿病，COPD等疾病自愿参加该项目的慢性病人，随机分为干预组和对照组。采用协方差的秩检验，比较了在基线及项目实施6个月之后两次问卷调查的140名干预组病人和129名对照组病人在自我管理行为，自我效有，健康状况和卫生服务利用等方面的变化。结果：与对照组合组比较，干预组在一种自我管理和为方面明显提高，6个月内认知性症状管理方法实践评分，干预组平均多增加了0．11分，症状管理自我效能和疾病共性管理自我效能评分6个月的增加值，分别经对照组高出1．08分和1．07分，干预组在健康状况的8个方面（整合健康自评，健康担忧，疲劳、气短、疼痛，疾病对病人生活影响，情绪低落及社会活动／角色受限），明显好于对照组（P值均＜0．05），干预组6个月内住院次数平均比对照组减少了0．14次（P＝0．01）；住院天数比对照组平均下降了0．87天（P＜0．01）。结论：上海浦东新区慢性病自我管理项目实施6个月之后改善参加者的自我管理行为，自我效能，部分健康状况，减少住院次数和住院天数。     

武进区慢性病自我管理项目实施效果评价

目的评价武进区慢性病自我管理项目实施1年后的效果。方法将919名患有高血压和(或)糖尿病的患者按随机对照试验研究设计,随机分成干预组和对照组,比较两组在干预前后的自我效能、自我管理行为和卫生服务利用等方面的变化。结果 1年后干预组和对照组相比,平均收缩压多下降6.69 mm Hg,舒张压多下降1.89 mm Hg,空腹血糖多下降0.29mmol/L,体质指数多下降0.27kg/m2,差异均有统计学意义(P0.05);自我效能评估,症状管理自我效能多增加0.29分,疾病共性管理自我效能多增加0.74分,差异均有统计学意义(P0.05);自我管理行为,有氧锻炼多增加22.28min/周,认知症状管理多增加0.22分,与医生沟通情况多增加0.23分,差异均有统计学意义(P0.05);卫生服务利用情况,干预组在近6个月内看门诊次数、急诊次数、住院次数和住院天数分别下降1.31次、0.03次、0.05次和0.48天,但差异未见统计学意义。结论开展慢性病自我管理项目能提高患者自我效能,改善自我管理行为,降低血压、血糖水平。     

社区实施慢性病自我管理项目的研究

[目的]在社区实施慢性病自我管理项目，并评估其对慢性病患者综合干预效果，进而在多个社区进行推广。[方法]在徐汇区长桥社区，开展慢性病自我管理项目社区动员6个月，对636名志愿参加慢性病自我管理项目的居民，随机分为干预组326人，对照组278人，采用统一问卷进行基线调查后，对干预组实施慢性病自我管理项目综合干预，对照组不做干预，6个月后再次进行问卷调查。[结果]干预组每周平均耐力锻炼时间增加，明显高于对照组（F=6．09，P：0．01），认知症状管理方法实践评分亦高于对照组，两者差异有统计学意义（F=121．95，P=0．00）；干预组在健康状况的6个方面（整体健康自评、健康担忧、气短、疼痛、失能、情绪低落）明显好于对照组，两组之间差异有统计学意义（P〈0．05）。[结论]在社区开展慢性病自我管理项目综合干预,取得了良好效果。     

社区高血压自我管理模式及血压控制效果分析

目的　评价社区高血压自我管理模式实施 6个月之后对高血压患者健康状况及血压控制的影响。方法　按照以社区为基础的随机对照试验研究设计 ,将 2 1 9名自愿参加该研究的高血压病人 ,随机分为干预组和对照组。干预组接受高血压自我管理模式 ,对照组接受常规的高血压三级管理模式。然后比较 1 1 1名干预组病人和 1 0 8名对照组病人在项目实施 6个月之后健康状况及血压控制方面的变化。结果　干预组 6个月内在健康状况 3个方面的变化值 (健康自评、疲劳、情绪低落 ) ,明显好于对照组 (P <0 0 5 )。 6个月内干预组病人平均比对照组多降低收缩压 1 0 77mmHg ,舒张压 2 2 0mmHg ;与对照组比较 ,干预组、对照组 6个月内的血压控制率分别为 5 9 5 0 %和 3 4 3 0 %。结论　社区高血压自我管理模式较传统的高血压三级管理在改善健康状况、降低血压、提高高血压控制率方面效果更好     

社区高血压患者自我管理对自我效能及其血压相关行为危险因素的影响

目的评价自我管理在改变高血压患者自我效能及其血压相关行为危险因素等方面的效果,为高血压的干预提供依据。方法采用实验流行病学中的社区试验方法,将社区中自愿参加自我管理小组的高血压患者以社区为单位随机分为干预组（1410例）和对照组（665例）。干预组采用自我管理,对照组采用高血压规范化管理。干预组和对照组均接受基线和6周之后的2次问卷调查,并对干预组和对照组活动前后的数据进行比较。结果经过6周活动,干预组每日吸烟率与饮酒率分别下降了16．9％和17．9％,而规律运动参与率与心理调节率则分别提高了18．3％和7．9％,差异均有统计学意义（P〈0．01）;对照组基本无变化。干预组干预后收缩压和血压控制率有明显改善,差异有统计学意义（P〈0．05）,干预组干预后比干预前症状管理自我效能和疾病共性管理自我效能评分的增加值分别比对照组高0．55分和3．24分;增加值与对照组比较,差异均有统计学意义（t值分别为172．209、166．075,P〈0．01）。结论社区高血压患者通过自我管理措施不仅可以提高其自我效能指标,而且有助于促进管理对象健康行为的形成。     

深圳市福田区社区高血压患者自我管理健康教育项目实施效果评价

目的探讨社区高血压患者自我管理健康教育项目实施效果。方法选择2012年1—12月福田区社区高血压患者80例进行自我管理健康教育的为研究组,选择同期社区高血压患者80例进行传统的高血压分级管理的为对照组,管理前、管理后采用《慢性病自我管理研究测量表》中的指标及评分标准评价患者自我管理行为、自我效能、健康功能改善情况,并观察患者血压水平变化及控制情况。结果管理6个月后,研究组自我管理行为中耐力锻炼时间、认知性症状管理评分变化值,自我效能中症状管理评分、疾病共性管理评分变化值,健康功能中健康自评评分、疲劳评分、抑郁评分变化值与对照组比较,差异均有统计学意义（P<0.05）。管理6个月后研究组患者收缩压、舒张下平均下降值、血压控制优良率明显高于对照组,差异有统计学意义（P<0.05）。结论社区高血压患者自我管理健康教育项目可以改善患者部分自我管理行为,提高自我效能,提高血压控制效果,可作为社区高血压管理的有效手段。     

全科医生管理对社区老年慢性病患者疾病知晓率、自我管理能力的影响

目的 探讨在社区老年慢性病管理中实施全科医生管理及其对患者疾病知晓率、自我管理能力的影响。方法 选取吉首市某医院2019年3月—2021年3月收治的90例社区老年慢性病患者为研究对象,采用随机数字表法分为对照组和观察组,各45例。对照组患者实施常规社区管理模式,观察组患者实施全科医生管理的社区慢性病管理模式,2组患者均持续干预6个月。比较2组患者干预前后生活质量[慢性病患者生命质量量表(QLICD-GM)评分]、自我管理能力[中国版慢性病自我管理研究测量表(CDSMS)评分],比较2组患者干预后疾病知晓率[(汉化版生命体征量表(NVS)评分]。结果 干预后,2组患者QLICD-GM、CDSMS评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P<0.05)。观察组患者干预后疾病知晓率为95.56%,高于对照组的75.56%,差异有统计学意义(P<0.05)。结论 全科医生管理的社区慢性病管理模式可有效提高社区老年慢性病患者生命质量、自我管理能力及疾病知晓率。     

深圳市社区高血压自我管理小组效果分析

目的评价深圳市社区高血压自我管理小组项目实施6个月后在改变患者行为、健康状况、生活质量和自我效能方面的效果。方法将社区自愿报名参加该项目的高血压患者随机分为干预组（n=120）和对照组（n=110）。干预组接受高血压自我管理小组课程管理,对照组不接受管理,项目实施6个月。干预前后进行问卷调查,对两组患者的高血压防治知识的知晓情况、高血压相关行为危险因素、血压控制和自我效能进行比较。结果干预后,干预组高血压防治相关知识知晓率、控制体重率（51．7％）、规律服药率（80．8％）、高血压控制率（90．0％）及自我管理效能得分均高于干预前和对照组干预后,差异均有统计学意义（P〈0．05）。结论社区高血压自我管理小组模式在改善高血压患者生活方式相关行为、自我管理行为、自我效能、降低血压、提高高血压控制率方面效果良好。     

Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai,China: randomized controlled trial

OBJECTIVE: To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program (CDSMP). METHODS: A randomized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment (waiting-list controls) in five urban communities in Shanghai, China. Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately; those in the control group received the same education and book six months later. FINDINGS: In total, 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension, heart disease, chronic lung disease, arthritis, stroke, or diabetes who lived in communities were assigned randomly to treatment (n = 526) and control (n = 428) groups. Overall, 430 (81.7%) and 349 (81.5%) patients in the treatment and control groups completed the six-month study. Patients who received treatment had significant improvements in weekly minutes of aerobic exercise, practice of cognitive symptom management, self-efficacy to manage own symptoms, and self-efficacy to manage own disease in general compared with controls. They also had significant improvements in eight indices of health status and, on average, fewer hospitalizations. CONCLUSION: When implemented in Shanghai, the CDSMP was acceptable culturally to Chinese patients. The programme improved participants' health behaviour, self-efficacy, and health status and reduced the number of hospitalizations six months after the course. The locally based delivery model was integrated into the routine of community government organizations and community health services. Chinese lay leaders taught the CDSMP courses as successfully as professionals.     

Volunteer, lay tutors' experiences of the Chronic Disease Self-Management Course: being valued and adding value

Chronic disease is a public health issue that could be addressed, in part, by increasing the ability of individuals to better manage their condition and its consequences on a day-to-day basis. One intervention designed to facilitate this is the Chronic Disease Self Management Course (CDSMC) that is delivered by volunteer, lay tutors who themselves have a chronic disease. Although there is growing evidence of course effectiveness for participants, the experiences of tutors have been neglected. This study aims to address this omission. Telephone interviews were conducted with 11 (six male) tutors: all interviews were transcribed and thematically analysed. Being a volunteer lay-tutor was perceived to be an enjoyable and valuable experience despite the challenges associated with course delivery, such as organizational demands and managing the diverse needs of mixed groups of chronic disease participants that led to a tension between disease-specific needs and the generic approach of the course. Being valued and adding value to the lives of others were key benefits of being a volunteer tutor, along with increased confidence that they were doing something positive for others. Course delivery prompted the initiation and maintenance of tutors' own self-management behaviours.     

The net fiscal impact of a chronic disease management program: Indiana Medicaid

In 2003 the Indiana Office of Medicaid Policy and Planning implemented the Indiana Chronic Disease Management Program (ICDMP). This paper reports on the fiscal impact of the ICDMP from the state's perspective, as estimated from the outcomes of a randomized trial. Medicaid members with congestive heart failure (CHF) or diabetes, or both, were randomly assigned by practice site to chronic disease management services or standard care. The effect of the ICDMP varied by disease group and risk class: while cost savings were achieved in the CHF subgroup, disease management targeted to patients with only diabetes resulted in no significant fiscal impact.     

社区高血压患者自我管理对自我效能的影响分析

目的 探讨自我管理方法对高血压患者自我效能的影响.方法 2011年11月至2012年2月,在北京市14个区县中各选择2个中等规模且依从性较好的社区,采用实验流行病学中的社区试验方法,将社区中自愿参加自我管理小组的高血压患者以社区为单位随机分为干预组和对照组,其中干预组159例,对照组164例.干预组采用自我管理,对照组按照中国高血压防治指南采用高血压规范化管理.干预组和对照组均接受基线和6周之后的2次问卷调查.对计量资料采用秩和检验,对计数资料采用x2检验.调查结束后对干预组和对照组症状指标管理前后变化值及自我效能管理前后变化值进行比较.结果 干预组和对照组的平均年龄分别为（61.9±9.1）岁和（61.8±9.0）岁,两组在平均年龄、年龄分组、性别和文化程度构成方面具有可比性,差异无统计学意义（F=0.164,x2=0.649、0.782、2.093;P ＞0.05）.通过对管理前后症状指标的差值进行比较发现,干预组无论是男性还是女性,疲劳程度、头疼程度、呼吸短促程度的分值有所下降,女性变化程度与对照组相比,差异有统计学意义（Z=-5.198、-3.873、-2.781,P＜0.05）.干预组管理后比管理前自我效能得分有所增加,女性的症状管理自我效能和疾病共性管理自我效能增加值明显高于对照组的增加值,差异有统计学意义（Z=-2.958,-2.582; P＜0.05）.干预组自我管理前后与医生交往能力得分的增加值较对照组的增加值高,但差异无统计学意义（P＞0.05）.结论 社区高血压患者通过自我管理小组的活动和干预可以提高管理对象对疾病管理的自我效能.     

Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older people in the Netherlands

Many chronically ill older patients in the Netherlands have a combination of more than one chronic disease. There is therefore a need for self-management programs that address general management problems, rather than the problems related to a specific disease. The Chronic Disease Self-Management Program (CDSMP) seems to be very suitable for this purpose. In evaluations of the program that have been carried out in the United States and China, positive effects were found on self-management behaviour and health status. However, the program has not yet been evaluated in the Netherlands. Therefore, the aim of this study was to evaluate the short-term and longer-term effects of the program among chronically ill older people in the Netherlands. One hundred and thirty-nine people aged 59 or older, with a lung disease, a heart disease, diabetes, or arthritis were randomly assigned to an intervention group (CDSMP) or a control group (care-as-usual). Demographic data and data on self-efficacy, self-management behaviour and health status were collected at three measurement moments (baseline, after 6 weeks, and after 6 months). The patients who participated rated the program with a mean of 8.5 points (range 0-10), and only one dropped out. However, our study did not yield any evidence for the effectiveness of the CDSMP on self-efficacy, self-management behaviour or health status of older patients in the Netherlands. Because the patients who participated were very enthusiastic, which was also indicated by very high mean attendance (5.6 out of 6 sessions) and only one dropout, it seems too early to conclude that the program is not beneficial for these patients.     

上海市虹口区中老年居民自我保健意识状况的调查

目的　了解上海市社区居民自我保健意识状况。　方法　采取随机抽样方法对凉城社区 113 0名中老年居民进行问卷调查。　结果　 83 .8%的居民具有自我保健意识 ,性别和文化程度对其有影响 ( P<0 .0 5和 P<0 .0 1)。绝大多数居民采用的措施是体育锻炼、合理营养和有节奏的生活规律 ,分别为 73 .3、67.1和 5 9.7 ,并且有自我保健意识的慢性病患病率低于无自我保健意识 ,为 61.9和 86.8 ( P<0 .0 5 )。吸烟率和饮酒率分别为 11.9和 3 .5 ,男性高于女性( P<0 .0 1)。居民预防保健知识的知晓率在 80 %以上 ,并受性别和文化程度的影响。　结论　加强媒体的健康教育宣传的力度与深度 ,从而提高居民自我保健意识     

父母教养方式与孩子的自信、自尊、自我效能及心理健康水平的相关研究

目的 了解影响青少年心理健康的因素。方法 采用心理健康自评量表（SCL-90）、自信量表（PEI）、自尊调查表（SES）、自我效能问卷（SEI）以及父母教养方式问卷（EMBU）对173名师专二年级大学生进行测查。结果 大学生 在心理健康的多个因子上存在着非常显或显的性别差异；父母在对大学生所采取的教养方式上存在显的男、女性别差异，同时父亲对头生子的过分干涉要较末生子为多；大学生在自信、自尊、自我效能方面存在着出生次序上的显差异。结论 大学生的心理健康水平与其父母教养方式之间存在着不同程度的显正相关关系；大学生的自信、自尊、自我效能与其心理健康水平之间存在着不同程度的相关关系。     

A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine

PURPOSE. This article reports on a process evaluation of three Planned Approach to Community Health (PATCH) projects and three Community Chronic Disease Prevention Programs (CCDPP) that operated in the State of Maine. PATCH and CCDPP are similar approaches to community health promotion developed and disseminated by the Centers for Disease Control. The evaluators studied how the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models worked as community health strategies across the six field sites. RESEARCH METHODS USED. Qualitative methods were used in a cross-case comparison of the six field sites. In studying each site, the evaluators focused on six stages common to both the Planned Approach to Community Health and the Community Chronic Disease Prevention program models: Stage 1: conducting a community needs assessment; Stage 2: analyzing needs assessment data; Stage 3: setting priorities for the project based on the data; Stage 4: implementing activities; Stage 5: producing process outcomes; and Stage 6: institutionalizing the project. The analysis focused on how each of the six communities traversed these stages. SUMMARY OF FINDINGS. Eight recommendations for refining Planned Approach to Community Health and Community Chronic Disease Prevention strategies resulted from the study: 1) do a community capacity assessment prior to initiating a community needs assessment; 2) do not overly rely on Behavioral Risk Factor Surveys; 3) analyze needs assessment data rapidly for community consumption; 4) allow flexibility and community input in determining priority health objectives; 5) provide technical assistance throughout a project, not just in the beginning; 6) fund at least one full-time local coordinator and extensive capacity building; 7) emphasize multiple interventions around one chronic condition at a time; and 8) emphasize program institutionalization. CONCLUSIONS. Community development approaches like Planned Approach to Community Health and Community Chronic Disease Prevention are promising health promotion strategies. To be optimally effective, however, these strategies need refinement based on systematic study in field settings. Because this study was limited to six sites in Maine, some of these findings may have limited generalizability.