轻度认知障碍老年人跨理论模型教育的健康变化：一项随机对照试验

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2024-11-19 DOI:10.1016/j.ijnurstu.2024.104961

Lulu Shi , Bei Wu , Xiaoshen Liu , Yinxia Ren , Chen Zhang , Xiaoyan Wang , Lina Wang

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引用次数: 0

摘要

背景对轻度认知障碍的认识不足和误解凸显了开展有效健康教育的迫切需要。不愿寻求干预和不遵守管理战略使得以行为为导向的健康教育至关重要。目的评价基于跨理论模型的健康教育项目对老年轻度认知障碍患者认知行为结局的影响及其临床意义。设计一项双臂评估盲随机对照试验。环境和参与者：中国湖州100名轻度认知障碍的社区老年人。方法将参与者随机分配到基于跨理论模型的健康教育计划（每周45-60分钟，持续8周，随后是12周的无监督实践）或接受标准健康教育的等候名单对照组。在基线、8周和20周时评估疾病知识、行为阶段和对健康管理行为的依从性。在组水平上通过广义估计方程评估效果，在个体水平上使用可靠和临床显著的变化来评估效果。结果以跨理论模型为基础的健康教育方案对候补对照有显著效果。广义估计方程分析显示，对行为阶段的影响具有统计学意义(β8周= 1.04,95%CI = 0.34-1.75；细致谨慎β= 1.72,95% ci -2.49 = 0.95),疾病知识(β8周= 1.14,95% ci = 0.26 - -2.02;β20周= 1.78,95%CI = 0.87-2.69)，坚持健康管理行为(β8周= 6.20,95%CI = 2.03-10.37；β20周= 10.74,95%CI = 6.47-15.01)。此外，整体认知功能(β8周= 0.60,95%CI = - 0.18-1.38；β20周= 2.42,95%CI = 1.64-3.20)，普渡钉板测试装配和双手工任务(β8周= 0.16/0.38,95%CI = - 0.21-0.53 / - 0.18-0.94；β20周= 0.96/1.80,95%CI = 0.57-1.35/1.17-2.43)随着时间的推移显著改善。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%的参与者在疾病知识方面有所改善（22%具有临床意义），90%的参与者在坚持健康管理行为方面有所改善（17%具有临床意义），61%的参与者在整体认知功能方面有所改善（10%具有临床意义）。到20周时，这些比例分别增加到63%（29%）、100%（25%）和78%（27%）。然而，在个体水平评估中发现抑郁症状和睡眠质量没有显著改善。结论本研究表明，基于跨理论模型的健康教育项目能有效提高轻度认知障碍老年人的认知行为健康结果，且效果持续12周。未来的研究应进一步探索该程序的认知和行为增强效应的潜在机制。登记numberChiCTR1900028351。

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Health changes from trans-theoretical model-based education in older adults with mild cognitive impairment: A randomized controlled trial

Background

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.

Objective

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.

Design

A two-arm and assessor-blinded randomized controlled trial.

Settings and participants

100 community-dwelling older adults with mild cognitive impairment in Huzhou, China.

Methods

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.

Results

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_8-week = 1.04, 95%CI = 0.34–1.75; β_20-week = 1.72, 95%CI = 0.95–2.49), disease knowledge (β_8-week = 1.14, 95%CI = 0.26–2.02; β_20-week = 1.78, 95%CI = 0.87–2.69), and adherence to health management behaviors (β_8-week = 6.20, 95%CI = 2.03–10.37; β_20-week = 10.74, 95%CI = 6.47–15.01) at both measured intervals. Additionally, global cognitive function (β_8-week = 0.60, 95%CI = − 0.18–1.38; β_20-week = 2.42, 95%CI = 1.64–3.20), Purdue Pegboard Test Assembly and Bimanual Tasks (β_8-week = 0.16/0.38, 95%CI = − 0.21–0.53/− 0.18–0.94; β_20-week = 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.

Conclusions

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.

Registration number

ChiCTR1900028351.

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).