作者：李顶峰1，邵振莉2，张文杰2，尹海宁3，刘君1

单位：

1.212001江苏省镇江市，江苏大学附属医院心内科　2.212001江苏省镇江市，江苏大学附属医院护理部3.212013江苏省镇江市，江苏大学医学院

单位（英文）：

1.Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China2.Nursing Department, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China3.School of Medicine, Jiangsu University, Zhenjiang 212013, China

关键词：

高血压；中年人；青年人；跨理论模型；健康管理

关键词（英文）：

Hypertension; Middle aged; Young adult; Transtheoretical model; Health management

中图分类号：

R 544.1

DOI：

10.12114/j.issn.1008-5971.2022.00.257

基金项目：

2021年江苏省研究生实践创新计划项目（SJCX21_1732）；江苏大学临床医学专项基金项目（JDLCHL202007）

摘要：

目的　构建基于跨理论模型（TTM）的中青年高血压患者健康管理方案。方法　本研究时间为2021年1—7月。通过文献回顾法，结合社区中青年高血压患者健康管理实际情况，根据TTM及小组讨论结果，形成基于TTM的中青年高血压患者健康管理方案初稿。采用德尔菲法构建基于TTM的中青年高血压患者健康管理方案，并评价专家积极程度、专家意见百分比、专家协调程度、专家权威度，统计基于TTM的中青年高血压患者健康管理方案的重要性评分。结果　两轮专家函询的有效回收率均为100.0%。两轮专家函询的专家意见百分比分别为53.3%（8/15）、20.0%（3/15）。第一轮专家函询的变异系数（CV ）为0.064~0.218，肯德尔协调系数为0.204（P ＜0.05）；第二轮专家函询的CV 为0.051~0.179，肯德尔协调系数为0.336（P ＜0.05）。两轮专家函询的权威系数（Cr）分别为0.850和0.835。第一轮专家函询后，修改了5个一级条目、2个二级条目，增加了5个二级条目；第二轮专家函询后删除了5个二级条目，修改了5个二级条目。专家函询结束后，意见趋向统一，最终确定了基于TTM的中青年高血压患者健康管理方案，共包含无意图阶段（5个二级条目）、意图阶段（5个二级条目）、准备阶段（5个二级条目）、行动阶段（5个二级条目）、维持阶段（5个二级条目）5个一级条目、25个二级条目，各条目的重要性评分均＞3.5分、CV 均＜0.25。结论　本研究构建的基于TTM的中青年高血压患者健康管理方案的科学性较好，其可评估中青年高血压患者健康行为改变的阶段，进而实施精准干预，也可采用动态评估策略，促进连续管理，为后续社区开展有效规范的健康管理提供了参考。

英文摘要：

Objective　To construct a health management program for young and middle-aged hypertensive patientsbased on transtheoretical model (TTM) . Methods　This study was conducted from January 2021 to July 2021. Throughliterature review, combined with the actual situation of health management of young and middle-aged hypertensive patients in thecommunity, according to TTM and group discussion results, the first draft of health management program for young and middleagedhypertensive patients based on TTM was formed. Delphi method was used to construct a health management program foryoung and middle-aged hypertensive patients based on TTM. The active degree of experts, percentages of expert opinions,coordination degree of experts and authority of experts were evaluated, and the importance score of health management programfor young and middle-aged hypertensive patients based on TTM was calculated. Results　The effective recovery rate of thetwo rounds of expert consultation was 100.0%. The percentages of expert opinions of the two rounds of expert consultation were53.3% (8/15) and 20.0% (3/15) , respectively. The coefficient of variation (CV ) of the first round of expert consultation was 0.064-0.218, and Kendall's coordination coefficient was 0.204 (P < 0.05) . The CV of the second round of expert consultation was 0.051-0.179, and Kendall's coordination coefficient was 0.336 (P < 0.05) . The authoritative coefficients Cr of the two rounds of expertconsultation were 0.850 and 0.835, respectively. After the first round of expert consultation, 5 first-level items, 2 second-levelitems were revised, and 5 second-level items were added; after the second round of expert consultation, 5 second-level entrieswere deleted and 5 second-level entries were revised. After the expert consultation, opinions became unified and the healthmanagement program for young and middle-aged hypertensive patients based on TTM was finally determined. There were 5 firstlevel items and 25 second level items in no intention phase (5 second-level items) , intention phase (5 second-level items) ,preparation phase (5 second-level items) , action phase (5 second-level items) , maintenance phase (5 second-level items) . Theimportance score of each item was > 3.5 points, and the CV was < 0.25. Conclusion　The health management scheme for youngand middle-aged hypertensive patients based on TTM constructed in this study is scientific. It can assess the stage of healthbehavior change of young and middle-aged hypertensive patients, and then implement precise intervention. It can also adoptdynamic evaluation strategies to promote continuous management, and provide a reference for the follow-up community to carryout effective and standardized health management.

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