基于不同信息框架的健康教育对老年慢性心力衰竭患者自我管理的影响研究

doi:10.3761/j.issn.0254-1769.2025.21.007

摘要/Abstract

摘要：

目的探讨基于不同信息框架的健康教育对老年慢性心力衰竭患者自我管理的影响。方法于2023年11月至2024年10月，便利选取江苏省徐州市某三级甲等综合医院心内科收治的住院老年慢性心力衰竭患者健康教育为研究对象，随机分为收益框架组、损失框架组和对照组，每组各47例。收益框架组实施基于收益框架信息的健康教育，损失框架组实施基于损失框架信息的健康教育，对照组进行常规健康教育。比较三组干预前和出院3个月后体重管理情况、自我管理能力、生活质量、N末端B型利钠肽原和再住院率的差异。结果最终收益框架组47例、损失框架组45例、对照组45例完成研究。出院3个月后，收益框架组和损失框架组的体重管理量表各维度得分、心力衰竭自我护理指数量表总分及各维度得分均高于对照组（P<0.05），且损失框架组上述得分高于收益框架组（P<0.05）；损失框架组明尼苏达心力衰竭生活质量量表总分及各维度得分、N末端B型利钠肽原均低于收益框架组（P<0.05）；损失框架组再住院率低于收益框架组和对照组（P<0.05）。结论基于不同信息框架对老年慢性心力衰竭患者开展自我管理健康教育能有效提高其自我管理能力，改善生活质量；相比较而言，损失框架的信息更具说服力。

关键词: 信息框架, 老年, 慢性心力衰竭, 自我管理, 护理

Abstract:

Objective To explore the impact of health education based on different massage framing in the self-management of elderly patients with chronic heart failure. Methods The research is set to take place from November 2023 to October 2024，involving hospitalized elderly heart failure patients at a cardiac treatment center of a tertiary comprehensive hospital in Xuzhou，Jiangsu Province. Participants were conveniently selected and randomly assigned to 3 groups：the gain-framed group，the loss-framed group，and the control group，and each group had 47 cases. The gain-framed group received health education based on the gain framed messages，while the loss-framed group received health education based on the loss framed messages. The control group underwent routine health education. The research aimed to evaluate and compare the weight management status，self-care abilities，quality of life，levels of N-terminal pro-B-type natriuretic peptide，and readmission rates among the 3 groups，both prior to the intervention and 3 months post-discharge. Results A total of 47 patients in the gain-framed group，45 patients in the loss-framed group，and 45 patients in the control group successfully completed the research. 3 months after discharge，the gain-framed group and the loss-framed group exhibited significantly higher scores in weight monitoring，knowledge，beliefs，and behaviors related to weight management，as well as total self-care scores，self-care management，self-care confidence，and self-care maintenance，compared to the control group（P<0.05）. Furthermore，the scores in the loss-framed group surpassed those in the gain-framed group（P<0.05）. In terms of quality of life，the total score and scores across physical，emotional，and other domains，along with levels of N-terminal pro-B-type natriuretic peptide，were significantly lower in the loss-framed group than in the gain-framed group（P<0.05）. Additionally，the readmission rate for the loss-framed group was lower than that of both the gain-framed group and the control group（P<0.05）. Conclusion Health education for self-management based on different massage framing can effectively enhance the self-management abilities of elderly patients with chronic heart failure，thereby improving their quality of life. Notably，the loss-framed message had stronger persuasive.

Key words: Message Framing, Aged, Chronic Heart Failure, Self-Management, Nursing Care

李思哲, 沈莹, 刘文娟, 朱艳梅, 姜明慧, 娄明, 韩冰, 庄海峰, 史美英. 基于不同信息框架的健康教育对老年慢性心力衰竭患者自我管理的影响研究[J]. 中华护理杂志, 2025, 60(21): 2605-2612.

LI Sizhe, SHEN Ying, LIU Wenjuan, ZHU Yanmei, JIANG Minghui, LOU Ming, HAN Bing, ZHUANG Haifeng, SHI Meiying. A study on the impact of health education based on different message framing in self-management of elderly patients with chronic heart failure[J]. Chinese Journal of Nursing, 2025, 60(21): 2605-2612.

图/表 6

图1 基于不同信息框架的老年慢性心力衰竭患者自我管理健康教育方案

Figure 1 A health education program for self-management among elderly patients with chronic heart failure based on different message framing

表1 三组一般资料的比较

Table 1 Comparison of general information among the 3 groups

表2 三组干预前后体重管理量表得分的比较（分，$\bar{x} \pm s$）

Table2 Comparison of scores for Weight Management Scale before and after intervention among the 3 groups（分，$\bar{x} \pm s$）

表3 三组干预前后心力衰竭自我护理指数量表得分的比较（分， $\bar{x} \pm s$）

Table 3 Comparison of Self-Care of Heart Failure Index scores before and after intervention among the 3 groups（分， $\bar{x} \pm s$）

表4 三组干预前后明尼苏达心力衰竭生活质量量表得分的比较（分，$\bar{x} \pm s$）

Table 4 Comparison of Minnesota Living with Heart Failure Questionnaire scores before and after intervention among the 3 groups（分，$\bar{x} \pm s$）

表5 三组干预前后N末端B型利钠肽原水平的比较

Table 5 Comparison of NT-proBNP levels before and after intervention among the 3 groups

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