Zhongguo quanke yixue (Apr 2025)
Effectiveness of Individualized Health Education Interventions on Middle-aged and Elderly Patients with Chronic Diseases in the Community: a Cluster Randomized Controlled Trial
Abstract
Background The high incidence of chronic diseases is associated with the inadequate knowledge of health and disease risks. At the national level, traditional health education remains popular in community health services. The health education conducted by primary healthcare providers are often limited, and lacks specificity in the content. Additionally, community residents generally show a low enthusiasm for participating in health education. The quality and effectiveness of health education for chronic disease patients need an improvement. Objective To explore the effectiveness of individualized health education interventions generated through the application of an information-based knowledge base model on middle-aged and elderly patients with chronic diseases in the community. The findings are expected to provide insights to further enhance the management of community-based chronic diseases. Methods In 2021, a total of 7 390 patients at the age of 50-70 years with the chronic diseases of hypertension, diabetes, coronary heart disease, and stroke in Beijing Dongcheng District Community Health Service Center were selected as study subjects. A one-year cluster randomized controlled trial was conducted. Patients in both groups received routine follow-up management strategies for chronic diseases, with the preservation of the existing basic public health services for chronic diseases. Those in the intervention group were additionally given individualized health education programs generated through an information-based knowledge base model, including health education prescriptions and individualized health management. Follow-up visits and interventions were conducted every three months, for a total of 12 months. An end-point survey was conducted one year after recruitment. The primary outcome measures were the differences between the baseline and end-point results of the knowledge awareness of chronic diseases, self-management attitudes, self-efficacy, medication adherence, and acceptance of health information technology. Results A total of 7 390 patients with the four types of chronic diseases were included in the study, involving 3 673 patients in the intervention group and 3 717 in the control group. There were no significant differences in the age distribution, gender, education level, and employment status between groups (P>0.05). However, there was a significant difference in the type of medical insurance coverage between groups (P<0.05). After the intervention, patients in the intervention group demonstrated significantly higher correct awareness rates of overall disease knowledge, basic knowledge of chronic diseases, diabetes knowledge, coronary heart disease knowledge, and stroke knowledge compared to pre-intervention levels (P<0.05), while that of hypertension knowledge was not statistically significant (P>0.05). In the control group, there were no significant changes in the correct awareness rates of overall disease knowledge, basic knowledge of chronic diseases, hypertension knowledge, diabetes knowledge, or coronary heart disease knowledge before and after the intervention (P>0.05). However, the correct awareness rate of stroke knowledge in the control group was significantly lower after the intervention compared to pre-intervention levels (P<0.05). The scores of the self-management attitude questionnaire, self-efficacy questionnaire, medication adherence questionnaire, and health information acceptance questionnaire in the intervention group were significantly higher than those of the control group after the intervention (P<0.05). Additionally, in the intervention group, the scores on the self-management attitude questionnaire, self-efficacy questionnaire, medication adherence questionnaire, and health information acceptance questionnaire after the intervention were significantly higher compared to pre-intervention levels (P<0.05). In the control group, the scores of the self-efficacy questionnaire and medication adherence questionnaire improved significantly after the intervention compared to pre-intervention levels (P<0.05), while no significant changes in the scores of the self-management attitude questionnaire and health information acceptance questionnaire were detected (P>0.05) . Conclusion Knowledge awareness of chronic diseases, self-management attitude, and health information acceptance are more significantly improved in the intervention group than the control group. Both groups showed improvements in self-efficacy and medication adherence following the intervention, especially in the intervention group. Overall, an individualized health education based on an information-based knowledge base model is beneficial for enhancing the health literacy of patients with chronic diseases.
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