基于健康行为改变整合理论的老年慢性伤口 患者自我管理干预方案构建及初步效果评价

Construction and Preliminary Evaluation of a Self-Management Intervention Program for Older Adults with Chronic Wounds Based on the Integrated Theory of Health Behavior Change

摘要: 目的：构建基于健康行为改变整合理论(integrated theory of health behavior change, ITHBC)的老年慢性伤口患者自我管理干预方案，并对其初步应用效果进行评价。方法：以ITHBC为理论指导，通过文献回顾、专家函询及预实验构建老年慢性伤口患者自我管理干预方案。选取2025年7月至2026年1月河池市某三级甲等医院创伤手外科收治的113例老年慢性伤口患者为研究对象，实施基于ITHBC的自我管理干预，干预周期为12周。采用慢性伤口患者自我管理量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、简明健康状况调查量表(SF-36)及压疮愈合计分量表(PUSH)进行评价。结果：共纳入14名专家参与2轮函询，最终形成包含4个模块、13项主题和40项操作条目的老年慢性伤口患者自我管理干预方案。干预后，患者慢性伤口自我管理总分和SF-36总分均高于干预前，SAS、SDS评分均低于干预前，差异均有统计学意义(P < 0.001)。PUSH评分由干预前的(11.37 ± 1.93)分下降至干预12周的(3.01 ± 1.80)分，不同时间点比较差异有统计学意义(P < 0.001)。结论：基于ITHBC构建的老年慢性伤口患者自我管理干预方案具有较好的科学性和可行性，初步应用结果显示，该方案有助于提高患者自我管理能力，改善负性情绪，提高生活质量，并促进伤口愈合。

Abstract: Objective: To develop a self-management intervention program for older adults with chronic wounds based on the Integrated Theory of Health Behavior Change (ITHBC), and to conduct a preliminary evaluation of its effectiveness. Methods: Guided by the ITHBC, a self-management intervention program for older adults with chronic wounds was developed through a literature review, expert consultation, and a pilot study. A total of 113 older patients with chronic wounds who were admitted to the Department of Trauma and Hand Surgery of a tertiary Grade A hospital in Hechi City from July 2025 to January 2026 were enrolled. All participants received the ITHBC-based self-management intervention for 12 weeks. Outcomes were assessed using the Self-Management Scale for Patients with Chronic Wounds, the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), the 36-Item Short Form Health Survey (SF-36), and the Pressure Ulcer Scale for Healing (PUSH). Results: Fourteen experts participated in two rounds of consultation. The final intervention program consisted of 4 modules, 13 themes, and 40 operational items. After the intervention, patients showed significantly higher total self-management scores and SF-36 total scores than before the intervention, while SAS and SDS scores were significantly lower than baseline (P < 0.001). The PUSH score decreased from 11.37 ± 1.93 before the intervention to 3.01 ± 1.80 at 12 weeks after the intervention, with significant differences across time points (P < 0.001). Conclusion: The self-management intervention program for older adults with chronic wounds developed based on the ITHBC demonstrated good scientific rigor and feasibility. Preliminary findings suggest that this program may help improve patients’ self-management ability, alleviate negative emotions, enhance quality of life, and promote wound healing.