全膝关节置换术患者健康素养干预方案的构建与应用研究

doi:10.3761/j.issn.1672-9234.2025.09.015

摘要/Abstract

摘要： 目的构建全膝关节置换术患者健康素养干预方案，并验证其应用效果。方法通过文献回顾、半结构化访谈及德尔菲法，构建健康素养干预方案。采用便利抽样法，选取河北省某三级甲等医院关节科住院行全膝关节置换术且健康素养不足的患者为研究对象，按病区进行分组，试验组（n=33）接受健康素养干预方案，对照组（n=33）接受常规健康教育。比较两组出院后4周健康素养水平、功能锻炼依从性、膝关节功能及膝关节主动活动度。结果干预后试验组健康素养评分、功能锻炼依从性评分、膝关节功能评分及膝关节主动活动度均高于对照组（P<0.05）。结论健康素养干预方案具有较高的科学性和可行性，可以提升全膝关节置换术患者的健康素养水平、提高其功能锻炼依从性及康复效果。

关键词: 全膝关节置换术, 健康教育, 健康素养, 德尔菲技术, 康复护理

Abstract:

Objective To construct a health literacy education program for total knee arthroplasty patients and examin its application effect. Methods Through literature review，semi-structured interviews and Delphi method，a health literacy education program was developed. The convenience sampling method was used to select patients who underwent total knee arthroplasty in the joint department of a tertiary hospital in Hebei Province and had insufficient health literacy. The experimental group（n=33） received protocol-based health literacy education，while the control group（n=33） received routine health education. The health literacy level，functional exercise compliance，knee function and knee active range of motion were compared between the two groups at 4-week time after discharge. Results After intervention，the health literacy score，functional exercise compliance score，knee function score and knee active range of motion in the experimental group were all higher than those in the control group（P<0.05）. Conclusion The health literacy education program is scientific and feasible，which can improve the health literacy level of patients undergoing total knee arthroplasty，enhance the compliance with functional exercises and the rehabilitation effect.

Key words: Total knee arthroplasty, Health education, Health literacy, Delphi technology, Rehabilitation nursing

祖习前, 张静, 陈付英, 田苗, 王佳, 国春花. 全膝关节置换术患者健康素养干预方案的构建与应用研究[J]. 中华护理教育, 2025, 22(9): 1119-1126.

ZU Xiqian, ZHANG Jing, CHEN Fuying, TIAN Miao, WANG Jia, GUO Chunhua. Construction and preliminary application of a health literacy education program for patients undergoing total knee arthroplasty[J]. Chinese Journal of Nursing Education, 2025, 22(9): 1119-1126.

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参考文献 20

[1]	Konnyu KJ, Thoma LM, Cao WN, et al. Rehabilitation for total knee arthroplasty:a systematic review[J]. Am J Phys Med Rehabil, 2023, 102(1):19-33.
[2]	张雯越, 董建俐, 卫彦汝, 等. 基于Pender健康促进模式的干预方案在全膝关节置换病人康复中的应用[J]. 护理研究, 2025, 39(4):578-584.
	Zhang WY, Dong JL, Wei YR, et al. Application of intervention program based on Pender’s health promotion model in reha-bilitation of total knee arthroplasty patients[J]. Chin Nurs Res, 2025, 39(4):578-584.
[3]	Hasannejadasl H, Roumen C, Smit Y, et al. Health literacy and eHealth:challenges and strategies[J]. JCO Clin Cancer Inform, 2022,6:e2200005.
[4]	由建辉, 张东峰, 李倩倩, 等. 脑卒中病人健康素养与功能锻炼依从性的关系[J]. 青岛大学学报(医学版), 2020, 56(6):645-648.
	You JH, Zhang DF, Li QQ, et al. Association between health literacy and compliance with functional exercise in patients with stroke[J]. J Qingdao Univ Med Sci, 2020, 56(6):645-648.
[5]	张琳, 寇洁, 孟欣, 等. 中青年维持性血液透析患者健康素养与自体动静脉内瘘自我管理的相关性分析[J]. 中华护理教育, 2021, 18(11):1053-1056.
	Zhang L, Kou J, Meng X, et al. The association between health literacy and self-management of arteriovenous fistula for young and middleaged patients with maintenance hemodialysis[J]. Chin J Nurs Educ, 2021, 18(11):1053-1056.
[6]	De Oliveira GS Jr, McCarthy RJ, Wolf MS, et al. The impact of health literacy in the care of surgical patients:a qualitative systematic review[J]. BMC Surg, 2015,15:86.
[7]	Lans A, Schwab JH. Health literacy in orthopaedics[J]. J Am Acad Orthop Surg, 2023, 31(8):382-388. doi: 10.5435/JAAOS-D-22-01026 pmid: 36884220
[8]	张丽, 余春华, 许春燕, 等. 跨理论模型指导的321健康教育在维持性血液透析患者治疗中的效果评价[J]. 中国健康教育, 2024, 40(10):942-946,952.
	Zhang L, Yu CH, Xu CY, et al. Application of 321 health edu-cation method based on trans-theoretical model in the treat-ment of maintenance hemodialysis patients[J]. Chin J Health Educ, 2024, 40(10):942-946,952.
[9]	Don N. From health education to digital health literacy-build-ing on the past to shape the future[J]. Glob Health Promot, 2021, 28(4):51-55.
[10]	王婷婷, 易巧云, 万丽. 基于健康素养的健康教育研究现状[J]. 中华护理教育, 2018, 15(3):227-231.
	Wang TT, Yi QY, Wan L. A review of status of health educa-tion based on health literacy[J]. Chin J Nurs Educ, 2018, 15(3):227-231.
[11]	孙浩林, 彭慧, 傅华. 慢性病患者健康素养量表信效度的研究[J]. 复旦学报(医学版), 2012, 39(3):268-272.
	Sun HL, Peng H, Fu H. The reliabililty and consistency of health literacy scale for chronic patients[J]. Fudan Univ J Med Sci, 2012, 39(3):268-272.
[12]	王子豪, 李昕华, 郭赛男, 等. 基于社会认知理论的反馈式教育对全膝关节置换术后患者康复的影响[J]. 护理学杂志, 2024, 39(5):87-91.
	Wang ZH, Li XH, Guo SN, et al. Effect of teach-back based on Social Cognitive Theory on recovery of patients after total knee arthroplasty[J]. J Nurs Sci, 2024, 39(5):87-91.
[13]	Shoemaker SJ, Wolf MS, Brach C. Development of the patient education materials assessment tool(PEMAT):a new measure of understandability and actionability for print and audiovi-sual patient information[J]. Patient Educ Couns, 2014, 96(3):395-403. doi: 10.1016/j.pec.2014.05.027 pmid: 24973195
[14]	谭媛媛, 和晖, 杨秀贤, 等. 骨科患者功能锻炼依从性量表的编制及信度效度检验[J]. 中国护理管理, 2019, 19(11):1626-1631.
	Tan YY, He H, Yang XX, et al. Development and reliability and validity test of the compliance scale of functional exercise for orthopedic patients[J]. Chin Nurs Manag, 2019, 19(11):1626-1631.
[15]	Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system[J]. Clin Orthop Relat Res, 1989(248):13-14.
[16]	Jordan JE, Buchbinder R, Briggs AM, et al. The health literacy management scale(HeLMS):a measure of an individual’s capa-city to seek,understand and use health information within the healthcare setting[J]. Patient Educ Couns, 2013, 91(2):228-235.
[17]	Hogan A, Hughes L, Coyne E. Understanding nursing assess-ment of health literacy in a hospital context:a qualitative study[J]. J Clin Nurs, 2023, 32(19/20):7495-7508.
[18]	Galmarini E, Marciano L, Schulz PJ. The effectiveness of vi-sual-based interventions on health literacy in health care:a systematic review and meta-analysis[J]. BMC Health Serv Res, 2024, 24(1):718. doi: 10.1186/s12913-024-11138-1 pmid: 38862966
[19]	Özbaş N, Karadag M. The effect of education planned accord-ing to health literacy level on functionality，problems experie-nced，and quality of life in patients undergoing total knee replacement：a nonrandomized comparison group intervention study[J]. Orthop Nurs, 2023, 42(3):165-176.
[20]	邓音韵. 外科患者低健康素养干预方案构建及应用研究[D]. 蚌埠: 蚌埠医学院, 2021.
	Deng YY. Study on the construction and application of intervention scheme for low health literacy of surgical patients[D]. Bengbu: Bengbu Medical College, 2021.