A systematic evaluation of theories and research on self-health management interventions for community populations
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摘要: 基于当前慢性病患者人数的增加以及人们对健康管理需求的不断增长，自我健康管理的重要性日益凸显，社区居民实施有效的自我管理有助于提升慢性病管理效果、促进健康生活方式、减轻医疗系统负担、提高健康意识。随着健康教育和行为研究的发展，健康信念模型、自我效能理论、计划行为理论、社会认知理论、自我决定理论等健康行为改变理论模型以及PRECEDE-PROCEED模型、IKAP模型、CCM模型、跨理论模型、IMB模型、BCW模型等干预模型应运而生。这些理论和模型为健康教育和干预方案提供了理论基础，通过精确了解其在不同社区环境中的作用和效果，帮助医务人员和政策制定者设计更符合社区特征的健康促进项目。本文综述了当前在国内外社区人群中应用的主要自我健康管理理论、模型创立信息、理论基础、应用领域和局限性以及在实际应用中，不同研究方案下的干预策略和相关干预措施，探讨了这些理论和模型如何促进健康行为的改变和慢性病的有效管理。通过综合分析, 本文强调了在提升社区人群自我管理能力方面, 理论与模型的实践应用价值, 以及将现代信息技术融入健康管理实践的重要性和潜力。Abstract: Based on the current increase in the number of patients with chronic diseases and the growing demand for health management, the importance of self-health management is becoming more and more prominent, and the implementation of effective self-management by community residents can help to improve the effectiveness of chronic disease management, promote healthy lifestyles, reduce the burden on the healthcare system, and raise health awareness. With the development of health education and behavioral research, health behavior change theory models such as the health belief model, self-efficacy theory, planned behavior theory, social cognitive theory, and self-determination theory, as well as intervention models such as the PRECEDE-PROCEED model, the IKAP model, the CCM model, the trans-theoretical model, the IMB model, and the BCW model, have emerged. These theories and models provide a theoretical foundation for health education and intervention programs, and help health professionals and policy makers design health promotion programs that are more in line with the characteristics of the community by accurately understanding their role and effectiveness in different community settings. This paper reviews the major self-health management theories and models currently applied in community populations at home and abroad, their founding information, theoretical foundations, areas of application and limitations, as well as intervention strategies related to interventions under different research protocols in practical applications, and explores how these theories and models can contribute to changes in health behaviors and the effective management of chronic diseases. Through comprehensive analysis, this paper emphasizes the practical application of theories and models in enhancing the self-management capacity of community populations, and the importance and potential of integrating modern information technology into health management practices.
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Key words:
- Self-management /
- Community health management /
- Theory /
- Modeling
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表 1 社区人群自我健康管理的主要理论对比
Table 1. Comparison of self-health management theories in community populations
理论 创立信息 主要内容 应用领域 局限性 HBM 二十世纪五十年代由美国公共卫生服务的社会心理学家开发 个体对健康风险的感知易感性和严重性，对采取行动的感知益处与障碍以及自我效能 预防性健康行为、慢性病管理 关注个人层面的信念和态度，未充分考虑社会、经济和环境因素对健康行为的影响 SET 1977年由Albert Bandura出 个体在完成特定任务或达成目标时的信心水平及其如何影响行为和动机 慢性病管理、健康行为改变、心理健康促进 忽视外部因素及社会因素的影响，且对于动态行为和复杂行为的适用性不足 TPB 1985年由Icek Ajzen提出 个体对行为的态度、社会环境中的主观规范以及对行为控制的感知 理解和预测健康行为 忽视个人行为的非理性因素并且存在不同文化背景的适用性局限 SCT 二十世纪七十年代由Albert Bandura提出 考察个人因素、环境及其对行为的影响，强调自我效能和观察性学习 慢性病患者自我管理、健康行为改变 关注短期行为改变的机制，在解释和促进长期行为维持方面的应用存在局限性 SDT 1985年由Edward L. Deci和Richard M. Ryan提出 侧重于自主性、归属感和胜任感在动机中的作用，区分内在动机与外在动机 脑卒中康复、体力活动、饮食行为改变 在面对个体差异、内外动机的干预时，需要精细化地设计，实施难度较大 PMT 1975年由加拿大心理学家罗杰斯提出 解释个体对健康威胁的认知和反应，强调认知过程 健康饮食、疾病预防、慢性病管理 过于依赖于个体对威胁的感知，导致恐惧信息的传递，可能产生逆反心理或无力感 KAP 二十世纪中期公共卫生研究中提出 链接健康知识、态度和实践，强调知识增加是行为变化的关键 健康教育、慢性病知识提升、健康行为促进 过于简化行为改变过程，忽视习惯、情感、环境及阻碍行动实施的障碍等因素 
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表 2 人群自我健康管理的模型与框架比较
Table 2. Comparison of models and frameworks for population self-health management in populations
模型 创立信息 主要理论基础 主要内容 应用领域 局限性 PRECEDE-PROCEED Lawrence Green和Marshall Kreuter于二十世纪七十年代开发 SCT；HBM；TPB；系统理论 分为PRECEDE和PROCEED两部分，着重教育和环境诊断以及通过政策和法规影响行为 药师工作、儿童步行安全、社区健康教育、癌症筛查、慢性病管理 模型关注于干预计划的发展和评估，实施过程需要复杂的数据收集和分析，并随着动态变化不断修改 CCM WAGNER E H于二十世纪九十年代后期开发 社会生态模型；系统理论 包含6个相互关联的要素，强调以患者中心的护理方法和跨学科团队协作 慢性病管理 该模型有效实施依赖充足的资源，对于发展中国家的应用存在局限性 TTM PROCHASKA J O等于二十世纪八十年代初期提出 认知行为理论 聚焦于个体行为改变的决策能力，认为行为改变是一个分阶段的过程 戒烟、体重管理、体育锻炼、饮食习惯改变 认为行为改变是线性过程，应用时存在阶段界定的模糊情况，且在行为维持方面未做拓展 IMB FISHER J D于1992年提出 HBM；SCT；TPB 包含信息、动机和行为技能3个部分，强调整合信息、动机和行为技能 慢性病管理、健康行为改变 忽视了影响个体行为的非理性因素、环境和社会背景对健康行为的影响 BCW MICHIE S等于2011年提出 基于68种行为改变理论的综合分析，包括：SCT、TPB、HBM 基于COM-B系统以及九种干预模式和7种政策类别 社区健康促进、慢性病管理 模型组成部分的多样性和复杂性可能导致模型难以完全应用 ICCC 世界卫生组织(WHO)开发 CCM 整合微观、中观和宏观3个层面，强调患者自我管理能力的提升和卫生资源的统筹协调 慢性病管理 强调系统层面的改革，其有效实施依赖充足的资源，可能缺乏对特殊群体的灵活性 HAPA SCHWARZER R于1992年提出 SET；TPB 包含动机阶段和执行阶段，强调风险感知、结果预期、自我效能、行动计划和应对计划 慢性病管理 人群的行为可能存在多阶段变化，且研究者对于行为阶段的划分存在主观性
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