基于LEARNS模式的健康教育在成人精神分裂症患者中的应用

马莉; 骆名进; 张开元

doi:10.16766/j.cnki.issn.1674-4152.004175

基于LEARNS模式的健康教育在成人精神分裂症患者中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004175

浙江大学医学院附属精神卫生中心/杭州市第七人民医院精神三科，浙江杭州 310013

基金项目:

浙江省医药卫生科技计划项目 2020PY062

详细信息

通讯作者:
马莉，E-mail：mali6401@sina.com

中图分类号: R749.3
计量
- 文章访问数: 4
- HTML全文浏览量: 1
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-01-09
- 网络出版日期: 2025-11-17

Application of health education intervention based on LEARNS model in patients with schizophrenia

The Third Department of Psychiatry, Affilliated Mental Health Center & Hangzhou Seventh People' s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310013, China

摘要

摘要: 目的构建成人精神分裂症LEARNS模式健康教育方案，为临床对该类患者开展健康教育提供参考。方法选取2022年3月—2024年3月杭州市第七人民医院治疗的101例精神分裂症住院患者，采用随机数字表法分为对照组和观察组，分别为50例、51例，对照组给予常规健康教育干预，观察组给予基于LEARNS模式的健康教育干预。比较2组疾病相关知识掌握评分、服药依从性、社会功能、临床症状及出院准备度。结果观察组干预后“疾病基本知识”“用药指导”“康复训练”知识掌握评分高于对照组(P＜0.05)；服药依从性调查问卷(MAQ)总分(1.70±0.33 vs. 2.40±0.45)低于对照组(P＜0.05)；精神病患者社会功能评定量表(SSPI)总分(27.78±4.77 vs. 24.22±4.24)高于对照组(P＜0.05)；阳性与阴性症状量表(PANSS)中阳性症状评分、阴性症状评分、一般精神病理评分及总分均低于对照组(P＜0.05)；出院准备度调查问卷(RHDS)总分(100.43±10.15 vs. 92.03±11.54)高于对照组(F=20.091, P＜0.001)。结论给予成人精神分裂症住院患者基于LEARNS模式的健康教育干预能够提升患者疾病认知水平，增强服药依从性，改善社会功能，减轻临床症状，提高出院准备度。
- 精神分裂症 /
- 健康教育 /
- 依从性 /
- 社会功能 /
- 出院准备度
Abstract: Objective The construction of a healthy education program for schizophrenia LEARNS model was provided to provide a reference for the health education of similar patients in clinical practice. Methods A total of 101 patients with schizophrenia admitted to the Hangzhou Seventh People' s Hospital were selected and randomly divided into a control group and an observation group using a random number table, with 50 and 51 cases respectively. The control group received routine health education, while the observation group received health education intervention based on the LEARNS model. The study compared the scores for disease-related knowledge, medication adherence, social function, clinical symptoms, and readiness for discharge between the two groups. Results After the intervention, the scores of knowledge mastery of "basic disease knowledge", "medication guidance" and "rehabilitation training" in the observation group were higher than those in the control group (P < 0.05). The total score of the medication adherence questionnaire (MAQ, 1.70±0.33 vs. 2.40±0.45) was lower than that of the control group (P < 0.05); The total score of the scale of social function in psychosis inpatients (SSPI) for psychiatric patients (27.78±4.77 vs. 24.22±4.24) was higher than that of the control group (P < 0.05); The scores of positive symptoms, negative symptoms, general psychopathology and the total score in the positive and negative symptoms scale (PANSS) were all lower than those in the control group (P < 0.05). The total score of the readiness for hospital discharge questionnaire (RHDS, 100.43±10.15 vs. 92.03±11.54) was higher than that of the control group (F=20.091, P < 0.001). Conclusion Health education intervention based on the LEARNS model for adult schizophrenia inpatients can improve disease cognition levels, enhance medication compliance, improve social function, reduce clinical symptoms, and improve discharge readiness.
- Schizophrenia /
- Health education /
- Compliance /
- Social function /
- Readiness for discharge

HTML全文

表 1 2组精神分裂症患者一般资料比较

Table 1. Comparison of basic data between the two groups of patients with schizophrenia

项目	对照组(n=50)	观察组(n=51)	统计量	P值
性别[例(%)]			0.084^a	0.772
男性	27(54.00)	29(56.86)
女性	23(46.00)	22(43.14)
年龄(x±s，岁)	42.09±6.56	41.90±7.12	0.139^b	0.889
BMI(x±s)	22.01±3.15	21.94±4.51	0.090^b	0.928
文化程度[例(%)]			0.532^c	0.766
初中及以下	24(48.00)	28(54.90)
高中	15(30.00)	14(27.45)
大专及以上	11(22.00)	9(17.65)
婚姻状况[例(%)]			4.820^a	0.090
未婚	4(8.00)	3(5.88)
已婚	45(90.00)	41(80.39)
离异或分居	1(2.00)	7(13.73)
病程(x±s，年)	2.88±0.56	2.75±0.54	1.188^b	0.238
注：^a为χ²值，^b为t值，^c为Z值。

下载: 导出CSV

表 2 2组精神分裂症患者干预前后疾病相关知识掌握评分比较(x ±s，分)

Table 2. Comparison of disease-related knowledge scores before and after intervention in the two groups of schizophrenia patients(x ±s, points)

组别	例数	疾病基本知识		用药指导		康复训练
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	50	18.90±3.11	22.45±4.02^b	16.78±3.44	20.09±3.46^b	17.23±3.27	22.35±4.56^b
观察组	51	18.65±3.22	30.67±5.21^b	16.85±3.52	30.06±4.57^b	17.59±4.11	31.27±5.81^b
统计量		0.397^a	17.892^c	0.101^a	22.453^c	0.487^a	19.224^c
P值		0.692	＜0.001	0.920	＜0.001	0.648	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 3 2组精神分裂症患者干预前后MAQ评分比较(x ±s，分)

Table 3. Comparison of MAQ scores before and after intervention in the two groups of schizophrenia patients(x ±s, points)

组别	例数	是否忘记服药		是否不注意服药		自觉症状减轻时停止服药		自觉症状加重时停止服药		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	50	0.81±0.11	0.61±0.23^b	0.83±0.14	0.60±0.15^b	0.78±0.20	0.59±0.17^b	0.74±0.22	0.60±0.13^b	3.16±0.37	2.40±0.45^b
观察组	51	0.79±0.23	0.45±0.11^b	0.80±0.18	0.41±0.12^b	0.75±0.16	0.49±0.22^b	0.81±0.17	0.35±0.09^b	3.15±0.42	1.70±0.33^b
统计量		0.556^a	15.341^c	0.934^a	16.543^c	0.833^a	19.231^c	1.791^a	22.123^c	0.127^a	15.891^c
P值		0.580	＜0.001	0.353	＜0.001	0.407	＜0.001	0.076	＜0.001	0.899	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 4 2组精神分裂症患者干预前后SSPI评分比较(x ±s，分)

Table 4. Comparison of SSPI scores before and after intervention in the two groups of schizophrenia patients(x ±s, points)

组别	例数	活动性与交往		社会活动技能		日常生活能力		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	50	6.80±1.56	7.56±1.44^b	6.45±1.17	7.89±1.22^b	7.90±1.09	8.77±2.10^b	21.15±3.41	24.22±4.24^b
观察组	51	6.78±1.24	9.12±2.34^b	6.51±1.23	9.45±1.23^b	7.88±1.23	9.21±1.34^b	21.17±4.56	27.78±4.77^b
统计量		0.071^a	24.341^c	0.251^a	20.709^c	0.086^a	16.466^c	0.025^a	29.084^c
P值		0.943	＜0.001	0.802	＜0.001	0.931	＜0.001	0.980	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 5 2组精神分裂症患者干预前后PANSS评分比较(x ±s，分)

Table 5. Comparison of PANSS scores before and after intervention in the two groups of schizophrenia patients(x ±s, points)

组别	例数	阳性症状		阴性症状		一般精神病理		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	50	12.56±2.34	10.56±3.11^b	20.75±4.67	16.77±3.51^b	18.90±4.22	15.67±5.08^b	52.21±7.90	43.00±6.17^b
观察组	51	12.30±3.25	9.11±1.22^b	20.89±4.71	14.56±2.50^b	19.11±5.27	12.12±4.56^b	52.30±5.67	35.79±4.92^b
统计量		0.461^a	20.411^c	0.150^a	22.842^c	0.221^a	28.705^c	0.066^a	33.231^c
P值		0.646	＜0.001	0.881	＜0.001	0.826	＜0.001	0.948	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 6 2组精神分裂症患者干预前后RHDS评分比较(x ±s，分)

Table 6. Comparison of RHDS scores before and after intervention in the two groups of schizophrenia patients (x ±s, points)

组别	例数	个体状态		预期性支持		适应能力		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	50	19.34±3.56	22.67±5.62^b	22.78±5.23	28.45±5.44^b	36.71±5.21	40.91±5.68^b	78.83±5.66	92.03±11.54^b
观察组	51	19.50±4.11	24.89±4.51^b	22.81±5.45	32.09±5.12^b	36.85±6.44	43.45±6.01^b	79.16±9.21	100.43±10.15^b
统计量		0.209^a	22.778^c	0.028^a	30.454^c	0.120^a	25.562^c	0.216^a	34.137^c
P值		0.835	＜0.001	0.978	＜0.001	0.905	＜0.001	0.829	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

参考文献(17)

[1]	NAGAMINE T. Challenges of constipation in people suffering from schizophrenia: a narrative review[J]. Clin Pract, 2025, 15(2): 33. DOI: 10.3390/clinpract15020033.
[2]	SMITH S, KUMAR M, ABSHER J. Frontal damage and resolution of schizophrenia in a patient with self-inflicted gunshot wound: a case report[J]. BMC Neurol, 2025, 25(1): 78. DOI: 10.1186/s12883-024-03862-2.
[3]	孟欣, 李玉平, 李瑞, 等. 基于LEARNS模式构建维持性血液透析病人营养健康教育方案[J]. 护理研究, 2024, 38(19): 3435-3441. MENG X, LI Y P, LI R, et al. Construction of nutrition and health education program for maintenance hemodialysis patients based on LEARNS model[J]. Chinese Nursing Research, 2024, 38(19): 3435-3441.
[4]	赵佳妮, 吕婧, 张月英. LEARNS模式在冠状动脉CT血管成像检查患者健康教育中的应用[J]. 中国实用护理杂志, 2024, 40(16): 1207-1213. ZHAO J N, LYU J, ZHANG Y Y. Application of LEARNS model in health education for patients undergoing coronary computed tomography angiography examination[J]. Chinese Journal of Practical Nursing, 2024, 40(16): 1207-1213.
[5]	申东雯, 刘俊杰, 赵微, 等. LEARNS模式健康教育对2型糖尿病患者的干预效果分析[J]. 中国健康教育, 2022, 38(9): 845-848. SHEN D W, LIU J J, ZHAO W, et al. Analysis of the intervention effect of LEARNS model health education on patients with type 2 diabetes[J]. Chinese Journal of Health Education, 2022, 38(9): 845-848.
[6]	高苗苗, 金瑞华, 淮盼盼, 等. 基于LEARNS模式的健康教育对慢性肾脏病病人的影响[J]. 护理研究, 2023, 37(16): 2983-2987. GAO M M, JIN R H, HUAI P P, et al. nfluence of health education based on LEARNS model on patients with chronic kidney disease[J]. Chinese Nursing Research, 2023, 37(16): 2983-2987.
[7]	刘珊珊, 张冰, 李晶, 等. LEARNS模式在老年高血压患者健康教育中的应用[J]. 护理学杂志, 2022, 37(8): 76-79. LIU S S, ZHANG B, LI J, et al. Health education for elderly patients with hypertension based on LEARNS model[J]. Journal of Nursing Science, 2022, 37(8): 76-79.
[8]	王丽娜, 周郁秋, 赵莉, 等. 精神分裂症恢复期患者疾病知识-态度-行为知晓度问卷的编制[J]. 中国全科医学, 2014, 17(32): 3800-3804. WANG L N, ZHOU Y Q, ZHAO L, et al. Questionnaires on Knowledge-Attitude-Practice Awareness for Schizophrenia Reconvalescents[J]. Chinese General Practice, 2014, 17(32): 3800-3804.
[9]	寸金芝, 赵丽琴. Morisky问卷评价精神分裂症恢复期患者服药依从性的信度和效度[J]. 临床精神医学杂志, 2016, 26(3): 185-186. CUN J Z, ZHAO L Q. Reliability and validity of the Morisky questionnaire in measurement of the compliance with recovering schizophrenia[J]. Journal of Clinical Psychiatry, 2016, 26(3): 185-186.
[10]	WEISS M E, PIACENTINE L B. Psychometric properties of the readiness for hospital discharge scale[J]. J Nurs Meas, 2006, 14(3): 163-180. doi: 10.1891/jnm-v14i3a002
[11]	赵会玲, 冯先琼, 余蓉, 等. 喉切除术患者出院准备程度量表中文版的验证[J]. 护理研究杂志, 2016, 24(4): 321-328. ZHAO H L, FENG X Q, YU R, et al. Validation of the Chinese version of the Discharge Readiness Scale for Patients undergoing Laryngectomy[J]. Journal of Nursing Research, 2016, 24(4): 321-328.
[12]	李姗, 谢冬. 以患者为中心的LEARNS宣教模式对老年慢性阻塞性肺疾病患者健康认知、自理能力和依从性的影响[J]. 国际护理学杂志, 2024, 43(17): 3205-3208. LI S, XIE D. The influence of patient-centered LEARNS education model on health cognition, self-care ability and compliance in elderly patients with chronic obstructive pulmonary disease[J]. International Journal of Nursing, 2024, 43(17): 3205-3208.
[13]	张萍, 徒文静, 韩娟. 对成人初显期炎症性肠病患者基于LEARNS模式健康教育的效果观察[J]. 护理学报, 2022, 29(4): 74-78. ZHANG P, TU W J, HAN J. Effect of Health Education Based on LEARNS Model on Self-care Ability of Adult Patients with Incipient Inflammatory Bowel Disease[J]. Journal of Nursing, 2022, 29(4): 74-78.
[14]	SEN M, KARAMUSTAFALIOGLU N, CELIKKIRAN P, et al. Altered volumes of the amygdala and hippocampus in the brain of suicidal patients with first episode schizophrenia[J]. Psychiatr Q, 2025, 25(12): 981-984.
[15]	SUE-RICA S, JACOBUS S J, JANUS P P, et al. Seven loci associated with schizophrenia and bipolar Ⅰ disorder in selected southern african population groups[J]. Eur J Med Genet, 2025, 23(11): 105005. DOI: 10.1016/j.ejmg.2025.105005.
[16]	姚丽伟, 章金娟, 傅根莲, 等. 肺结核患者出院准备度与延续护理需求现状及相关性分析[J]. 中华全科医学, 2023, 21(3): 519-521, 529. doi: 10.16766/j.cnki.issn.1674-4152.002921 YAO L W, ZHNAG J J, FU G L, et al. Current situation and correlation analysis between readiness for hospital discharge and continuing nursing needs of patients with pulmonary tuberculosis[J]. Chinese Journal of General Practice, 2023, 21(3): 519-521, 529. doi: 10.16766/j.cnki.issn.1674-4152.002921
[17]	刘泰驿, 李小麟, 张秀英. 精神分裂症患者出院准备度与30天内非计划再入院的相关性研究[J]. 护士进修杂志, 2023, 38(8): 673-678. LIU T Y, LI X L, ZHANG X Y. Correlation between readiness for discharge and 30-day unplanned readmission in patients with schizophrenia[J]. Journal of Nurses Training, 2023, 38(8): 673-678.