健康信念模式干预对单纯性肥胖儿童青少年BMI及健康行为的影响

史东文; 陈凤兰; 吕霞; 王芳; 何岱昆

doi:10.16766/j.cnki.issn.1674-4152.004217

健康信念模式干预对单纯性肥胖儿童青少年BMI及健康行为的影响

doi: 10.16766/j.cnki.issn.1674-4152.004217

史东文¹,
陈凤兰²,
吕霞³,
王芳⁴,
何岱昆^5, ,

1.
上海市金山区漕泾镇社区卫生服务中心预防保健科, 上海 201507
2.
广西医科大学附属武鸣医院病案管理科，广西南宁 530199
3.
上海市金山区疾病预防控制中心儿少科，上海 201599
4.
上海市金山区漕泾镇社区卫生服务中心院办，上海 201507
5.
复旦大学附属金山医院全科医学科，上海 201508

基金项目:

上海市金山区卫生和计划生育委员会科研课题 JSKJ-KTGW-2021-06

详细信息

通讯作者:
何岱昆，E-mail: daikun_he@126.com

中图分类号: R723.14 R179
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出版历程
- 收稿日期: 2025-04-16

Effect of health belief model intervention on BMI and health behavior in children and adolescents with simple obesity

1.
Preventive Health Care Department, Shanghai Jinshan District Caojing Town Community Health Service Center, Shanghai 201507, China

摘要

摘要: 目的探讨基于健康信念模式(HBM)的健康教育对单纯性肥胖儿童青少年肥胖相关知识认知、健康行为及BMI的影响，为该群体身心健康发展提供参考。方法采用方便抽样法从上海市金山区2022年学生体检数据库中筛选240名单纯性肥胖儿童青少年，采用分层随机分为干预组和对照组。对照组采用常规健康教育，干预组在常规健康教育基础上实施HBM干预，为期1年。比较2组干预前后肥胖知识知晓率、BMI及健康行为变化，采用logistic回归分析行为因素对BMI的影响。结果最终240人完成随访，其中干预组共90人，对照组共150人。干预1年后，干预组知识知晓率(62.22%)高于对照组(43.33%，χ²=8.028，P＜0.05)；干预组学生身高、BMI指标较对照组差异均有统计学意义(P＜0.05)；干预组中，体力活动、睡眠时长、视屏时间、汽水饮料摄入、甜点摄入、油炸食品摄入、水果摄入、蔬菜摄入、西式快餐摄入及路边摊摄入等健康行为指标对BMI的影响差异均有统计学意义(P＜0.05)。增加体力活动(OR=0.041，95% CI: 0.005~0.346)、增加水果摄入(OR=0.158，95% CI: 0.026~0.964)、增加蔬菜摄入(OR=0.052，95% CI: 0.011~0.256)、减少西式快餐摄入(OR=0.175，95% CI: 0.036~0.851)是BMI改善的独立保护因素。结论基于HBM的健康教育可显著提高单纯性肥胖儿童青少年的健康认知，促进行为改变，助力科学减重及儿童青少年身心健康发展。
- 单纯性肥胖 /
- 儿童青少年 /
- 健康信念模式 /
- 健康教育 /
- 健康行为
Abstract: Objective To explore the influence of health education based on the health belief model (HBM) on obesity-related knowledge cognition, health behavior, and physical fitness index in simple obese children and adolescents, so as to provide a reference for the physical and mental health development of this group. Methods Using the convenience sampling method, 240 children and adolescents with pure obesity were selected from the 2022 student health examination database in Shanghai' s Jinshan District. They were stratified and randomly assigned to an intervention group and a control group. The control group received standard health education, while the intervention group underwent HBM interventions supplemented with routine health education for one year. Both groups' obesity knowledge awareness rates, BMI, and health behaviors were compared before and after the interventions. Logistic regression analysis was conducted to examine how behavioral factors influenced BMI changes. Results Ultimately, 240 people completed the follow-up, including 90 in the intervention group and 150 in the control group. After one year of intervention, the obesity-related knowledge awareness rate in the intervention group (62.22%) was significantly higher than that in the control group (43.33%, χ²=8.028, P < 0.05). The height and BMI indexes of the intervention group were significantly different from those of the control group (P < 0.05). In the intervention group, the improvement of health behavior indicators such as physical activity, sleep duration, video time, soda intake, dessert intake, fried food intake, fruit intake, vegetable intake, western fast food intake, and roadside stall intake had statistically significant differences in the impact on BMI (P < 0.05). The independent protective factors for BMI improvement were: increased physical activity (OR=0.041, 95% CI: 0.005-0.346), increased fruit intake (OR=0.158, 95% CI: 0.026-0.964), increased vegetable intake (OR=0.052, 95% CI: 0.011-0.256), and reduced consumption of Western fast food (OR=0.175, 95% CI: 0.036-0.851). Conclusion Health education based on HBM can significantly improve the health cognition of children and adolescents with simple obesity, promote behavioral change, and help with scientific weight loss and physical and mental health development.
- Simple obesity /
- Children and adolescents /
- Health belief patterns /
- Health education /
- Health behavior
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表 1 2组学生基本情况比较

Table 1. Comparison of baseline characteristics between the two student groups

组别	例数	性别[例(%)]		居住地[例(%)]		年龄(x±s，岁)
组别	例数	男	女	农村	城镇	年龄(x±s，岁)
干预组	90	51(56.67)	39(43.33)	33(36.67)	57(63.33)	11.94±3.52
对照组	150	86(57.33)	64(42.67)	50(33.33)	100(66.67)	11.99±3.14
统计量		0.010^a		0.276^a		0.111^b
P值		0.920		0.599		0.911
注：^a为χ²值，^b为t值。

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表 2 2组学生在干预前后的身高、体重及BMI的变化情况(x±s)

Table 2. Comparison of changes in height, weight, and BMI between the two student groups before and after the intervention(x±s)

组别	例数	体重(kg)		身高(cm)		BMI
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	150	55.36±16.90	56.69±16.38	145.80±14.24	148.95±13.44	25.47±4.11	25.03±3.07
干预组	90	54.84±16.25	55.29±16.40	145.45±14.07	149.96±14.14^b	25.42±4.10	24.00±3.58^b
统计量		0.233^a	0.417^c	0.187^a	3.414^c	0.096^a	5.541^c
P值		0.816	0.519	0.852	0.035	0.923	0.019
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

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表 3 2组学生干预前后体力活动变化比较[M(P₂₅, P₇₅), h]

Table 3. Comparison of physical activity changes between two groups of students before and after the intervention[M(P₂₅, P₇₅), h]

组别	例数	中等强度运动时长		静坐时长		睡眠时长
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	150	0.67(0.00，1.00)	0.50(0.00，1.18)	7.00(7.00，8.00)	7.00(7.00，8.00)	8.00(8.00，9.00)	8.00(8.00，9.00)
干预组	90	0.00(0.00，1.00)	0.50(0.00，1.50)^a	7.00(7.00，8.00)	7.00(7.00，8.00)^a	8.00(7.00，9.00)	8.00(8.00，9.00)^a
Z值		-0.031	-2.369	-1.820	-1.409	-0.138	-2.413
P值		0.976	0.018	0.069	0.159	0.890	0.016

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表 4 2组学生干预前后过去7 d中膳食行为变化情况比较[M(P₂₅, P₇₅), d]

Table 4. Comparison of self-reported 7-day dietary behaviors between the two student groups at baseline and post-intervention[M(P₂₅, P₇₅), d]

组别	例数	汽水饮料(如可乐、雪碧等)摄入		油炸食物(如油条、炸鸡翅等)摄入
组别	例数	干预前	干预后	干预前	干预后
对照组	150	1.00(0.00，1.00)	1.00(0.00，1.00)	1.00(0.00，2.00)	1.00(0.00，2.00)
干预组	90	0.50(0.00，1.00)	0.00(0.00，1.00)^a	1.00(0.00，2.00)	0.50(0.00，2.00)^a
Z值		-0.525	-0.388	-1.753	-1.723
P值		0.600	0.698	0.080	0.085

组别	例数	水果摄入		西式快餐(如麦当劳、肯德基等)摄入
组别	例数	干预前	干预后	干预前	干预后
对照组	150	5.00(3.00，7.00)	5.00(3.00，7.00)	0.00(0.00，1.00)	0.00(0.00，0.00)
干预组	90	4.00(2.00，7.00)	5.00(3.00，7.00)^a	0.00(0.00，1.00)	0.00(0.00，0.00)
Z值		-1.209	-2.221	-0.126	-2.849
P值		0.227	0.026	0.900	0.004
注：与同组干预前比较，^aP＜0.05。

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表 5 干预组学生在干预后的健康行为改善情况对体质指数的影响[例(%)]

Table 5. Effect of improved health behaviors on body mass index in the intervention group after the intervention[cases (%)]

项目	正常或超重(n=23)	肥胖(n=67)	χ²值	P值
增加体力活动			10.664	0.001
是	10(43.48)	8(11.94)
否	13(56.52)	59(88.06)
改善睡眠时长			21.029	＜0.001
是	13(56.52)	7(10.45)
否	10(43.48)	60(89.55)
控制屏幕使用时长			33.044	＜0.001
是	15(65.22)	5(7.46)
否	8(34.78)	62(92.54)
控制喝汽水饮料			26.699	＜0.001
是	14(60.87)	6(8.96)
否	9(39.13)	61(91.04)
控制吃甜点			23.030	＜0.001
是	16(69.57)	11(16.42)
否	7(30.43)	56(83.58)
控制吃油炸食物			4.211	0.040
是	16(69.57)	30(44.78)
否	7(30.43)	37(55.22)
增加吃水果			14.439	＜0.001
是	6(26.09)	1(1.49)
否	17(73.91)	66(98.51)
增加吃蔬菜			19.023	＜0.001
是	13(56.52)	8(11.94)
否	10(43.48)	59(88.06)
控制吃西式快餐			11.280	＜0.001
是	5(21.74)	1(1.49)
否	18(78.26)	66(98.51)
控制吃路边摊			14.439	＜0.001
是	6(26.09)	1(1.49)
否	17(73.91)	66(98.51)

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表 6 变量赋值情况

Table 6. Variable assignment

变量	赋值方法
BMI	正常或超重=0，肥胖=1
增加体力活动	无=0，有=1
控制视频时长	无=0，有=1
控制喝汽水饮料	无=0，有=1
控制吃甜品	无=0，有=1
控制吃油炸食物	无=0，有=1
增加吃水果	无=0，有=1
增加吃蔬菜	无=0，有=1
控制吃西式快餐	无=0，有=1
控制吃路边摊	无=0，有=1

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表 7 健康信念干预12个月后肥胖儿童青少年BMI控制效果影响因素的logistic回归分析

Table 7. Logistic regression analysis of factors associated with BMI control outcomes in obese children and adolescents at 12 months following a health belief intervention

变量	B	SE	Waldχ²	P值	OR(95% CI)
增加体力活动	-3.204	1.093	8.596	0.003	0.041(0.005~0.346)
改善睡眠时长	0.114	0.811	0.020	0.889	1.120(0.229~5.487)
控制视频时长	1.151	0.773	2.216	0.137	3.162(0.695~14.399)
控制喝汽水饮料	-0.038	1.006	0.001	0.970	0.963(0.134~6.910)
控制吃甜品	-0.974	0.950	1.050	0.305	0.378(0.059~2.432)
控制吃油炸食物	0.161	0.965	0.028	0.868	1.174(0.177~7.783)
增加吃水果	-1.847	0.924	3.998	0.046	0.158(0.026~0.964)
增加吃蔬菜	-2.958	0.813	13.221	＜0.001	0.052(0.011~0.256)
控制吃西式快餐	-1.740	0.806	4.665	0.031	0.175(0.036~0.851)
控制吃路边摊	0.582	0.807	0.520	0.471	1.789(0.368~8.699)

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