基于循证和行为干预的养老设施外部环境健康促进度量研究

Promoting the construction of the elderly livable environment is the key point of the ‘13th Five-Year’ National Aging Issue Development and Pension System Construction Plan. The scientific understanding of promotion mechanism where the external environment benefits the elderly health is the effective way to achieve ‘Healthy China in 2030’ and ‘Healthy Aging’. Developing scientific and applicable promotion measurement method on external environment health can effectively solve the health promotion problem of facilities for the elders. This aim of this proposal focuses on problem of how the scientific measurement of external environment affects the health of the elderly. The approach to solve this issue is based on the advantages of behavioral intervention theory in the study of the elderly health behaviors, as well as the combination of the evidence-based method and the social ecological model of behavioral modification theory. It explores the coupling relationship and the promotion mechanism between the external environment of the elderly facilities and the elderly health. In addition to the study of the mechanism of action towards the health behaviors from the dual angles of “the elderly cognitive external environment and the buildup external environment”, it clarifies the “interactive” influence mechanism of how the subjective cognition and the objective external environment affects the health behaviors and solves the external environment intervention issues under the influence of three factors named “individual characteristics, social atmosphere and external environment”. This proposal develops and establishes the health promotion quantitative and measurement method of elderly facilities external environment and set up the optimization system of health promotion measurement based on the PDCA cyclical model. It verifies and dynamically corrects the health promotion measurement through the elderly activity intensity and spatial distribution data which measured by the actigraphy and the GPS. Finally, the outcome of proposal will provide theoretical support for the site selection and design of the elderly facilities health plan through the health promotion measurement towards the external environment.

推进老年宜居环境建设是《“十三五”国家老龄事业发展和养老体系建设规划》的重点，科学认识外部环境对老年人健康促进机制是实现“健康中国2030”和“健康老龄化”的有效途径，开发科学适用的外部环境健康促进度量方法是有效破解养老设施健康促进问题的关键。本课题着眼于科学度量养老设施外部环境对老年人健康的影响这一难题，将循证方法和行为干预理论中的社会生态模型有机结合，探究养老设施外部环境与老年人健康的耦合关系和促进机制，从“老年人认知外部环境和建成外部环境”双重角度研究对健康行为的作用机制，破解“个体特征、社会氛围、外部环境”三维因素对健康行为的“交互式”影响机理，开发建立养老设施外部环境健康促进定量度量方法，并基于PDCA循环模型建立健康促进度量优化体系，运用体动记录仪和GPS定位仪测量的真实数据对健康促进度量验证和修正。通过对外部环境的健康促进度量，为养老设施健康规划选址和场地设计提供理论支撑。

本项目基于循证理论和社会生态模型，从养老设施外部城市和场地环境、社会环境以及老年人主观认知环境等多个层面入手，探究养老设施外部环境与老年人健康行为的耦合关系和促进机制。首先，对代表性健康行为干预模型综述评价，制定养老设施中老年人个体、社会环境和外部环境的三维健康促进影响要素分析框架，细分养老设施外部城市环境和场地环境双层要素，通过老年人和专家评价、问卷数据的信度效度和相关性分析，实证养老设施外部环境与老年人多种类型健康行为的耦合关系，筛选出养老设施外部环境健康促进要素；接着，对我国多个城市大样本调研，建立多元统计模型，定量研究养老设施外部城市环境和场地环境对老年人多类型健康行为的促进效益和交互式影响机制；此外，通过对模型数据结论进行无量纲化和降维化处理，分别建立基于“信息全面性”和“信息精确性”的健康促进度量体系，并基于PDCA循环模型，通过数据拟合、模拟测算等方法对健康促进度量体系进行验证和动态修正；最后，基于实证研究结论，在总结分析国外养老设施建设经验和国内城市更新实践的基础上，研究提出养老设施健康促进型规划选址和场地设计策略。