基于移动健康技术的社区脑卒中预防控制综合干预研究

Stroke deaths in China account for about 1/3 of global deaths, ranking the first cause-of-death among 27 provinces and the country as a whole, and the first cause of disability for adults as well. China has suffering a heavy burden of disease from stroke. The new wave of health reform in China has strengthened the community-based prevention and control of cardiovascular diseases, however, there are huge number of patients, potential cases with high risk factors, and relatively the number and capacity of primary health care givers as the main force for chronic diseases control and prevention are limited. The efficiency of stroke prevention and control is not expectant. Compared to traditional methods, the mobile health based interventions are characterized with easy-to-implement, low-cost, and allow interactions between providers and users. The rapid popularization of smart phone makes it possible to apply mobile health in stroke intervention research. However, with the background of current chronic diseases prevention and treatment system, and health policies, there is lacking of an integrated intervention model for stroke and its high risk factors based on mobile health technology, supportive professional guidelines and health behavior promotion theories. In this study, we will firstly construct an integrated intervention model for health management of stroke with hospital-community-family-individual interactions, based on professional guidelines, technical regulations and health behavior promotion theory, and then design and develop the intervention application (APP) on the basis of needs assessment, and finally evaluate the effectiveness of APP intervention using a randomized controlled trial with paralleled design. This study is highly expected to provide a new intervention method for community-based prevention and control of stroke in China.

我国脑卒中死亡约占全球的1/3，是全国及27个省份的首要死因，也是首位成人致残原因，疾病负担沉重。尽管新一轮“医改”加强了心脑血管病的社区防控，由于患者基数庞大、高危人群众多，而作为慢性病防控主力军的基层医务人员数量和能力有限，脑卒中防控效果并不理想。与传统手段相比，基于移动健康技术的干预具有简单易行、成本低廉、便于互动交流等优点。近年来智能手机的快速普及使将移动健康技术用于脑卒中健康管理综合干预研究成为可能。但是，在当前慢性病防治体系和政策背景下，尚缺乏以防治指南和健康行为促进理论支撑的，基于移动健康技术的脑卒中综合干预模式。本研究依据脑卒中防治指南、技术规范，健康行为促进理论和移动学习分析框架构建基于移动健康技术、医院-社区-家庭-个体互动式的脑卒中健康管理综合干预模式，通过需求分析设计和开发干预APP，采用平行设计的随机对照试验评价APP干预的效果，为我国脑卒中防控提供新的干预手段。

慢性病已成为影响人类健康的重大公共卫生问题，脑卒中及其高危人群，包括高血压和糖尿病是最重要的慢性病之一，疾病负担沉重。加强慢性病患者管理和危险因素干预可以显著减少致残和死亡，然而，我国慢性病管理仍存在许多问题，包括慢性病患者数量庞大，但基层医疗力量十分薄弱；居民慢性病相关健康素养水平不高；医护人员缺乏对患者做出个性化、精准化管理的干预适宜技术和工具；居民普遍缺乏自我管理意识，慢性病患者健康管理依从性差；缺乏高效、便捷的干预模式。本研究在南北方各选择一个区县，针对慢性病患者、慢性病患者的家属、社区医护人员、专科医生和管理人员等各种相关人群，采用定量调查和定性访谈相结合的方法开展干预APP研发需求分析，梳理脑卒中防治指南、技术规范，分析当前我国慢性病防控现状、政策环境，利用现代互联网技术、移动健康技术和健康行为促进理论，开发脑卒中社区干预APP（患者端、医护端和管理端）和微信小程序，形成综合干预模式。通过平行对照试验设计，在南北方各选择两个省市的部分区县，将其分为干预组和对照组，对干预组实施干预，对照组按原有的管理模式，采用倍差法对干预效果进行评价。结果显示，基于移动健康技术的社区干预模式可以有效提高研究对象的运动（缺乏运动率下降2.53个百分点）、改善饮食习惯（饮食偏咸率下降1.88个百分点、饮食偏荤率下降1.52个百分点、水果摄入≤2天/周比例下降1.77个百分点）、降低血压（收缩压下降2.02 mmHg）和血糖（空腹血糖下降0.52 mmol/L），对其他危险因素亦有正向影响，比如降低吸烟率和饮酒率。基于移动健康技术的社区干预模式具有服务方便、可及、高效，成本低廉等特点，可以提高患者依从性、促进行为改变、提高管理效率等，既可适用于患者，也可适用于亚健康人群和有健康需求的一般人群，具有良好的应用前景和成本效益。