关键词: 结核,肺, 痰, 健康教育, 自我心理学, 基于能力的教育, 护理理论

Abstract:

Objective: To investigate the effect of health education based on the Knowledge-Attitude-Practice (KAP) model on the quality of sputum specimen collection in newly diagnosed pulmonary tuberculosis (PTB) patients, and to provide a reference for clinical health education on sputum specimen collection. Methods: A prospective study method was adopted. A total of 227 clinically and laboratory diagnosed PTB patients were referred and recommended by other comprehensive medical institutions or referred and tracked by the tuberculosis reporting system, who first visited the tuberculosis clinic of Zhengzhou Sixth People’s Hospital from January to November 2024 were selected as the research objects. The patients were divided into the control group (111 cases, implementing routine health education) and the experimental group (116 cases, implementing multiform intervention based on the KAP theory on the basis of the control group) by using the random number table method. After excluding 27 patients according to the inclusion criteria, 100 cases were included in each group. The differences between the two groups in the cognitive level of knowledge related to sputum specimen collection, self-efficacy level, as well as indicators such as sputum sample volume, characteristics, and the proportion of standardized sputum collection volume before and after intervention were compared. Results: After sputum collection education by different ways, the total items awareness rate of the experimental group before sputum collection were significantly higher the control group (98.7% (987/1000) vs. 87.4% (874/1000), χ²=98.725, P<0.001). The proportion of qualified sputum exterior, actual sputum collection volume, the proportion of standard sputum examination patients, and the positive rate of mycobacterium culture of the experimental group were significantly higher those of the control group (86.1% (216/251) vs. 70.2% (177/252), χ²=18.414, P<0.001; (3.45±0.98) ml vs. (2.86±0.70) ml, t=4.882, P=0.039; 94.0% (94/100) vs. 74.0% (74/100), χ²=14.881, P<0.001; 35.0% (35/100) vs. 21.0% (21/100), χ²=4.861, P=0.027), respectively. In addition, the self-efficacy scores of the symptom, the self-efficacy scores of the disease comorbidity dimension and the total self-efficacy scores ((34.26±3.47) points, (17.30±1.76) points, (51.56±4.94) points) were significantly higher those of the control group ((30.78±6.65) points, (15.09±3.24) points, (45.87±9.64) points), respectively, the differences were statistically significant (t=4.642, P<0.001; t=5.987, P<0.001; t=5.256, P<0.001). The pathogen positivity rate after sputum education in the experimental group was significantly higher than that before sputum education (45.0% (45/100) vs. 31.0% (31/100), χ²=4.160, P=0.041). Conclusion: The intervention model the KAP theory can effectively improve the quality of sputum specimen collection in newly diagnosed PTB patients by improving the cognitive level of knowledge related to sputum specimen collection, which is conducive to improving the self-efficacy level of patients and has clinical promotion value.

Key words: Tuberculosis, pulmonary, Sputum, Health education, Self psychology, Competency-based education, Nursing theory