ﺗﺎﺛﯿﺮ ﻣﺪاﺧﻠﻪ آﻣﻮزﺷﯽ در ﻣﯿﺰان آﮔﺎﻫﯽ ﺗﻐﺬﯾﻪ اي، ادراك ﺑﯿﻤﺎري و ﭘﯿﮕﯿﺮي رژﯾﻢ ﻏﺬاﯾﯽ در زﻧﺎن ﻣﯿﺎﻧﺴﺎل ﻣﺒﺘﻼ ﺑﻪ ﭘﺮﻓﺸﺎري ﺧﻮن: ﮐﺎرﺑﺮد ﻣﺪل ﻓﺮاﻧﻈﺮي

The Effect of Educational Intervention on the Nutritional Knowledge, Illness Perception and Dietary Adherence in Middle-Aged Women with Hypertension: Application of the Transtheoretical Model

ﺑﯿﻤﺎري ﻫﺎي ﻗﻠﺒﯽ و ﻋﺮوﻗﯽ ﺷﺎﯾﻊ ﺗﺮﯾﻦ ﻋﻠﺖ ﻣﺮگ وﻣﯿﺮ در ﺑﯿﺸﺘﺮ ﮐﺸﻮرﻫﺎي ﺟﻬﺎن و ﭘﺮﻓﺸﺎري ﺧﻮن ﻣﻬﻤﺘﺮﯾﻦ ﻋﻠﺖ از ﮐﺎراﻓﺘﺎدﮔﯽ ﺑﻪ ﺷﻤﺎر ﻣﯽ رود. ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺎ ﻫﺪف ﺗﻌﯿﯿﻦ ﺗﺎﺛﯿﺮﻣﺪاﺧﻠﻪ ي آﻣﻮزﺷﯽ ﺑﺮ اﺳﺎس ﻣﺪل ﻓﺮاﻧﻈﺮي ﺑﺮ ﻣﯿﺰان آﮔﺎﻫﯽ ﺗﻐﺬﯾﻪ اي، ادراك ﺑﯿﻤﺎري، ﭘﯿﮕﯿﺮي رژﯾﻢ ﻏﺬاﯾﯽ و ﻓﺸﺎر ﺧﻮن، در زﻧﺎن ﻣﯿﺎﻧﺴﺎل ﻣﺒﺘﻼ ﺑﻪ ﭘﺮﻓﺸﺎري ﺧﻮن ﻣﺒﺘﻨﯽ ﺑﺮ ﮐﺎرﺑﺮد ﻣﺪل ﻓﺮاﻧﻈﺮي ﻃﺮاﺣﯽ و اﺟﺮا ﺷﺪ. روش ﮐﺎر: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﯾﮏ ﭘﮋوﻫﺶ ﻧﯿﻤﻪ ﺗﺠﺮﺑﯽ ﺑﺎ ﺟﺎﻣﻌﻪ آﻣﺎري زﻧﺎن ﻣﯿﺎﻧﺴﺎل )30-59( ﺳﺎل ﻣﺒﺘﻼ ﺑﻪ ﭘﺮﻓﺸﺎري ﺧﻮن ﻣﺮاﺟﻌﻪ ﮐﻨﻨﺪه ﺑﻪ ﻣﺮاﮐﺰ و ﭘﺎﯾﮕﺎﻫﻬﺎي ﺑﻬﺪاﺷﺘﯽ درﻣﺎﻧﯽ ﺗﺤﺖ ﭘﻮﺷﺶ ﻣﻨﻄﻘﻪ 21 ﺗﻬﺮان در ﺳﺎل 1399-1400ﺑﻮد. ﺗﻌﺪاد 164 ﻧﻔﺮ)82ﻧﻔﺮ ﮔﺮوه ﮐﻨﺘﺮل و 82 ﻧﻔﺮ ﮔﺮوه ﻣﺪاﺧﻠﻪ( ﺑﺎ ﺗﺨﺼﯿﺺ ﺗﺼﺎدﻓﯽ ﺑﻪ روش ﺑﻠﻮك ﻫﺎي ﭼﻬﺎر ﺗﺎﯾﯽ ﺗﺼﺎدﻓﯽ ﺷﺪه در دو ﮔﺮوه ﻣﺪاﺧﻠﻪ و ﮐﻨﺘﺮل ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﭘﺮﺳﺸﻨﺎﻣﻪ ﭼﻨﺪ وﺟﻬﯽ ﺑﺮاي ﻫﺮ دو ﮔﺮوه ﮐﻨﺘﺮل و ﻣﺪاﺧﻠﻪ ﺗﮑﻤﯿﻞ و ﻓﺸﺎر ﺧﻮن اﻓﺮاد اﻧﺪازه ﮔﯿﺮي ﮔﺮدﯾﺪ. ﺳﭙﺲ ﻣﺪاﺧﻠﻪ آﻣﻮزﺷﯽ ﺑﻪ ﻣﺪت ﯾﮏ ﻣﺎه در ﻗﺎﻟﺐ ﻣﺤﺘﻮاي ﻣﺠﺎزي ﺑﻪ ﺻﻮرت ﺗﺸﮑﯿﻞ ﮔﺮوه واﺗﺲ اپ و ﻃﺮاﺣﯽ و ﺗﺪوﯾﻦ 56 ﻋﺪد ﭘﺎدﮐﺴﺖ و ﮐﻠﯿﭗ آﻣﻮزﺷﯽ ﺑﺎ ﺣﺪاﮐﺜﺮ زﻣﺎن ﭼﻬﺎر دﻗﯿﻘﻪ ﻣﺒﺘﻨﯽ ﺑﺮ ﺳﺎزه ﻫﺎي ﻣﺪل ﻓﺮاﻧﻈﺮي ﺑﺮ روي ﮔﺮوه ﻣﺪاﺧﻠﻪ اﺟﺮا و ﺑﻌﺪ از ﮔﺬﺷﺖ زﻣﺎن ﯾﮏ و ﺳﭙﺲ ﺷﺶ ﻣﺎه ﺑﻌﺪ از ﻣﺪاﺧﻠﻪ ﭘﺮﺳﺶ ﻧﺎﻣﻪ ﺑﺮاي ارزﯾﺎﺑﯽ ﻣﺠﺪد ﺑﻪ ﻫﺮ دو ﮔﺮوه داده ﺷﺪ و ﻣﺠﺪدا ﻓﺸﺎر ﺧﻮن اﻓﺮاد ﮐﻨﺘﺮل ﺷﺪ. ﺑﺮاي ﺗﺠﺰﯾﻪ ﺗﺤﻠﯿﻞ داده ﻫﺎ از آﻣﺎر ﺗﻮﺻﯿﻔﯽ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓﺰار SPSS25 اﺳﺘﻔﺎده ﺷﺪ. ﻧﺘﺎﯾﺞ: ﻗﺒﻞ از ﻣﺪاﺧﻠﻪ در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﯿﺎﻧﮕﯿﻦ و اﻧﺤﺮاف ﻣﻌﯿﺎر، ﻓﺸﺎرﺧﻮن ﺳﯿﺴﺘﻮﻟﯿﮏ و دﯾﺎﺳﺘﻮﻟﯿﮏ ﺑﻪ ﺗﺮﺗﯿﺐ 1/35±0/49و1/84±0/41 ﻣﯿﻠﯿﻤﺘﺮ ﺟﯿﻮه ﺑﻮد. ﻗﺒﻞ از ﻣﺪاﺧﻠﻪ آﻣﻮزﺷﯽ دو ﮔﺮوه از ﻧﻈﺮ ﻣﺘﻐﯿﺮ ﻫﺎي زﻣﯿﻨﻪ اي و ﺳﺎزه ﻫﺎي آﮔﺎﻫﯽ ﺗﻐﺬﯾﻪ اي، ادراك ﺑﯿﻤﺎري، ﭘﯿﮕﯿﺮي رژﯾﻢ ﻏﺬاﯾﯽ، ﻓﺸﺎر ﺧﻮن ﺳﯿﺴﺘﻮﻟﯿﮏ و دﯾﺎﺳﺘﻮﻟﯿﮏ، ﺷﺎﺧﺺ ﺗﻮده ﺑﺪﻧﯽ )BMI( و ﻫﻤﭽﻨﯿﻦ ﺳﺎزه ﻫﺎي ﻣﺪل ﻓﺮاﻧﻈﺮي ﺗﻔﺎوت ﻣﻌﻨﺎداري ﻧﺪاﺷﺘﻨﺪ. ﯾﮏ ﻣﺎه ﭘﺲ از ﻣﺪاﺧﻠﻪ در ﺳﺎزه ﻫﺎي آﮔﺎﻫﯽ ﺗﻐﺬﯾﻪ اي، ادراك ﺑﯿﻤﺎري، ﺳﺎزه ﺧﻮدﮐﻔﺎﯾﺘﯽ ﻣﺪل ﻓﺮاﻧﻈﺮي و ﻓﺸﺎر ﺧﻮن ﺳﯿﺴﺘﻮﻟﯿﮏ اﺧﺘﻼف ﻣﻌﻨﺎ دار در ﺑﯿﻦ دو ﮔﺮوه ﻣﺸﺎﻫﺪه و ﮐﻨﺘﺮل ﻣﺸﺎﻫﺪه ﮔﺮدﯾﺪ )0/001

Cardiovascular diseases are the most common cause of death in most countries of the world, hypertension being the most important cause of disability. The aim of this study conducted in 2020-2021 was to determine the effect of educational intervention on the nutritional knowledge, illness perception and dietary adherence in hypertensive middle aged women based on the transtheoretical model (TTM). Materials and Methods: This was a quasi-experimental study on middle-aged women (30-59 years old) suffering from hypertension referred to the health centers and health bases in the 21st district of Tehran in 2020-2021. A total of 164 subjects were randomly assigned to the intervention (n=82) or control (n=82) group by randomized quadruple blocks. A multifaceted questionnaire was completed for both the control and intervention groups and their blood pressure measured. This was followed by a one-month virtual education for the intervention group in the form of a WhatsApp group and designing and developing fiftysix podcasts and educational clips with a maximum duration of four minutes based on the transtheoretical model constructs. After a lapse of one and six months both groups completed the questionnaire again and their blood pressure was measured. Descriptive statistics and general linear model were used for data analysis using the SPSS version 25 (p<0.05). Results: Before the intervention the mean age of the subjects was 50.16 years and their systolic and diastolic blood pressures were 1.35 and 1.84 mmHg, respectively, and there were no statistically significantly differences between the two groups as regards contextual variables, constructs of nutritional awareness, disease perception, diet adherence, systolic and diastolic blood pressures and body mass index (as an ananthropometric index) and transtheoretical model constructs. Data one month after the intervention revealed significant differences (p<0/001) between the two groups (p <0/001) as regards the constructs of nutritional awareness, disease perception, self-sufficiency construct of the transtheoretical model and systolic blood pressure. Six months after the intervention significant differences were observed between the two groups as regatds nutritional awareness constructs, disease perception (p<0.007), diet adherence (p<0.001), stages of change constructs (p<0.001) and self-sufficiency (p<0.001) of the transtheoretical model. Conclusion: The results of this study show that educational intervention based on the transtheoretical model in middle-aged women with hypertension can increase their nutritional knowledge, illness perception, selfsufficiency, self-adequacy and diet adherence.