目的：本研究以“知信行”模式(KABP)为理论指导，以健康素养干预形式对血液透析患者进行健康教育。了解血液透析患者健康素养、疾病不确定感、不确定性评价、自我管理能力的现状。评价血液透析患者健康素养干预前后疾病不确定感和自我管理能力变化，为今后提高健康素养水平、降低疾病不确定感、改善自我管理状况提供依据。

方法：本研究属于类实验性研究，采用便利抽样方法，抽取于2016年6月至2016年10月间在延吉市某一三甲医院血液透析室进行血液透析的患者，根据患者排班情况将周一周二的患者采用抛硬币法随机分为观察组和对照组，根据病历资料和患者意愿选择符合纳入标准的患者，并完成基线调查。开发以“知信行”模式(KABP)为理论指导的健康素养干预策略，对干预组实施健康素养干预，对照组给予常规的健康教育。干预1、3月后收集有关数据，对两组患者干预前后健康素养、疾病不确定感、不确定性评价、自我管理的变化进行重复测量方差分析。所有数据应用统计软件SPSS17.0进行分析。

结果：

（1）干预前血液透析患者健康素养整体水平较低，具备健康素养的比例为24.4%；患者不确定感水平较高，有疾病不确定感患者的比例为54.4%；患者的不确定性评价倾向于机遇，具有积极乐观的心态；血液透析患者自我管理水平较低，不具备自我管理能力的比例为92.2%。

（2）两组患者在基本资料、健康素养、疾病不确定感、不确定性评价、自我管理能力方面，差异均无统计学意义（p>0.05），具有可比性。

（3）健康素养平均得分的重复测量方差分析时间效应（F=134.884，p<0.01）、组别效应（F=4.767，p=0.032）及二者之间交互作用（F=95.999，p<0.01），均具有统计学意义。

（4）疾病不确定感平均得分的重复测量方差分析时间效应（F=49.655，p<0.01）、时间与组别的交互作用（F=38.556，p<0.01）具有统计学意义，但其组别效应（F=1.945，p=0.167）不显著。

（5）不确定性评价为机遇平均得分的重复测量方差分析时间效应（F=67.586，p<0.01）、组别效应（F=30.788，p<0.01）及两者之间交互作用（F=57.161，p<0.01）均具有统计学意义。不确定性评价为危险平均得分的重复测量方差分析时间效应（F=44.365，p<0.01）、时间与组别交互作用（F=37.281，p<0.01）显著，但其组别效应（F=1.458，p=0.230）不显著。

（6）自我管理能力平均得分的重复测量方差分析时间效应（F=195.309，p<0.01）、组别效应（F=28.674，p<0.01）及二者之间交互作用（F=122.243，p<0.01）均具有统计学意义。

结论：

（1）75.6%的患者不具备健康素养，54.4%的患者具有较高水平的疾病不确定感，血液透析患者的不确定性评价从整体而言倾向于机遇，92.2%的患者不具有自我管理能力。

（2）参照现代健康教育学理论中的“知信行”模式指导血液透析患者健康素养干预，能够改善患者的健康素养、疾病不确定感、不确定性评价及自我管理能力，科学严谨的指导理论体现了干预模式的科学性和可操作性。

Objective：This study is using“KABP”as a theoretical guide and a healthy literacy intervention to educate the hemodialysis patients.To understand the health literacy,uncertainty,appraisal of uncertainty,self-management of hemodialysis patients,to evaluate the uncertainty and self-management of hemodialysis patients before and after the intervention of health literacy,so as to provide the basis for improving the level of health literacy,reducing the sense of uncertainty and improving self-management.

Methods：This study was a quasi-experimental study,using a convenient sampling method.Hemodialysis patients were from June 2016 to October 2016 in a hemodialysis room from a top three hospital in Yanji City.According to the patient scheduling,hemodialysis patients on Monday and Tuesday were divided into observation group and control group by tossing a coin. Patients who met the inclusion criteria were selected according to the medical records and patient's intention,and the baseline survey was completed.To develop  health literacy intervention strategy as the theory of KABP,the health literacy intervention was implemented in the intervention group, the control group was given regular health education. The data was collected after 1 and 3 months,repeated-measure analysis of variance was performed on changes of mean score in health literacy, uncertainty in illness,the appraisal of uncertainty and the self-management before and after the intervention in both groups.All data was analyzed by using statistical software SPSS17.0.

Results：

(1)The overall health status of hemodialysis patients before intervention was poor,the ratio of patients with healthy literacy was 24.4%;patients were with a high level of uncertainty,the proportion of patients with disease uncertainty was 54.4%;the patients’ uncertainty evaluation overall was more inclined to as the opportunity,with a positive and optimistic attitude;Self-management ability of patients was low, the ratio of the patients with no self-management was 92.2%.

(2)There was no significant difference between the two groups in terms of basic data,health literacy,uncertainty in illness,appraisal of uncertainty and self-management ability (P>0.05).

(3)Repeated-measure analysis of variance of health literacy mean score showed the time effect (F=134.884,P<0.001),group effect (F=4.767，P=0.032) and the interaction effect of two groups (F=95.999，P<0.001) were all statistically significant.

(4)Repeated-measure analysis of variance of uncertainty in illness mean score showed the time effect (F=49.655,P<0.001) and the interaction effect of time and group (F=38.556，P<0.001) were all statistically significant.But group effect (F=1.945，P=0.167) was not significant.

(5)Repeated-measure analysis of variance of appraisal of uncertainty as opportunity  mean scores showed the time effect(F=67.586,P<0.001),group effect (F=30.788,P<0.001)and the interaction effect of both (F=57.161,P<0.001)were all significant.Repeated-measure analysis of variance of appraisal of uncertainty as danger mean scores showed the time effect(F=44.365,P<0.001)and interaction effect of time and group (F=37.281，P<0.001)were all significant,but group effect(F=1.458, P=0.230)was not significant.

(6)Repeated-measure analysis of variance of self-management mean score showed the time effect(F=195.309,P<0.001),group effect(F=28.674，P<0.001) and the interaction effect of both(F=122.243,P<0.001)were all statistically significant.

Conclusions:

(1)75.6% of patients did not have health literacy,54.4% of patients had a higher level of uncertainty in illness,hemodialysis patients’ evaluation of the uncertainty in illness tend to opportunities,92.2% of patients did not have self-management capacity.

(2)With the reference to the theory of“KABP”in modern health education theory to guide health literacy intervention,it could improve patients’ health literacy,uncertainty in illness,appraisal of uncertainty and self-management ability.Scientific rigorous guiding theory embodies the scientific and operable nature of the intervention model.

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