Page 70 - 2023-01-中国全科医学

2023年1月 第26卷 第1期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·65·

health education，but its significance in public stroke education is still unclear. Objective To compare the impact of gain- and
loss-framed messages about "Stroke 1-2-0"（a kind of stroke educational video）on residents' intention to delay seeking care in
the situation of identifying pre-stroke symptoms. Methods From January to September 2021，the gain-framed message video
and loss-frame message video based on "Stroke 1-2-0" were developed through three steps：script writing，video production，
and video evaluation. Then during October to November 2021，81 residents aged 35-80 selected by convenience sampling from
Guangzhou，Guangdong Province were randomized into a gain-framed message video intervention group（n=40）and a loss-
framed message video intervention group（n=41），to watch the gain-framed message video and loss-framed message video，
respectively. The impact of the intervention was appraised by comparing pre- and post-intervention status of correct recognition
and management of pre-stroke symptoms assessed using a self-developed Pre-stroke Symptom Recognition and Management
Questionnaire，and pre- and post-intervention total score and domains scores of the Stroke Pre-hospital Delay Behavior
Intention（SPDBI）scale. Results A total of 75 cases（37 in the gain-framed message video intervention group and 38 in the
loss-framed message video intervention group）who completed the study were finally included. Two groups had no significant
differences in pre-intervention rates of correct recognition and management of pre-stroke symptoms（P>0.05）. There were no
significant intergroup differences in mean pre-intervention total score and each domain score of the SPDBI scale（P>0.05）.
After intervention，significantly increased rates of correct recognition and management of various pre-stroke symptoms，and
significantly lowered mean total score and domain scores（except the non-treatment justification）of the SPDBI scale were found
in the gain-framed message video intervention group（P<0.05）. In the loss-framed message video intervention group，the
correct recognition rate of various pre-stroke symptoms significantly improved（P<0.05），and the rate of correct management
of pre-stroke symptoms（except the deviated mouth）was also notably improved（P<0.05）. Moreover，the total score and each
domain score of the SPDBI scale were lowered notably（P<0.05）. Post-intervention intergroup comparison demonstrated that
the loss-framed message video intervention group had lower mean total score of the SPDBI scale and lower mean scores of three
domains（non-treatment justification，symptom attributions，habitual response style）of the scale（P<0.05）. Conclusion
The loss-framed message had stronger persuasive impact on reducing residents' intention to delay accessing of care when pre-
stroke symptoms occurred. Thus，the loss-framed message can be used as an expression form of health education on pre-hospital
delay in stroke，focusing on the relationship between pre-stroke symptoms and the time of triggering an emergency call on the
phone，and highlighting the importance and urgency of seeking medical treatment quickly.
【Key words】 Message framing；Stroke；Pre-hospital delayed；Patient delay；Behavior intention；Video
intervention；Stroke 1-2-0

脑卒中患者就医延迟是指患者在发病后因疾病认 明确。“中风 120”是国家卫生健康委脑卒中防治专家
知、转运方式、医院诊治条件等因素而错过治疗时间 委员会主推的脑卒中健康教育工具 ［11］ 。得到其研发者
窗 ［1-2］ 。随着国内卒中中心建设进程不断加快，患者及 同意后，研究团队编制了“中风 120”信息框架微视频，
其家属未能识别脑卒中症状和患者未及时就医日益成为 并通过探讨基于“中风 120”的收益与损失框架信息对
脑卒中患者就医延迟的主要原因 ［3］ ，这也是公众脑卒 居民脑卒中院前延迟行为意向影响的差异，旨在为公众
中认知教育亟待解决的核心问题 ［4］ 。居民的脑卒中院 脑卒中认知教育工作的开展提供决策参考与依据。
前延迟行为意向水平可预测其罹患脑卒中后延迟就医的 1 “中风 120”信息框架微视频编制
可能性 ［5］ ，也是目前用于评价公众脑卒中认知教育实 2021 年 1—9 月，根据视频创作指南的要求，通过
施效果的重要指标 ［6］ 。信息框架理论指出，信息的表 脚本撰写、视频制作、视频评价 3 个步骤 ［12］ ，形成基
达方式会影响人们的决策偏好和判断，而相同客观信息 于“中风 120”的收益框架视频和损失框架视频。
可以以收益框架（从事某健康行为将带来收益）或损失 1.1 撰写脚本
框架（不从事某健康行为将带来损失）呈现 ［7］ 。已有 1.1.1 文 献 研 究 2021 年 1—2 月， 以“ 脑 卒 中 / 中
学者对收益 - 损失框架在疾病防治、筛查健康教育中的 风（stroke）、 症 状 识 别（symptom recognition）、
应用效果进行了深入研究，发现对于乳腺自检教育，收 院 前 延 误（pre-hospital delay）、 公 众 脑 卒 中 认 知 教
益框架信息比损失框架信息更具有说服力 ［8］ ，而在增 育（public stroke cognitive education/stroke awareness
强目标人群戒烟意愿及对皮肤癌等疾病预防意识方面， campaigns）、FAST（Face，Arm，Speech，Time）、
损失框架信息比收益框架的信息更有效 ［9-10］ 。目前， 中风 120（stroke 1-2-0）、框架效应（message framing
信息框架理论在公众脑卒中认知教育中的应用效果尚不 effect）、 信 息 框 架（message framing）、 目 标 框 架