Effectiveness of a health promotion programme on self-efficacy and practice of exercise in Chinese metabolic syndrome population: a single-centre, open-label, randomised controlled trial.

BACKGROUND: The health promotion model (HPM) is widely used in promoting lifestyle changes. Metabolic syndrome, the combination of multiple cardio-metabolic risk factors, has imposed heavy burden to the Chinese health-care system. Lifestyle intervention, especially exercise, is recommended as the primary intervention for management of metabolic syndrome. However, HPM has not been used in the population with metabolic syndrome. We assessed the effectiveness of a health promotion programme guided by HPM on self-efficacy and practice of exercise in Chinese people with metabolic syndrome.

METHODS: In this single-centre, randomised controlled trial, we recruited patients with metabolic syndrome following the International Diabetes Federation definition from a general hospital in Shandong, China. All patients received usual care from the hospital. Patients were randomly assigned to either the control group (usual care) or the intervention group (consisting of usual care plus a 3-month health promotion programme, including a booklet, one face-to-face education, and bi-weekly telephone calls). The randomisation was done through a computer-generated block randomisation list with a block size of four. Patients and the researchers were aware of group assignment. Guided by the HPM, the primary outcomes of self-efficacy of exercise and practice exercise were measured using the Self-rated Abilities of Health Practice subscale (SRAHP-E, seven-item, score range 0-28) and the Health Promoting Lifestyle Profile subscale (HPLP-E, eight-item, score range 0-32), respectively. Data were collected at baseline (T0), 1 month (T1), and 3 months (T2) by a research nurse who was blinded with the group assignment. We used the generalised estimating equations (GEE) model to test the study hypotheses. The study was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee and the study hospital, and was registered in the Chinese Clinical Trial Registry. A written informed consent was obtained from each participant before data collection.

FINDINGS: Between April and October, 2014, we recruited 173 participants with metabolic syndrome, the mean age was 55·62 years (SD 10·65), and 85 (49%) were males. 86 participants were randomly assigned to the intervention group and 87 to the control group. The demographic characteristics were well balanced between the two groups. At T0, the mean SRAHP-E score was 17·67 (SD 4·97) in the intervention group and 16·99 (SD 6·99) in the control group (p=0·458); whereas the HPLP-E score was 15·43 (SD 4·97) in the intervention group and 17·32 in the control group (p=0·032). Both groups demonstrated continuous improvements in self-efficacy and practice of exercise at T1 and T2. Moreover, the GEE models revealed significant group-by-time interaction effects on self-efficacy (T2, p=0·048) and practice (T1, p=0·019 and T2, p<0·001).

INTERPRETATION: A HPM-based health promotion programme was effective in improving the self-efficacy and practice of exercise in Chinese population with metabolic syndrome. This programme could be applied in practice to improve the quality of care for this population of patients.

FUNDING: None.