系统综述
ENGLISH ABSTRACT
公共健康领域的行为干预方法及其涟漪效应的心理机制
贺金波
郑阳
边慧冕
白汉平
李睿婷
作者及单位信息
·
DOI: 10.3760/cma.j.issn.1674-6554.2017.12.018
The psychological mechanism of behavioral intervention and ripple effect in public health
He Jinbo
Zheng Yang
Bian Huimian
Bai Hanping
Li Ruiting
Authors Info & Affiliations
He Jinbo
School of Psychology, Central China Normal University, Wuhan 430079, China
Zheng Yang
School of Psychology, Central China Normal University, Wuhan 430079, China
Bian Huimian
School of Psychology, Central China Normal University, Wuhan 430079, China
Bai Hanping
Department of Psychiatry, People's Hospital of Wuhan University, Wuhan 430060, China
Li Ruiting
Department of Psychiatry, People's Hospital of Wuhan University, Wuhan 430060, China
·
DOI: 10.3760/cma.j.issn.1674-6554.2017.12.018
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摘要

发展行为医学是提高国民健康水平的一种高效益路径,而行为干预是行为医学的核心内容。叙事法、行为-意向法和病人中心式健康评估咨询法已被许多研究证明是行之有效的行为干预方法,心理学中的同质化理论、自我调节理论和问题解决模型为这三种方法的有效性提供了科学解释。涟漪效应放大了行为干预的效果,其心理机制是自我决定论和自我调节论。未来的行为干预及其心理机制研究需要在理论、方法和技术层面获得新的突破。

行为医学;行为干预;涟漪效应;心理机制
ABSTRACT

The development of behavioral medicine is a new and efficient way to improve the level of national health and the behavior intervention is the core content.There are three methods including story-tellingmethod, behavior-image method and patient-centered assessment and counseling for exercise and nutrition intervention(PACE) which have been proven to be effective.The psychological theory of homophily, self-regulation and problem solving provide a scientific explanation for the effectiveness of these three kinds of behavior intervention.Ripple effect amplifies the effect of behavioral intervention and its psychological mechanism is self-determinism and self-regulation theory.In the future, the research of behavior intervention and its psychological mechanism needs to make new breakthroughs in aspects of theory, method and technology.

Behavioral medicine;Behavior intervention;Ripple effect;Psychological mechanism
Corresponding author: Li Ruiting, Email: mocdef.qabq486312637
National Natural Science Foundation of China(31571139)
引用本文

贺金波,郑阳,边慧冕,等. 公共健康领域的行为干预方法及其涟漪效应的心理机制[J]. 中华行为医学与脑科学杂志,2017,26(12):1147-1152.

DOI:10.3760/cma.j.issn.1674-6554.2017.12.018

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行为医学(behavioral medicine)是行为科学和医学相结合产生的新兴学科。它起源于20世纪70~80年代的美国,当时的背景是,虽然美国人在生活水平和医疗保健花费上位居世界前列,但国民的整体健康情况却并不乐观,人均寿命仅排在全球的35位左右。统计表明,当时美国人因病死亡原因中70%~80%死于心脏病、脑卒中、高血压和肿瘤等所谓"生活方式疾病",这些不健康的生活方式主要是暴饮暴食、抽烟、喝酒、少运动、赌博、纵欲和吸毒等。一些研究发现,通过对这些不健康行为进行干预,可极大地提高民众的健康水平和增大医疗保健的收益/投入比率,如在一些人群中劝导戒烟措施只需很小的花费却可使该人群的肺癌、高血压等发病率降低1/3,计算出的医疗保健的收益/投入比率增加了近20倍[ 1 ]。这种通过行为干预来提升国民健康水平的新学科被称为行为医学[ 2 ]。1977年在耶鲁大学召开的世界第一届行为医学大会将行为医学正式定义为"一种行为科学中的多学科、发展中的知识与技术,并与健康和疾病以及如何将它们运用到康复、预防、诊断和疾病治疗中相关联"[ 3 ]。由此可见,行为医学以解决身心健康问题和促进身心健康为主要目标,以行为干预为主要内容。所谓行为干预,就是运用行为科学理论,采取适当措施来促使人们改变不利于健康的行为和培养有益于健康的行为。在这个过程中,心理学理论和心理干预技术发挥着非常重要的作用。通过查阅和统计1990年至2016年7月期间发表的数万篇行为医学论文发现,心理学类论文占到了24%左右的比率。而且,诸多行为干预的研究还发现,行为干预不只单纯改变了当初设计的目标行为(如戒烟),而且还可引发其他行为的相继改变(如体育锻炼),这就是行为干预的"涟漪效应(ripple effect)"。一些研究证明,涟漪效应的内在本质是人的心理改变的连续过程及其机制[ 4 ]。但遗憾的是,在这众多的行为医学文献中,除了个体临床行为干预研究报告,少有针对公共健康问题的行为干预方法及其涟漪效应的总结和对其内在心理机制的分析。而且,近30年来,随着经济的快速发展和人民生活水平的提高,中国的心血管病和肿瘤等主要由不健康生活方式引起的疾病也已逐渐取代过去的传染性疾病,成为威胁中国人健康的主要致死性疾病[ 5 , 6 ],这使得当前的中国也面临着与美国20世纪70~80年代相类似的国民医疗保健问题。有鉴于美国行为医学发展的经验,把心理学和行为医学结合起来,建立和发展符合我国国情的行为医学学科体系具有非常重大的现实意义。但事实却是,中国的心理学迄今为止还很少关注行为医学和健康行为干预问题。因此,促使心理学主动介入行为医学,并积极参与对不健康行为的干预研究,应该成为我国行为医学当前和未来一项新的使命。基于此,本研究系统介绍了行为医学中公共健康领域的几种主要行为干预方法及其涟漪效应的心理机制,并从理论、方法和实践三个方面提出了一些促进行为医学中行为干预研究健康发展的建议。
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通信作者:李睿婷,Email:mocdef.qabq486312637
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国家自然科学基金项目 (31571139)
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