Research ArticleEffect of Health Belief Model Education on Increasing Cognitionand Self-Care Behaviour among Elderly Women with MalignantGynaecological Tumours in Fujian China

Chenyin Liu Xianjing Chen Mengli Huang Qun Xie Qiaoming Lin Siai Chenand Danfeng Shi

Department of Gynecology Fujian Maternity and Child Health Hospital Affiliated Hospital of Fujian Medical UniversityFuzhou 350001 Fujian China

Correspondence should be addressed to Danfeng Shi shidanfeng2000163com

Received 7 July 2021 Revised 26 September 2021 Accepted 28 September 2021 Published 7 October 2021

Academic Editor Redha Taiar

Copyright copy 2021 Chenyin Liu et al is is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Objective is study evaluated the effect of a health belief model (HBM) educational intervention on the self-perception of andcomplications related to disease in elderly gynaecological malignancy patients Methods is randomized controlled trial wasconducted at the Fujian Maternal and Child Health Hospital China A total of 301 women aged 60 years and older who werediagnosed with gynaecological malignancies from January 2019 to August 2020 were recruited Participants were randomlydivided into the HBM education and basic nursing groups e participants in the HBM education group received perioperativerehabilitation education based on the HBM and the participants in the basic nursing group received routine basic nursingRehabilitation training compliance psychological resilience psychological flexibility self-efficacy self-care ability and lowerextremity deep venous thrombosis (LEDVT) incidence were assessed before and after the intervention Results irty-threewomen were excluded based on the exclusion criteria and 268 participants were eventually included and randomly divided intotwo groups 134 participants in the HBM education group and 134 participants in the basic nursing group Before HBM educationthere were no significant differences in the mean scores of psychological resilience (5043plusmn 329 vs 5055plusmn 229 P 0738)psychological flexibility (4898plusmn 345 vs 4929plusmn 359 P 0465) self-efficacy (2649plusmn 526 vs 2629plusmn 641 P 0781) or reha-bilitation training compliance (284 vs 278 P 0922) between the two groups After HBM education the scores of trainingcompliance (806 vs 301 Plt 0001) psychological resilience (5547plusmn 501 vs 5046plusmn 262 Plt 0001) psychological flexibility(5653plusmn 451 vs 4913plusmn 362 Plt 0001) self-efficacy (3079plusmn 456 vs 2641plusmn 637 Plt 0001) self-care knowledge (4336plusmn 760 vs3405plusmn 699 Plt 0001) self-concept (2957plusmn 567 vs 2011plusmn 386 Plt 0001) self-care responsibility (2754plusmn 509 vs 2086plusmn 453Plt 0001) and self-care skills (3451plusmn 562 vs 2162plusmn 564 Plt 0001) were higher in the HBM education group than those in thebasic nursing group Additionally the incidence of LEDVT was lower in the HBM group than that in the basic nursing group(22 vs 83 P 0027) Conclusion is study indicated that perioperative HBM education can improve the cognition and self-care ability of elderly gynaecological malignancy patients and reduce postoperative complications

1 Introduction

In recent years the incidence of cervical cancer endometrialcancer and ovarian cancer in China has increased sub-stantially [1] in particular with the gradual extension of theaverage life span of humans the number of elderly patientswith gynaecological malignancies has increased rapidly [1]Elderly female patients especially elderly patients with

gynaecological malignancies have a relatively high incidenceof perioperative complications due to their poor physicalfunction wide scope of operation and adverse psychologicaleffects [2] It was reported that the incidence of postoperativecomplications in elderly patients with malignant gynaeco-logical tumours can reach more than 30 and the incidenceof lower extremity deep venous thrombosis (LEDVT) ac-counts for more than one-third of these complications [3]

HindawiJournal of Healthcare EngineeringVolume 2021 Article ID 1904752 9 pageshttpsdoiorg10115520211904752

erefore it is essential to implement interventions to re-duce the poor prognosis of elderly patients with gynaeco-logical malignancies

Data show that many elderly patients with gynaeco-logical malignancies die not from the disease itself but fromunawareness of their own health and unhealthy lifestylefactors [4] e memory psychological resilience cognitiveability and athletic ability of elderly patients are generallydeclining causing their self-care ability and rehabilitationcompliance to decrease [4ndash6] erefore it is particularlyimportant to pay attention to the cognitive function andhealth education of elderly patients with gynaecologicalmalignancies and systematically implement related inter-ventions [7]

e health belief model (HBM) was developed byRosenstock [8] in the 1950s e HBM is a framework usedto motivate people to take actions that have positive healthbenefits with preventing negative health consequences as aprimary motivation [8 9] e HBM focuses on the for-mation of individual health beliefs by influencing patientsrsquobeliefs guiding the formation of their health compliancebehaviours and then improving the patientrsquos physicalfunction status In recent years HBM-based interventionshave received increasing clinical attention [10 11]

Many studies [10 11] have confirmed that HBM edu-cation interventions can improve patientsrsquo cognition ofdisease and improve patientsrsquo confidence and compliancewith treatment Previous evidence [12 13] suggests thatHBM-based education can improve womenrsquos perceivedsusceptibility to cervical cancer and perceived self-efficacy toparticipate in cervical cancer screening and increasescreening coverage HBM educational interventions [14] canhelp cancer patients fight the disease and survive longerOther evidence [10] has also shown that an HBM-basednursing intervention can prevent the occurrence of lym-phedema after breast cancer surgery which is considered acost-effective intervention However the effects of HBMeducation intervention on self-perception psychologicalresilience and postoperative complications in women withgynaecological malignancies especially in elderly womenwith a high incidence of complications are still unclear

In this study we aimed to explore the effect of peri-operative HBM-based education interventions on thepostoperative rehabilitation of elderly patients with gynae-cological malignant tumours providing evidence for theapplication of HBM-based interventions in elderly patientswith gynaecological malignant tumours

2 Participants and Methods

21 Participants e present study a randomized con-trolled trial was conducted from January 2019 to August2020 Elderly (60 years and older) women with gynaeco-logical malignant tumours who were treated in FujianMaternity and Child Health Hospital were included in thisstudy All participants were required to meet the followinginclusion criteria (1) initially diagnosed with gynaecologicalmalignant tumours (including cervical endometrial andovarian cancers) by histopathology and (2) age 60 years or

older Participants meeting the following criteria were ex-cluded (1) diagnosed with benign gynaecological tumour bypostoperative pathology (2) had LEDVT before the oper-ation (3) did not know their disease status (4) suffered othermajor life events (such as divorce or widowhood) or trau-matic events (such as natural disasters or man-made di-sasters) in the previous six months (5) had previously hadother malignancies (6) had mental disorders or mentalretardation (7) were unable to communicate normally in theChinese language and (8) were lost to follow-up All eligibleparticipants were randomly divided into an HBM educationintervention group and a basic nursing group using arandomized comparison table We performed a sample sizecalculation according to two independent design data cal-culation formulas

nA κnB and nB 1 +1κ

1113874 1113875 σZ1minus α2 + Z1minus β

μA minus μB

1113888 1113889

2

1 minus β Φ Z minus Z1minusα2( 1113857 +Φ minusZ minus Z1minusα2( 1113857

Z μA minus μB

σ1nA + 1nB

1113968

(1)

κ nAnB is the matching ratio σ is the standard de-viation and Φ is the standard normal distribution functione result we obtained was that each group needed at least 63patients e sample size calculated was sufficient and thepower was 08 HBM indicators were assessed twice for allparticipants before and after the intervention e data ofthis study came from the Hospital Information System(HIS) e HIS system is an automatic recording system ofmedical data generated in the process of diagnosis andtreatment of patients e HIS system can record all thetreatment processes of patients including treatmentmethod treatment time treatment effect prognosis andfollow-up In China the HIS system is an automatic datarecording system that is purchased by the government andwidely used in all government-sponsored hospitals (Fig-ure 1) Informed consent for the research was obtained fromall participants prior to the study is study was approvedby the Ethics Committee of the Fujian Maternity and ChildHealth Hospital (2014-068)

22 HBM Education Intervention Preparation e inter-vention team consisted of 7 members 1 head nurse 3gynaecological duty nurses and 3 doctors To ensure theeffectiveness of the intervention the head nurse arranged theintervention content and trained the nurses in a unified wayso that they were familiar with the intervention content evideo ldquoprevention of LEDVT-healthy exercise in bedrdquo wasmade for the intervention group and was strictly reviewed bygynaecological clinical medicine experts and the NursingDepartment of our hospital e set of videos was composedof five episodes including information of the followingphases before the operation the period of anaesthesia-in-duced unconsciousness after the operation and within 6 h7ndash23 h and 24 h after waking from anaesthesia to discharge

2 Journal of Healthcare Engineering

23 HBM Intervention Programme ImplementationAccording to the patientrsquos understanding in-person edu-cation evaluation guidance and training were carried outthrough a combination of face-to-face teaching video ob-servation simulation teaching handgrip guidance etc Eachsession did not exceed 30min and family members wereinvited to join e intervention programme mainly in-cluded three stages

In the first stage (the first day after operation) the aim ofthe educational component was to enhance health aware-ness change cognitive bias and carry out a cognitiveevaluation e details were as follows (1) According to thepatientsrsquo own specific status they might be given individ-ualized psychological response education HBM guidanceor self-coping methods (2) After assessing the innerthoughts of the depressed patients and obtaining supportand cooperation from their families the patients were en-couraged to face the disease positively and optimistically

strengthening their confidence in overcoming the diseaseand their educational compliance (3) e causes diagnosistreatment nursing and postoperative complications ofcommon gynaecological malignant tumours were explainedto the patients helping them understand the disease andcorrect any misunderstanding

In the second stage (2ndash5 days after the operation) theaim of the educational component was to implement andevaluate the health behaviours of patients and establish asense of self-efficacy e details were as follows (1) Suc-cessful experiences were shared the patientsrsquo subjectiveinitiative in the treatment process was encouraged andparticipants were made to consciously realize that proactivehealth behaviour can reduce postoperative complications(2) Patients were encouraged to actively participate in themanagement of their own diseases and psychological ad-justment methods such as emotional transfer and trans-formation relaxation training and discussion methods were

Recruited women with cervical cancer aged 60 years and older from 012019 to 082020

(n=301)

Eligible participant (n=268)

Randomly divided into two groups (n=268)

Excluded (n=33)1 Previous other malignancies (n=8)2 LEDVT before operation (n=12)3 Unable normal communication(n=13)

HBM education group (n=134) Basic nursing group (n=134)

Initial evaluation of the HBMscore (n=134)

Initial evaluation of the HBMscore (n=133)

Excludedloss follow-up

(n=1)

HBM education intervention(n=134) Basic nursing (n=133)

HBM scores were assessed at discharge after the intervention

Figure 1 Flowchart of this study HBM health belief model

Journal of Healthcare Engineering 3

explained and demonstrated to patients (3) e patientswere allowed to continue to watch the health exercise videosfrom their beds and were guided through the exercises eindividual pain threshold and psychological characteristicsof patients were determined the flow chart of the bed healthexercise training plan was formulated the purpose andmethod of health exercise were explained to patients andtheir families by the intervention nurse and a targeteddemonstration of the operation and guidance was providedto patients (4) e patients were guided and encouraged toput the acquired knowledge into action and to play the videotwice a day with ldquoone-to-onerdquo guidance and training as-sistance e nurse often evaluated and guided the patientsrsquorehabilitation training again urging them to conduct thetraining according to the programme

In the third stage (from the 5th day after operation todischarge) the educational theme was to implement andevaluate health education e details were as follows (1)Based on the theoretical framework of the HBM questionsand answers were formulated to help patients establishhealth beliefs and engage in healthy behaviours to promotepostoperative rehabilitation For patients with incorrectanswers and training the intervention nurse provided ad-ditional explanations and demonstrations until most of thepatients answered more than 80 of the questions correctly(2) On the day of discharge the intervention nurse reas-sessed the patientrsquos mastery of the content of healthy be-haviours and patiently answered the questions raised by thepatient Further striving for the cooperation and support ofrelatives and society patients were urged to continue toestablish health beliefs and adopt healthy behaviours andwere directed to review the material regularly and to en-hance their self-care ability (3) e nurse made a rehabil-itation training plan for the discharged patients and thefamily members urged the patients to complete the planepatients were followed up 1ndash2 timesweek by telephone

24 Evaluating Indicators of Intervention EffectIndicators included compliance with training psychologicalresilience self-care ability self-efficacy psychological flex-ibility and incidence of LEDVT All the indicator ques-tionnaires have been used in China and their validity andreliability have been verified [15ndash19] We once again in-vestigated the validity and reliability of HBM index ques-tionnaires among all our participants To evaluate thevalidity we invited 6 senior nursing physicians to carry outthe item-content validity index (I-CVI) for each item using aLikert scoring system e average I-CVI for all items wascalculated as the scale-content validity index (S-CVI) einternal consistency was assessed with Cronbachrsquos alphacoefficients of each subscale All participants were evaluatedby highly trained senior nurses twice before the interventionand one day before discharge To ensure the consistency ofthe results only one observer (senior nursing physician) wasused to evaluate the indicators of all participants

Training compliance was assessed as follows (a) com-plete compliance patients actively participated in the ex-ercise and actively completed more than 80 of the

rehabilitation exercises after being reminded (b) Partialcompliance patients actively participated in the exercise butthey needed the supervision and inspection of nursing staffor family members to complete 31ndash79 of the rehabilitationexercises (c) Noncompliance patients did not activelyparticipate in exercise or chose to reduce exercise time andthey completed only 30 or less of the rehabilitation exercisecontent Partial compliance and noncompliance representedlow compliance Psychological resilience was assessed asfollows e Chinese version of the Connor DavidsonResilience Scale (CD-RISC) was used to assess the level ofpsychological resilience of patients [15] Psychologicalresilience included three factors including tenacitystrength and optimism e CD-RISC consisted of 25 itemsand was categorized into 5 levels For each item ldquo0 (never) to4 (always)rdquo was chosen in response to the item and the totalscore was 100 e self-care ability scale was used as follows[16 17] the scale included 11 items assessing various do-mains such as self-care skills self-concept self-care re-sponsibility and self-care knowledge Each item had a scoreof 0ndash4 points e better the self-care ability the higher thescore Self-efficacy was assessed as follows e self-efficacyscale (GSE) [18 20] was developed by the German scholarSchwarzer ere are 10 items in the GSE with a scoreranging from 1 (not at all true) to four (exactly true) a highscore represents high self-efficacy e scale has good reli-ability and validity in our country Psychological flexibilitywas assessed as follows e PsyFlex questionnaire [19 21]was used to assess the psychological flexibility includingcontacting the present moment diffusion acceptance self-as-context values and committed action of an individual (6items 5-point Likert scale) An example item is ldquoEven if I amsomewhere else with my thoughts in important moments Ican focus on what is going on at that timerdquo Each item isscored from one (very often) to five (very seldom) e totalscore was reversed so that a higher score was indicative ofgreater psychological flexibility e PsyFlex question itemsshowed good internal consistency in our study sample(α 083) e incidence of postoperative LEDVT wasassessed as follows [22] From the first day after the oper-ation LEDVT was evaluated daily on the patientsrsquo lowerextremities and the circumference changes at 15 cm abovethe patella and 15 cm below the patella were measured with aruler to evaluate the tenderness of the gastrocnemius musclemuscular tension Homans sign limb temperature the skincolour of extremities and pulsation of the dorsalis pedisartery In the case of one or more abnormalities colourDoppler ultrasonography in the double lower extremity veinwas performed to determine whether LEDVT existed

25 Statistical Analysis Statistical analysis was performedusing SPSS 200 software (IBM Armonk NY USA) In thestatistical analysis of the difference between the two groups anormality test was first performed for the measurement dataa T-test was used for those with a normal distribution and anonparametric test was used for those with nonnormaldistribution e X2 test or Fisherrsquos test was used to analysethe differences in enumeration data Categorical data are

4 Journal of Healthcare Engineering

expressed as percentages and measurement data are de-scribed as the meansplusmn standard deviations (SDs) e dif-ferences were considered statistically significant whenPlt 005

3 Results

31General Information of Participants e study originallyrecruited 301 participants 33 were excluded based on theexclusion criteria and 268 eligible participants (including137 patients with cervical cancer 82 patients with endo-metrial cancer and 48 patients with ovarian cancer) wereeventually included in the study According to the ran-domized comparison table we divided 268 eligible partic-ipants into two groups 134 women were included in theHBM education intervention group and 134 women wereincluded in the basic nursing group One woman in the basicnursing group was lost to follow-up and 133 women wereeventually included in the basic nursing group analysis Weanalysed the characteristics of participants between the twogroups As shown in Table 1 there were no significantdifferences in age (P 0603) BMI (P 0656) educationallevel (P 0475) marital status (P 0509) medical expenses(P 0715) tumour type (P 0755) International Federa-tion of Gynecology and Obstetrics (FIGO) stage (P 0668)hospitalization time (P 0614) or basic venous thrombo-embolism (VTE) risk (P 002) between the two groupseI-CVI of the HBM indicator ranged from 082 to 096 andthe S-CVI was 093 Cronbachrsquos alpha coefficients of eachsubscale ranged from 072 to 093 and the values for the totalscore were 086 and 085 in the HBM group and controlgroup respectively

32 Comparison of HBM Indicator Scores between the HBMEducation Group and the Basic Nursing Group before Edu-cational Intervention Before the educational interventionHBM indicator scores were compared between the twogroups (Table 2) and the complete compliance of trainingpsychological resilience score psychological flexibility self-care knowledge self-concept self-care responsibility self-care skills and self-efficacy were 284 (38134)5043plusmn 329 4898plusmn 345 3422plusmn 747 2087plusmn 4342044plusmn 458 2278plusmn 671 and 2649plusmn 526 respectivelyere were no differences compared to the basic nursinggroup (all Pgt 005)

33 Comparison of HBM Indicator Scores between the TwoGroups after the Educational Intervention e results inTable 3 show that after the HBM educational interventionwomen in the HBM education group had higher trainingcompliance (806 vs 301 Plt 0001) psychologicalresilience scores (5547plusmn 501 vs 5046plusmn 262 Plt 0001)psychological flexibility scores (5653plusmn 451 vs 4913plusmn 362Plt 0001) self-care knowledge scores (4336plusmn 760 vs3405plusmn 699 Plt 0001) self-concept scores (2957plusmn 567 vs2011plusmn 386 Plt 0001) self-care responsibility scores(2754plusmn 509 vs 2086plusmn 453 Plt 0001) self-care skillsscores (3451plusmn 562 vs 2162plusmn 564 Plt 0001) and self-

efficacy scores (3079plusmn 456 vs 2641plusmn 637 Plt 0001) thanthose in the basic nursing group Additionally the incidenceof LEDVT decreased (22 vs 83 P 0027)

34ComparisonofHBMScoresbetween theTwoGroupsbeforeand after the Intervention In the HBM education groupwomen had higher training compliance (806 vs 284Plt 0001) psychological resilience scores (5547plusmn 501 vs5043plusmn 329 Plt 0001) psychological flexibility scores(5653plusmn 451 vs 4898plusmn 345 Plt 0001) self-care knowledgescores (4336plusmn 760 vs 3422plusmn 747 Plt 0001) self-conceptscores (2957plusmn 567 vs 2087plusmn 434 Plt 0001) self-careresponsibility scores (2754plusmn 509 vs 2044plusmn 458Plt 0001) self-care skills scores (3451plusmn 562 vs2278plusmn 671 Plt 0001) and self-efficacy scores (3079plusmn 456vs 2649plusmn 526 Plt 0001) after the educational interventionthan before the intervention However there was no suchchange in the basic nursing group (Table 4)

4 Discussion

Elderly patientsrsquo cognition is relatively poor and theirpsychological flexibility level is low When confronted withdisease challenges they often cannot fully and correctlyunderstand the disease and make reasonable and positiveself-adjustments in time [23] Gynaecological cancer surgeryand postoperative life place a substantial amount of pressureon patients When elderly patients know that they aresuffering from gynaecological malignant tumours they alsoexperience high levels of psychological distress Moreoverhigh medical costs curative effects and adverse reactionswill also cause patients to experience fear which leads pa-tients to experience depression anxiety negative and pes-simistic psychological issues and pessimism [24] ereforereasonable rehabilitation intervention based on the HBMwill allow patients to develop new mechanisms of cognitionand evaluation of their disease construct new psychologicaldefences change their coping style and improve theirquality of life [25]

In this study according to the characteristics of cognitivebias and a low level of psychological flexibility of elderlypatients with gynaecological cancer rehabilitation educationbased on the HBM and positive psychological counsellingwere used to improve their cognition of the disease alleviatetheir negative emotions realize their potential and play thesubjective and active role of patients in the treatmentprocess Moreover by actively organizing and continuouslyguiding patients to perform health exercise training in bedwe consolidated and deepened patientsrsquo grasp of interven-tion information and skills which allowed patients togradually establish a positive psychological state and activelyparticipate in and cooperate with rehabilitation treatmentOur results indicated that the level of psychological resil-ience of elderly patients with gynaecological cancer wassignificantly increased after rehabilitation based on theHBM which suggested that rehabilitation based on theHBM was an important measure to improve the psycho-logical resilience of patients with gynaecological cancer

Journal of Healthcare Engineering 5

Table 1 Comparison of individual characteristics in the two groups

Characteristics HBM education group (n 134) Basic nursing group (n 133) P valueAge (years plusmnSD) 6690plusmn 725 6735plusmn 686 0603BMI (plusmnSD) 2477plusmn 329 2458plusmn 345 0656Educational level (n ())le junior middle school 98 (731) 92 (692) 0475ge senior high school 36 (269) 41 (308)Marital status (n ())Married 112 (836) 115 (865) 0509Unmarried 22 (164) 18 (135)Medical expenses (n ())Medical insurance 118 (881) 119 (895) 0715Self-paying 16 (119) 14 (105)Tumour types (n ())Cervical cancer 66 (493) 71 (534)

0755Endometrial cancer 42 (313) 40 (301)Ovarian cancer 26 (194) 22 (165)FIGO stages (n ())I 66 (493) 69 (519) 0668geII 68 (507) 64 (481)Hospitalization times (n ())lt3 126 (940) 123 (925) 0614ge3 8 (60) 10 (75)Basic VTE risk (n ())Middle risk 56 (418) 61 (459) 0502Extremely high risk 78 (582) 72 (541)HBM health belief mode SD standard deviation FIGO International Federation of Gynecology and Obstetrics VTE venous thrombus embolism

Table 2 Comparison of HBM indicator scores between the HBM education group and the basic nursing group before educationalintervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of trainingComplete compliance (n ()) 38 (284) 37 (278) 0922Low compliance (n ()) 96 (716) 96 (722)Psychological resilience score (xplusmnSD) 5043plusmn 329 5055plusmn 229 0738Psychological flexibility (xplusmnSD) 4898plusmn 345 4929plusmn 359 0465Self-care knowledge (xplusmnSD) 3422plusmn 747 3377plusmn 705 0614Self-concept (xplusmnSD) 2087plusmn 434 2022plusmn 410 0206Self-care responsibility (xplusmnSD) 2044plusmn 458 2064plusmn 471 0727Self-care skills (xplusmnSD) 2278plusmn 671 2177plusmn 582 0190Self-efficacy (xplusmnSD) 2649plusmn 526 2629plusmn 641 0781HBM health belief model x mean SD standard deviation

Table 3 Comparison of HBM indicator scores between the two groups after the educational intervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of training (n ())Complete compliance 108 (806) 40 (301) lt0001Low compliance 26 (194) 93 (699)Psychological resilience score (xplusmnSD) 5547plusmn 501 5046plusmn 262 lt0001Psychological flexibility (xplusmnSD) 5653plusmn 451 4913plusmn 362 lt0001Self-care knowledge (xplusmnSD) 4336plusmn 760 3405plusmn 699 lt0001Self-concept (xplusmnSD) 2957plusmn 567 2011plusmn 386 lt0001Self-care responsibility (xplusmnSD) 2754plusmn 509 2086plusmn 453 lt0001Self-care skills (xplusmnSD) 3451plusmn 562 2162plusmn 564 lt0001Self-efficacy (xplusmnSD) 3079plusmn 456 2641plusmn 637 lt0001Incidence of LEDVT (n ())Yes 3 (22) 11 (83) 0027No 131 (978) 122 (917)HBM health belief model x mean SD standard deviation LEDVT lower extremity deep vein thrombosis

6 Journal of Healthcare Engineering

Rehabilitation based on the HBM can enhance the psy-chological resilience and rehabilitation compliance of pa-tients leading patients to actively participate inpostoperative rehabilitation treatment and achieve a moreideal rehabilitation effect Previous studies [26 27] have alsoshown that psychological interventions can improve survivalin cancer patients is evidence further proves the value ofHBM psychological intervention in elderly gynaecologicalcancer patients in improving survival

ere is likely to be a certain correlation betweenphysical health and treatment compliance Early psycho-logical intervention can improve treatment compliance incancer patients [28] Patients with a high level of mentalflexibility and good mental health are able to actively par-ticipate in and cooperate with treatment so they have highercompliance with rehabilitation training [29] Our studyshows that the level of patientsrsquo psychological resilience andcompliance can be increased through positivity HBM ed-ucation HBM education can help patients face their diseasepositively rebuild their confidence adopt healthy behav-iours and enhance their psychological immunity increasingtheir level of psychological resilience [25]

Self-efficacy is an important factor in maintaining orchanging health behaviours e higher the level of self-efficacy the higher the level of adopting maintaining andstriving for healthy behaviours and the stronger the self-nursing ability [30] According to Wen Yrsquos [31] study theearly self-nursing ability of patients affects later outcomeserefore perioperative rehabilitation education based onthe HBM can not only strengthen the self-nursing ability ofpatients with malignant tumours but also increase the self-nursing ability and quality of life after discharge

e decline in the learning and memory abilities ofelderly patients can impact their self-efficacy and self-nursing abilities In the context of special diseases patients

can build and strengthen their self-efficacy and self-nursingskills only through active intervention reconstruction oftheir self-confidence to overcome difficulties and contin-uous demonstrative learning [32] In light of the decline inlearning and memory ability of elderly patients withgynaecological malignant tumours during HBM-basedhealth education the patients were trained in the diaphragmand lower extremity movements through the guidance ofprofessional nurses and video demonstrations and weresupervised in the hospital and during follow-up after dis-charge in this study e results indicated that the self-ef-ficacy and self-nursing ability in the intervention group weremuch higher than those in the control group after the ap-plication of rehabilitation education based on the HBMsuggesting that rehabilitation education based on the HBMcan help elderly patients with gynaecological cancer masterdisease-related knowledge and skills enhance their self-ef-ficacy adopt good rehabilitation behaviour and self-nursingability and improve rehabilitation

LEDVT is one of the most common complications ingynaecological patients [33] It can cause pain swelling anddysfunction of the lower limbs rombus detachment ofLEDVT can induce pulmonary embolism and is even life-threatening Elderly patients with gynaecological cancerrequire a wide range of operations a long duration of bedrest after the operation and a low willingness to performactivities due to lower limb dysfunction Moreover elderlypatients with gynaecological cancer have high-risk factorssuch as old age malignant tumours and other vasculardiseases [33] which makes the probability of LEDVT higherthan that among general patients Based on the individualdifferences in elderly patients with gynaecological malignanttumours rehabilitation intervention based on the HBM canhelp patients fully understand the mechanism and severityand the importance of cooperative treatment and health

Table 4 Comparison of HBM scores between the two groups before and after intervention

Groups Variables Before intervention After intervention P value

HBM education group (n 134)

Compliance of training (n) lt0001Complete compliance 38 108

Low compliance 96 26Psychological resilience score (xplusmnSD) 5043plusmn 329 5547plusmn 501 lt0001

Psychological flexibility (xplusmnSD) 4898plusmn 345 5653plusmn 451 lt0001Self-care knowledge (xplusmnSD) 3422plusmn 747 4336plusmn 760 lt0001

Self-concept (xplusmnSD) 2087plusmn 434 2957plusmn 567 lt0001Self-care responsibility (xplusmnSD) 2044plusmn 458 2754plusmn 509 lt0001

Self-care skills (xplusmnSD) 2278plusmn 671 3451plusmn 562 lt0001Self-efficacy (xplusmnSD) 2649plusmn 526 3079plusmn 456 lt0001

Basic nursing group (n 133)

Compliance of training (n) 0685Complete compliance 37 40

Low compliance 96 93Psychological resilience score (xplusmnSD) 5055plusmn 229 5046plusmn 262 0467

Psychological flexibility (xplusmnSD) 4929plusmn 359 4913plusmn 362 0124Self-care knowledge (xplusmnSD) 3377plusmn 705 3405plusmn 699 0076

Self-concept (xplusmnSD) 2022plusmn 410 2011plusmn 386 0527Self-care responsibility (xplusmnSD) 2064plusmn 471 2086plusmn 453 0181

Self-care skills (xplusmnSD) 2177plusmn 582 2162plusmn 564 0519Self-efficacy (xplusmnSD) 2629plusmn 641 2641plusmn 637 0404

HBM health belief model x mean SD standard deviation

Journal of Healthcare Engineering 7

exercise training for LEDVTand enhance their health beliefsand active participation consciousness Postoperative re-habilitation training can effectively reduce the occurrence ofdeep vein thrombosis (DVT) [34] One-on-one guidancefrom the intervention nurse can promote the patientsrsquotransition from passive exercise to active routine exerciseimprove the prognosis of patients and effectively reduce theincidence of LEDVT [22] e results of this study showedthat the incidence of LEDVT in elderly patients withgynaecological cancer decreased significantly after receivingHBM-based rehabilitation education indicating thatstrengthening HBM rehabilitation interventions can pro-mote the postoperative rehabilitation of elderly patients withgynaecological cancer especially by effectively preventingLEDVT

ere are still some potential limitations to this studyFirst the number of participants in this study was small andwe will add more participants in the next stage to furtherverify the effectiveness of the HBM education interventionSecond this study was conducted in a single centre and thereproducibility of the results is still unclear so it will beextended to multiple centres to verify the applicability of theHBM in the future Finally the follow-up data of the par-ticipants were not analysed in this study because our follow-up work is ongoing and we will analyse the results after thefollow-up is completed

5 Conclusion

Evidence from this study suggests that perioperative HBM-based educational interventions benefit mental health anddisease outcomes in elderly women with gynaecologicalmalignancies by improving self-efficacy self-care ability andcompliance

Data Availability

e data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

All authors declare that they have no conflicts of interest

Authorsrsquo Contributions

All authors made substantial contributions to conceptionand design acquisition of data or analysis and interpreta-tion of data took part in drafting the article or revising itcritically for important intellectual content agreed to submitthe article to the current journal gave final approval of theversion to be published and agree to be accountable for allaspects of the work

Acknowledgments

e authors would like to thank the investigators for theircontributions to this trial Above all the authors are gratefulto all patients who participated in this study

References

[1] X Jiang H Tang and T Chen ldquoEpidemiology of gynecologiccancers in Chinardquo Journal of gynecologic oncology vol 29no 1 p e7 2018

[2] Y Yoshida and D Inoue ldquoClinical management of chemo-therapy for elderly gynecological cancer patientsrdquo Journal ofObstetrics and Gynaecology Research vol 47 no 7pp 2261ndash2270 2021

[3] E Reiser N Potsch V Seebacher et al ldquoImpact of frailty onthe management of patients with gynecological cancer aged 80years and olderrdquo Archives of Gynecology and Obstetricsvol 303 no 2 pp 557ndash563 2021

[4] F N Lupo P Arnaboldi L Santoro et al ldquoe effects of amultimodal training program on burnout syndrome in gy-necologic oncology nurses and on the multidisciplinarypsychosocial care of gynecologic cancer patients an Italianexperiencerdquo Palliative amp Supportive Care vol 11 no 3pp 199ndash203 2013

[5] N E Avis A Colvin R Hess and J T Bromberger ldquoMidlifefactors related to psychological well-being at an older agestudy of womenrsquos health across the nationrdquo Journal ofWomenrsquos Health vol 30 no 3 pp 332ndash340 2021

[6] A Abusalehi M Vahedian-Shahroodi H Esmaily A Jafariand H Tehrani ldquoMental health promotion of the elderly innursing homes a social-cognitive interventionrdquo InternationalJournal of Gerontology vol 15 no 3 pp 221ndash227 2021

[7] S-L Oh H-j Kim S Woo et al ldquoEffects of an integratedhealth education and elastic band resistance training programon physical function and muscle strength in community-dwelling elderly women healthy Aging and Happy Aging IIstudyrdquoGeriatrics and Gerontology International vol 17 no 5pp 825ndash833 2017

[8] I M Rosenstock ldquoHistorical origins of the health beliefmodelrdquo Health Education Monographs vol 24 pp 238ndash3351974

[9] T N Maseko H C Huang and K C Lin ldquoCervical cancerscreening behavior of African women the Rosenstock healthbelief model assessmentrdquo Health Care for Women Interna-tional vol 28 pp 1ndash16 2019

[10] A Cal Z Bahar and I Gorken ldquoEffects of Health BeliefModel based nursing interventions offered at home visits onlymphedema prevention in women with breast cancer arandomised controlled trialrdquo Journal of Clinical Nursingvol 29 no 13-14 pp 2521ndash2534 2020

[11] M Damghanian H Mahmoodzadeh Z KhakbazanB Khorsand and M Motaharinezhad ldquoSelf-care behaviors inhigh-risk women for breast cancer a randomized clinical trialusing health belief model educationrdquo Journal of Educationand Health Promotion vol 9 p 265 2020

[12] M Simbar M Ghazanfarpour and S Abdolahian ldquoEffects oftraining based on the health belief model on Iranian womenrsquosperformance about cervical screening a systematic review andmeta-analysisrdquo Journal of Education and Health Promotionvol 9 p 179 2020

[13] S B Eghbal M Karimy P Kasmaei Z A RoshanR Valipour and S M Attari ldquoEvaluating the effect of aneducational program on increasing cervical cancer screeningbehavior among rural women in Guilan Iranrdquo BMCWomenrsquosHealth vol 20 no 1 p 149 2020

[14] B E Azriful E Bujawati F Nildawati R RamdanF Mallapiang and S Suyuti ldquoHealth Belief Model on womenrsquoscancer recovery (a phenomenological study on cancer survi-vors)rdquo Gaceta Sanitaria vol 35 no 1 pp S9ndashS11 2021

8 Journal of Healthcare Engineering

[15] L Wu Y Tan and Y Liu ldquoFactor structure and psychometricevaluation of the Connor-Davidson resilience scale in a newemployee population of Chinardquo BMC Psychiatry vol 17no 1 p 49 2017

[16] Y Han X Han and X Xu ldquoIntervention effect of healtheducation pathway on self-care ability and health behavior ofpatients with chronic obstructive pulmonary diseaserdquo Chinaclinical nursing vol 8 no 5 pp 438ndash440 2016

[17] X-J Fu S-D Hu Y-F Peng L-Y Zhou T Shu andD-D Song ldquoObservation of the effect of one-to-one edu-cation on high-risk cases of diabetic footrdquo World Journal ofClinical Cases vol 9 no 14 pp 3265ndash3272 2021

[18] Y Xia H Zhang Y Xia H Li L Zhai and H Wang ldquoeself-psychological safety maintenance and its influencingfactors of community frontline staff during COVID-19pandemicrdquoMedicine vol 100 no 3 Article ID e24140 2021

[19] Y Y Chong W T Chien H Y Cheng A P KassianosA T Gloster and M Karekla ldquoCan psychological flexibilityand prosociality mitigate illness perceptions toward COVID-19 on mental health A cross-sectional study among HongKong adultsrdquo Globalization and Health vol 17 no 1 p 432021

[20] S M ompson L K Low L Bude R de Vries andM Nieuwenhuijze ldquoEvaluating the effect of an educationalintervention on student midwife self-efficacy for their role asphysiological childbirth advocatesrdquo Nurse Education Todayvol 96 Article ID 104628 2021

[21] J Villanueva A H Meyer M T B Rinner et al ldquoldquoChoosechangerdquo design and methods of an acceptance and com-mitment therapy effectiveness trial for transdiagnostictreatment-resistant patientsrdquo BMC Psychiatry vol 19 no 1p 173 2019

[22] L Hu and G Liu ldquoEffects of early rehabilitation nursing onneurological functions and quality of life of patients withischemic stroke hemiplegiardquo American Journal of TourismResearch vol 13 no 4 pp 3811ndash3818 2021

[23] E Parpa E Tsilika V Gennimata and K MystakidouldquoElderly cancer patientsrsquo psychopathology a systematic re-viewrdquo Archives of Gerontology and Geriatrics vol 60 no 1pp 9ndash15 2015

[24] J Chen H Xiao Y Chen H Sun S Chen and J ZhengldquoEffect of reminiscence therapy based on positive psychologytheory (RTBPPT) on the positive feelings of the spousalcaregivers of elderly patients with advanced cancer in ChinardquoEuropean Journal of Cancer Care vol 29 no 6 Article IDe13324 2020

[25] S Folkman R S Lazarus S Pimley and J Novacek ldquoAgedifferences in stress and coping processesrdquo Psychology andAging vol 2 no 2 pp 171ndash184 1987

[26] Y Zheng F Lei and B Liu ldquoCancer diagnosis disclosure andquality of life in elderly cancer patientsrdquo Healthcare vol 7no 4 p 163 2019

[27] F Hejazi M Bahrami M Keshvari and M Alavi ldquoe effectof a communicational program on psychological distress inthe elderly suffering from cancerrdquo Iranian Journal of Nursingand Midwifery Research vol 22 no 3 pp 201ndash207 2017

[28] T Naito S Mitsunaga S Miura et al ldquoFeasibility of earlymultimodal interventions for elderly patients with advancedpancreatic and non-small-cell lung cancerrdquo Journal of Ca-chexia Sarcopenia and Muscle vol 10 no 1 pp 73ndash83 2019

[29] H Kukihara N Yamawaki M Ando M Nishio H Kimuraand Y Tamura ldquoe mediating effect of resilience betweenfamily functioning and mental well-being in hemodialysis

patients in Japan a cross-sectional designrdquo Health andQuality of Life Outcomes vol 18 no 1 p 233 2020

[30] R Prieto B Ferrell J Kim and V Sun ldquoSelf-managementcoaching promoting postoperative recovery and caregivingpreparedness for patients with lung cancer and their familycaregiversrdquo Clinical Journal of Oncology Nursing vol 25no 3 pp 290ndash296 2021

[31] Y Wen J Ma X Jiang G Gao H Xie and P Lu ldquoInflu-encing factors of holistic nursing intervention under a socialmedical model on the psychology and quality of life of patientswith advanced gastric cancerrdquo American Journal of TourismResearch vol 13 no 4 pp 3369ndash3379 2021

[32] A Bandura ldquoHealth promotion by social cognitive meansrdquoHealth Educationamp Behavior vol 31 no 2 pp 143ndash164 2004

[33] Z Li and Z Zhang ldquoe incidence and risk factors of venousthromboembolism following elective gynecological surgerieswithout systemic thromboprophylaxis--an observational co-hort study in a Chinese tertiary hospitalrdquo Clinical amp Exper-imental Obstetrics amp Gynecology vol 43 no 3 pp 365ndash3692016

[34] H Wang Y Huo Y Zhao et al ldquoClinical rehabilitation effectof postoperative lower-limb training on the patients under-going olif surgery a retrospective studyrdquo Pain Research ampManagement vol 2020 Article ID 1065202 2020

Journal of Healthcare Engineering 9

23 HBM Intervention Programme ImplementationAccording to the patientrsquos understanding in-person edu-cation evaluation guidance and training were carried outthrough a combination of face-to-face teaching video ob-servation simulation teaching handgrip guidance etc Eachsession did not exceed 30min and family members wereinvited to join e intervention programme mainly in-cluded three stages

In the first stage (the first day after operation) the aim ofthe educational component was to enhance health aware-ness change cognitive bias and carry out a cognitiveevaluation e details were as follows (1) According to thepatientsrsquo own specific status they might be given individ-ualized psychological response education HBM guidanceor self-coping methods (2) After assessing the innerthoughts of the depressed patients and obtaining supportand cooperation from their families the patients were en-couraged to face the disease positively and optimistically

strengthening their confidence in overcoming the diseaseand their educational compliance (3) e causes diagnosistreatment nursing and postoperative complications ofcommon gynaecological malignant tumours were explainedto the patients helping them understand the disease andcorrect any misunderstanding

In the second stage (2ndash5 days after the operation) theaim of the educational component was to implement andevaluate the health behaviours of patients and establish asense of self-efficacy e details were as follows (1) Suc-cessful experiences were shared the patientsrsquo subjectiveinitiative in the treatment process was encouraged andparticipants were made to consciously realize that proactivehealth behaviour can reduce postoperative complications(2) Patients were encouraged to actively participate in themanagement of their own diseases and psychological ad-justment methods such as emotional transfer and trans-formation relaxation training and discussion methods were

Recruited women with cervical cancer aged 60 years and older from 012019 to 082020

(n=301)

Eligible participant (n=268)

Randomly divided into two groups (n=268)

Excluded (n=33)1 Previous other malignancies (n=8)2 LEDVT before operation (n=12)3 Unable normal communication(n=13)

HBM education group (n=134) Basic nursing group (n=134)

Initial evaluation of the HBMscore (n=134)

Initial evaluation of the HBMscore (n=133)

Excludedloss follow-up

(n=1)

HBM education intervention(n=134) Basic nursing (n=133)

HBM scores were assessed at discharge after the intervention

Figure 1 Flowchart of this study HBM health belief model

Journal of Healthcare Engineering 3

explained and demonstrated to patients (3) e patientswere allowed to continue to watch the health exercise videosfrom their beds and were guided through the exercises eindividual pain threshold and psychological characteristicsof patients were determined the flow chart of the bed healthexercise training plan was formulated the purpose andmethod of health exercise were explained to patients andtheir families by the intervention nurse and a targeteddemonstration of the operation and guidance was providedto patients (4) e patients were guided and encouraged toput the acquired knowledge into action and to play the videotwice a day with ldquoone-to-onerdquo guidance and training as-sistance e nurse often evaluated and guided the patientsrsquorehabilitation training again urging them to conduct thetraining according to the programme

In the third stage (from the 5th day after operation todischarge) the educational theme was to implement andevaluate health education e details were as follows (1)Based on the theoretical framework of the HBM questionsand answers were formulated to help patients establishhealth beliefs and engage in healthy behaviours to promotepostoperative rehabilitation For patients with incorrectanswers and training the intervention nurse provided ad-ditional explanations and demonstrations until most of thepatients answered more than 80 of the questions correctly(2) On the day of discharge the intervention nurse reas-sessed the patientrsquos mastery of the content of healthy be-haviours and patiently answered the questions raised by thepatient Further striving for the cooperation and support ofrelatives and society patients were urged to continue toestablish health beliefs and adopt healthy behaviours andwere directed to review the material regularly and to en-hance their self-care ability (3) e nurse made a rehabil-itation training plan for the discharged patients and thefamily members urged the patients to complete the planepatients were followed up 1ndash2 timesweek by telephone

24 Evaluating Indicators of Intervention EffectIndicators included compliance with training psychologicalresilience self-care ability self-efficacy psychological flex-ibility and incidence of LEDVT All the indicator ques-tionnaires have been used in China and their validity andreliability have been verified [15ndash19] We once again in-vestigated the validity and reliability of HBM index ques-tionnaires among all our participants To evaluate thevalidity we invited 6 senior nursing physicians to carry outthe item-content validity index (I-CVI) for each item using aLikert scoring system e average I-CVI for all items wascalculated as the scale-content validity index (S-CVI) einternal consistency was assessed with Cronbachrsquos alphacoefficients of each subscale All participants were evaluatedby highly trained senior nurses twice before the interventionand one day before discharge To ensure the consistency ofthe results only one observer (senior nursing physician) wasused to evaluate the indicators of all participants

Training compliance was assessed as follows (a) com-plete compliance patients actively participated in the ex-ercise and actively completed more than 80 of the

rehabilitation exercises after being reminded (b) Partialcompliance patients actively participated in the exercise butthey needed the supervision and inspection of nursing staffor family members to complete 31ndash79 of the rehabilitationexercises (c) Noncompliance patients did not activelyparticipate in exercise or chose to reduce exercise time andthey completed only 30 or less of the rehabilitation exercisecontent Partial compliance and noncompliance representedlow compliance Psychological resilience was assessed asfollows e Chinese version of the Connor DavidsonResilience Scale (CD-RISC) was used to assess the level ofpsychological resilience of patients [15] Psychologicalresilience included three factors including tenacitystrength and optimism e CD-RISC consisted of 25 itemsand was categorized into 5 levels For each item ldquo0 (never) to4 (always)rdquo was chosen in response to the item and the totalscore was 100 e self-care ability scale was used as follows[16 17] the scale included 11 items assessing various do-mains such as self-care skills self-concept self-care re-sponsibility and self-care knowledge Each item had a scoreof 0ndash4 points e better the self-care ability the higher thescore Self-efficacy was assessed as follows e self-efficacyscale (GSE) [18 20] was developed by the German scholarSchwarzer ere are 10 items in the GSE with a scoreranging from 1 (not at all true) to four (exactly true) a highscore represents high self-efficacy e scale has good reli-ability and validity in our country Psychological flexibilitywas assessed as follows e PsyFlex questionnaire [19 21]was used to assess the psychological flexibility includingcontacting the present moment diffusion acceptance self-as-context values and committed action of an individual (6items 5-point Likert scale) An example item is ldquoEven if I amsomewhere else with my thoughts in important moments Ican focus on what is going on at that timerdquo Each item isscored from one (very often) to five (very seldom) e totalscore was reversed so that a higher score was indicative ofgreater psychological flexibility e PsyFlex question itemsshowed good internal consistency in our study sample(α 083) e incidence of postoperative LEDVT wasassessed as follows [22] From the first day after the oper-ation LEDVT was evaluated daily on the patientsrsquo lowerextremities and the circumference changes at 15 cm abovethe patella and 15 cm below the patella were measured with aruler to evaluate the tenderness of the gastrocnemius musclemuscular tension Homans sign limb temperature the skincolour of extremities and pulsation of the dorsalis pedisartery In the case of one or more abnormalities colourDoppler ultrasonography in the double lower extremity veinwas performed to determine whether LEDVT existed

25 Statistical Analysis Statistical analysis was performedusing SPSS 200 software (IBM Armonk NY USA) In thestatistical analysis of the difference between the two groups anormality test was first performed for the measurement dataa T-test was used for those with a normal distribution and anonparametric test was used for those with nonnormaldistribution e X2 test or Fisherrsquos test was used to analysethe differences in enumeration data Categorical data are

4 Journal of Healthcare Engineering

expressed as percentages and measurement data are de-scribed as the meansplusmn standard deviations (SDs) e dif-ferences were considered statistically significant whenPlt 005

3 Results

31General Information of Participants e study originallyrecruited 301 participants 33 were excluded based on theexclusion criteria and 268 eligible participants (including137 patients with cervical cancer 82 patients with endo-metrial cancer and 48 patients with ovarian cancer) wereeventually included in the study According to the ran-domized comparison table we divided 268 eligible partic-ipants into two groups 134 women were included in theHBM education intervention group and 134 women wereincluded in the basic nursing group One woman in the basicnursing group was lost to follow-up and 133 women wereeventually included in the basic nursing group analysis Weanalysed the characteristics of participants between the twogroups As shown in Table 1 there were no significantdifferences in age (P 0603) BMI (P 0656) educationallevel (P 0475) marital status (P 0509) medical expenses(P 0715) tumour type (P 0755) International Federa-tion of Gynecology and Obstetrics (FIGO) stage (P 0668)hospitalization time (P 0614) or basic venous thrombo-embolism (VTE) risk (P 002) between the two groupseI-CVI of the HBM indicator ranged from 082 to 096 andthe S-CVI was 093 Cronbachrsquos alpha coefficients of eachsubscale ranged from 072 to 093 and the values for the totalscore were 086 and 085 in the HBM group and controlgroup respectively

32 Comparison of HBM Indicator Scores between the HBMEducation Group and the Basic Nursing Group before Edu-cational Intervention Before the educational interventionHBM indicator scores were compared between the twogroups (Table 2) and the complete compliance of trainingpsychological resilience score psychological flexibility self-care knowledge self-concept self-care responsibility self-care skills and self-efficacy were 284 (38134)5043plusmn 329 4898plusmn 345 3422plusmn 747 2087plusmn 4342044plusmn 458 2278plusmn 671 and 2649plusmn 526 respectivelyere were no differences compared to the basic nursinggroup (all Pgt 005)

33 Comparison of HBM Indicator Scores between the TwoGroups after the Educational Intervention e results inTable 3 show that after the HBM educational interventionwomen in the HBM education group had higher trainingcompliance (806 vs 301 Plt 0001) psychologicalresilience scores (5547plusmn 501 vs 5046plusmn 262 Plt 0001)psychological flexibility scores (5653plusmn 451 vs 4913plusmn 362Plt 0001) self-care knowledge scores (4336plusmn 760 vs3405plusmn 699 Plt 0001) self-concept scores (2957plusmn 567 vs2011plusmn 386 Plt 0001) self-care responsibility scores(2754plusmn 509 vs 2086plusmn 453 Plt 0001) self-care skillsscores (3451plusmn 562 vs 2162plusmn 564 Plt 0001) and self-

efficacy scores (3079plusmn 456 vs 2641plusmn 637 Plt 0001) thanthose in the basic nursing group Additionally the incidenceof LEDVT decreased (22 vs 83 P 0027)

34ComparisonofHBMScoresbetween theTwoGroupsbeforeand after the Intervention In the HBM education groupwomen had higher training compliance (806 vs 284Plt 0001) psychological resilience scores (5547plusmn 501 vs5043plusmn 329 Plt 0001) psychological flexibility scores(5653plusmn 451 vs 4898plusmn 345 Plt 0001) self-care knowledgescores (4336plusmn 760 vs 3422plusmn 747 Plt 0001) self-conceptscores (2957plusmn 567 vs 2087plusmn 434 Plt 0001) self-careresponsibility scores (2754plusmn 509 vs 2044plusmn 458Plt 0001) self-care skills scores (3451plusmn 562 vs2278plusmn 671 Plt 0001) and self-efficacy scores (3079plusmn 456vs 2649plusmn 526 Plt 0001) after the educational interventionthan before the intervention However there was no suchchange in the basic nursing group (Table 4)

4 Discussion

Elderly patientsrsquo cognition is relatively poor and theirpsychological flexibility level is low When confronted withdisease challenges they often cannot fully and correctlyunderstand the disease and make reasonable and positiveself-adjustments in time [23] Gynaecological cancer surgeryand postoperative life place a substantial amount of pressureon patients When elderly patients know that they aresuffering from gynaecological malignant tumours they alsoexperience high levels of psychological distress Moreoverhigh medical costs curative effects and adverse reactionswill also cause patients to experience fear which leads pa-tients to experience depression anxiety negative and pes-simistic psychological issues and pessimism [24] ereforereasonable rehabilitation intervention based on the HBMwill allow patients to develop new mechanisms of cognitionand evaluation of their disease construct new psychologicaldefences change their coping style and improve theirquality of life [25]

In this study according to the characteristics of cognitivebias and a low level of psychological flexibility of elderlypatients with gynaecological cancer rehabilitation educationbased on the HBM and positive psychological counsellingwere used to improve their cognition of the disease alleviatetheir negative emotions realize their potential and play thesubjective and active role of patients in the treatmentprocess Moreover by actively organizing and continuouslyguiding patients to perform health exercise training in bedwe consolidated and deepened patientsrsquo grasp of interven-tion information and skills which allowed patients togradually establish a positive psychological state and activelyparticipate in and cooperate with rehabilitation treatmentOur results indicated that the level of psychological resil-ience of elderly patients with gynaecological cancer wassignificantly increased after rehabilitation based on theHBM which suggested that rehabilitation based on theHBM was an important measure to improve the psycho-logical resilience of patients with gynaecological cancer

Journal of Healthcare Engineering 5

Table 1 Comparison of individual characteristics in the two groups

Characteristics HBM education group (n 134) Basic nursing group (n 133) P valueAge (years plusmnSD) 6690plusmn 725 6735plusmn 686 0603BMI (plusmnSD) 2477plusmn 329 2458plusmn 345 0656Educational level (n ())le junior middle school 98 (731) 92 (692) 0475ge senior high school 36 (269) 41 (308)Marital status (n ())Married 112 (836) 115 (865) 0509Unmarried 22 (164) 18 (135)Medical expenses (n ())Medical insurance 118 (881) 119 (895) 0715Self-paying 16 (119) 14 (105)Tumour types (n ())Cervical cancer 66 (493) 71 (534)

0755Endometrial cancer 42 (313) 40 (301)Ovarian cancer 26 (194) 22 (165)FIGO stages (n ())I 66 (493) 69 (519) 0668geII 68 (507) 64 (481)Hospitalization times (n ())lt3 126 (940) 123 (925) 0614ge3 8 (60) 10 (75)Basic VTE risk (n ())Middle risk 56 (418) 61 (459) 0502Extremely high risk 78 (582) 72 (541)HBM health belief mode SD standard deviation FIGO International Federation of Gynecology and Obstetrics VTE venous thrombus embolism

Table 2 Comparison of HBM indicator scores between the HBM education group and the basic nursing group before educationalintervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of trainingComplete compliance (n ()) 38 (284) 37 (278) 0922Low compliance (n ()) 96 (716) 96 (722)Psychological resilience score (xplusmnSD) 5043plusmn 329 5055plusmn 229 0738Psychological flexibility (xplusmnSD) 4898plusmn 345 4929plusmn 359 0465Self-care knowledge (xplusmnSD) 3422plusmn 747 3377plusmn 705 0614Self-concept (xplusmnSD) 2087plusmn 434 2022plusmn 410 0206Self-care responsibility (xplusmnSD) 2044plusmn 458 2064plusmn 471 0727Self-care skills (xplusmnSD) 2278plusmn 671 2177plusmn 582 0190Self-efficacy (xplusmnSD) 2649plusmn 526 2629plusmn 641 0781HBM health belief model x mean SD standard deviation

Table 3 Comparison of HBM indicator scores between the two groups after the educational intervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of training (n ())Complete compliance 108 (806) 40 (301) lt0001Low compliance 26 (194) 93 (699)Psychological resilience score (xplusmnSD) 5547plusmn 501 5046plusmn 262 lt0001Psychological flexibility (xplusmnSD) 5653plusmn 451 4913plusmn 362 lt0001Self-care knowledge (xplusmnSD) 4336plusmn 760 3405plusmn 699 lt0001Self-concept (xplusmnSD) 2957plusmn 567 2011plusmn 386 lt0001Self-care responsibility (xplusmnSD) 2754plusmn 509 2086plusmn 453 lt0001Self-care skills (xplusmnSD) 3451plusmn 562 2162plusmn 564 lt0001Self-efficacy (xplusmnSD) 3079plusmn 456 2641plusmn 637 lt0001Incidence of LEDVT (n ())Yes 3 (22) 11 (83) 0027No 131 (978) 122 (917)HBM health belief model x mean SD standard deviation LEDVT lower extremity deep vein thrombosis

6 Journal of Healthcare Engineering

Rehabilitation based on the HBM can enhance the psy-chological resilience and rehabilitation compliance of pa-tients leading patients to actively participate inpostoperative rehabilitation treatment and achieve a moreideal rehabilitation effect Previous studies [26 27] have alsoshown that psychological interventions can improve survivalin cancer patients is evidence further proves the value ofHBM psychological intervention in elderly gynaecologicalcancer patients in improving survival

ere is likely to be a certain correlation betweenphysical health and treatment compliance Early psycho-logical intervention can improve treatment compliance incancer patients [28] Patients with a high level of mentalflexibility and good mental health are able to actively par-ticipate in and cooperate with treatment so they have highercompliance with rehabilitation training [29] Our studyshows that the level of patientsrsquo psychological resilience andcompliance can be increased through positivity HBM ed-ucation HBM education can help patients face their diseasepositively rebuild their confidence adopt healthy behav-iours and enhance their psychological immunity increasingtheir level of psychological resilience [25]

Self-efficacy is an important factor in maintaining orchanging health behaviours e higher the level of self-efficacy the higher the level of adopting maintaining andstriving for healthy behaviours and the stronger the self-nursing ability [30] According to Wen Yrsquos [31] study theearly self-nursing ability of patients affects later outcomeserefore perioperative rehabilitation education based onthe HBM can not only strengthen the self-nursing ability ofpatients with malignant tumours but also increase the self-nursing ability and quality of life after discharge

e decline in the learning and memory abilities ofelderly patients can impact their self-efficacy and self-nursing abilities In the context of special diseases patients

can build and strengthen their self-efficacy and self-nursingskills only through active intervention reconstruction oftheir self-confidence to overcome difficulties and contin-uous demonstrative learning [32] In light of the decline inlearning and memory ability of elderly patients withgynaecological malignant tumours during HBM-basedhealth education the patients were trained in the diaphragmand lower extremity movements through the guidance ofprofessional nurses and video demonstrations and weresupervised in the hospital and during follow-up after dis-charge in this study e results indicated that the self-ef-ficacy and self-nursing ability in the intervention group weremuch higher than those in the control group after the ap-plication of rehabilitation education based on the HBMsuggesting that rehabilitation education based on the HBMcan help elderly patients with gynaecological cancer masterdisease-related knowledge and skills enhance their self-ef-ficacy adopt good rehabilitation behaviour and self-nursingability and improve rehabilitation

LEDVT is one of the most common complications ingynaecological patients [33] It can cause pain swelling anddysfunction of the lower limbs rombus detachment ofLEDVT can induce pulmonary embolism and is even life-threatening Elderly patients with gynaecological cancerrequire a wide range of operations a long duration of bedrest after the operation and a low willingness to performactivities due to lower limb dysfunction Moreover elderlypatients with gynaecological cancer have high-risk factorssuch as old age malignant tumours and other vasculardiseases [33] which makes the probability of LEDVT higherthan that among general patients Based on the individualdifferences in elderly patients with gynaecological malignanttumours rehabilitation intervention based on the HBM canhelp patients fully understand the mechanism and severityand the importance of cooperative treatment and health

Table 4 Comparison of HBM scores between the two groups before and after intervention

Groups Variables Before intervention After intervention P value

HBM education group (n 134)

Compliance of training (n) lt0001Complete compliance 38 108

Low compliance 96 26Psychological resilience score (xplusmnSD) 5043plusmn 329 5547plusmn 501 lt0001

Psychological flexibility (xplusmnSD) 4898plusmn 345 5653plusmn 451 lt0001Self-care knowledge (xplusmnSD) 3422plusmn 747 4336plusmn 760 lt0001

Self-concept (xplusmnSD) 2087plusmn 434 2957plusmn 567 lt0001Self-care responsibility (xplusmnSD) 2044plusmn 458 2754plusmn 509 lt0001

Self-care skills (xplusmnSD) 2278plusmn 671 3451plusmn 562 lt0001Self-efficacy (xplusmnSD) 2649plusmn 526 3079plusmn 456 lt0001

Basic nursing group (n 133)

Compliance of training (n) 0685Complete compliance 37 40

Low compliance 96 93Psychological resilience score (xplusmnSD) 5055plusmn 229 5046plusmn 262 0467

Psychological flexibility (xplusmnSD) 4929plusmn 359 4913plusmn 362 0124Self-care knowledge (xplusmnSD) 3377plusmn 705 3405plusmn 699 0076

Self-concept (xplusmnSD) 2022plusmn 410 2011plusmn 386 0527Self-care responsibility (xplusmnSD) 2064plusmn 471 2086plusmn 453 0181

Self-care skills (xplusmnSD) 2177plusmn 582 2162plusmn 564 0519Self-efficacy (xplusmnSD) 2629plusmn 641 2641plusmn 637 0404

HBM health belief model x mean SD standard deviation

Journal of Healthcare Engineering 7

exercise training for LEDVTand enhance their health beliefsand active participation consciousness Postoperative re-habilitation training can effectively reduce the occurrence ofdeep vein thrombosis (DVT) [34] One-on-one guidancefrom the intervention nurse can promote the patientsrsquotransition from passive exercise to active routine exerciseimprove the prognosis of patients and effectively reduce theincidence of LEDVT [22] e results of this study showedthat the incidence of LEDVT in elderly patients withgynaecological cancer decreased significantly after receivingHBM-based rehabilitation education indicating thatstrengthening HBM rehabilitation interventions can pro-mote the postoperative rehabilitation of elderly patients withgynaecological cancer especially by effectively preventingLEDVT

ere are still some potential limitations to this studyFirst the number of participants in this study was small andwe will add more participants in the next stage to furtherverify the effectiveness of the HBM education interventionSecond this study was conducted in a single centre and thereproducibility of the results is still unclear so it will beextended to multiple centres to verify the applicability of theHBM in the future Finally the follow-up data of the par-ticipants were not analysed in this study because our follow-up work is ongoing and we will analyse the results after thefollow-up is completed

5 Conclusion

Evidence from this study suggests that perioperative HBM-based educational interventions benefit mental health anddisease outcomes in elderly women with gynaecologicalmalignancies by improving self-efficacy self-care ability andcompliance

Data Availability

e data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

All authors declare that they have no conflicts of interest

Authorsrsquo Contributions

All authors made substantial contributions to conceptionand design acquisition of data or analysis and interpreta-tion of data took part in drafting the article or revising itcritically for important intellectual content agreed to submitthe article to the current journal gave final approval of theversion to be published and agree to be accountable for allaspects of the work

Acknowledgments

e authors would like to thank the investigators for theircontributions to this trial Above all the authors are gratefulto all patients who participated in this study

References

[1] X Jiang H Tang and T Chen ldquoEpidemiology of gynecologiccancers in Chinardquo Journal of gynecologic oncology vol 29no 1 p e7 2018

[2] Y Yoshida and D Inoue ldquoClinical management of chemo-therapy for elderly gynecological cancer patientsrdquo Journal ofObstetrics and Gynaecology Research vol 47 no 7pp 2261ndash2270 2021

[3] E Reiser N Potsch V Seebacher et al ldquoImpact of frailty onthe management of patients with gynecological cancer aged 80years and olderrdquo Archives of Gynecology and Obstetricsvol 303 no 2 pp 557ndash563 2021

[4] F N Lupo P Arnaboldi L Santoro et al ldquoe effects of amultimodal training program on burnout syndrome in gy-necologic oncology nurses and on the multidisciplinarypsychosocial care of gynecologic cancer patients an Italianexperiencerdquo Palliative amp Supportive Care vol 11 no 3pp 199ndash203 2013

[5] N E Avis A Colvin R Hess and J T Bromberger ldquoMidlifefactors related to psychological well-being at an older agestudy of womenrsquos health across the nationrdquo Journal ofWomenrsquos Health vol 30 no 3 pp 332ndash340 2021

[6] A Abusalehi M Vahedian-Shahroodi H Esmaily A Jafariand H Tehrani ldquoMental health promotion of the elderly innursing homes a social-cognitive interventionrdquo InternationalJournal of Gerontology vol 15 no 3 pp 221ndash227 2021

[7] S-L Oh H-j Kim S Woo et al ldquoEffects of an integratedhealth education and elastic band resistance training programon physical function and muscle strength in community-dwelling elderly women healthy Aging and Happy Aging IIstudyrdquoGeriatrics and Gerontology International vol 17 no 5pp 825ndash833 2017

[8] I M Rosenstock ldquoHistorical origins of the health beliefmodelrdquo Health Education Monographs vol 24 pp 238ndash3351974

[9] T N Maseko H C Huang and K C Lin ldquoCervical cancerscreening behavior of African women the Rosenstock healthbelief model assessmentrdquo Health Care for Women Interna-tional vol 28 pp 1ndash16 2019

[10] A Cal Z Bahar and I Gorken ldquoEffects of Health BeliefModel based nursing interventions offered at home visits onlymphedema prevention in women with breast cancer arandomised controlled trialrdquo Journal of Clinical Nursingvol 29 no 13-14 pp 2521ndash2534 2020

[11] M Damghanian H Mahmoodzadeh Z KhakbazanB Khorsand and M Motaharinezhad ldquoSelf-care behaviors inhigh-risk women for breast cancer a randomized clinical trialusing health belief model educationrdquo Journal of Educationand Health Promotion vol 9 p 265 2020

[12] M Simbar M Ghazanfarpour and S Abdolahian ldquoEffects oftraining based on the health belief model on Iranian womenrsquosperformance about cervical screening a systematic review andmeta-analysisrdquo Journal of Education and Health Promotionvol 9 p 179 2020

[13] S B Eghbal M Karimy P Kasmaei Z A RoshanR Valipour and S M Attari ldquoEvaluating the effect of aneducational program on increasing cervical cancer screeningbehavior among rural women in Guilan Iranrdquo BMCWomenrsquosHealth vol 20 no 1 p 149 2020

[14] B E Azriful E Bujawati F Nildawati R RamdanF Mallapiang and S Suyuti ldquoHealth Belief Model on womenrsquoscancer recovery (a phenomenological study on cancer survi-vors)rdquo Gaceta Sanitaria vol 35 no 1 pp S9ndashS11 2021

8 Journal of Healthcare Engineering

[15] L Wu Y Tan and Y Liu ldquoFactor structure and psychometricevaluation of the Connor-Davidson resilience scale in a newemployee population of Chinardquo BMC Psychiatry vol 17no 1 p 49 2017

[16] Y Han X Han and X Xu ldquoIntervention effect of healtheducation pathway on self-care ability and health behavior ofpatients with chronic obstructive pulmonary diseaserdquo Chinaclinical nursing vol 8 no 5 pp 438ndash440 2016

[17] X-J Fu S-D Hu Y-F Peng L-Y Zhou T Shu andD-D Song ldquoObservation of the effect of one-to-one edu-cation on high-risk cases of diabetic footrdquo World Journal ofClinical Cases vol 9 no 14 pp 3265ndash3272 2021

[18] Y Xia H Zhang Y Xia H Li L Zhai and H Wang ldquoeself-psychological safety maintenance and its influencingfactors of community frontline staff during COVID-19pandemicrdquoMedicine vol 100 no 3 Article ID e24140 2021

[19] Y Y Chong W T Chien H Y Cheng A P KassianosA T Gloster and M Karekla ldquoCan psychological flexibilityand prosociality mitigate illness perceptions toward COVID-19 on mental health A cross-sectional study among HongKong adultsrdquo Globalization and Health vol 17 no 1 p 432021

[20] S M ompson L K Low L Bude R de Vries andM Nieuwenhuijze ldquoEvaluating the effect of an educationalintervention on student midwife self-efficacy for their role asphysiological childbirth advocatesrdquo Nurse Education Todayvol 96 Article ID 104628 2021

[21] J Villanueva A H Meyer M T B Rinner et al ldquoldquoChoosechangerdquo design and methods of an acceptance and com-mitment therapy effectiveness trial for transdiagnostictreatment-resistant patientsrdquo BMC Psychiatry vol 19 no 1p 173 2019

[22] L Hu and G Liu ldquoEffects of early rehabilitation nursing onneurological functions and quality of life of patients withischemic stroke hemiplegiardquo American Journal of TourismResearch vol 13 no 4 pp 3811ndash3818 2021

[23] E Parpa E Tsilika V Gennimata and K MystakidouldquoElderly cancer patientsrsquo psychopathology a systematic re-viewrdquo Archives of Gerontology and Geriatrics vol 60 no 1pp 9ndash15 2015

[24] J Chen H Xiao Y Chen H Sun S Chen and J ZhengldquoEffect of reminiscence therapy based on positive psychologytheory (RTBPPT) on the positive feelings of the spousalcaregivers of elderly patients with advanced cancer in ChinardquoEuropean Journal of Cancer Care vol 29 no 6 Article IDe13324 2020

[25] S Folkman R S Lazarus S Pimley and J Novacek ldquoAgedifferences in stress and coping processesrdquo Psychology andAging vol 2 no 2 pp 171ndash184 1987

[26] Y Zheng F Lei and B Liu ldquoCancer diagnosis disclosure andquality of life in elderly cancer patientsrdquo Healthcare vol 7no 4 p 163 2019

[27] F Hejazi M Bahrami M Keshvari and M Alavi ldquoe effectof a communicational program on psychological distress inthe elderly suffering from cancerrdquo Iranian Journal of Nursingand Midwifery Research vol 22 no 3 pp 201ndash207 2017

[28] T Naito S Mitsunaga S Miura et al ldquoFeasibility of earlymultimodal interventions for elderly patients with advancedpancreatic and non-small-cell lung cancerrdquo Journal of Ca-chexia Sarcopenia and Muscle vol 10 no 1 pp 73ndash83 2019

[29] H Kukihara N Yamawaki M Ando M Nishio H Kimuraand Y Tamura ldquoe mediating effect of resilience betweenfamily functioning and mental well-being in hemodialysis

patients in Japan a cross-sectional designrdquo Health andQuality of Life Outcomes vol 18 no 1 p 233 2020

[30] R Prieto B Ferrell J Kim and V Sun ldquoSelf-managementcoaching promoting postoperative recovery and caregivingpreparedness for patients with lung cancer and their familycaregiversrdquo Clinical Journal of Oncology Nursing vol 25no 3 pp 290ndash296 2021

[31] Y Wen J Ma X Jiang G Gao H Xie and P Lu ldquoInflu-encing factors of holistic nursing intervention under a socialmedical model on the psychology and quality of life of patientswith advanced gastric cancerrdquo American Journal of TourismResearch vol 13 no 4 pp 3369ndash3379 2021

[32] A Bandura ldquoHealth promotion by social cognitive meansrdquoHealth Educationamp Behavior vol 31 no 2 pp 143ndash164 2004

[33] Z Li and Z Zhang ldquoe incidence and risk factors of venousthromboembolism following elective gynecological surgerieswithout systemic thromboprophylaxis--an observational co-hort study in a Chinese tertiary hospitalrdquo Clinical amp Exper-imental Obstetrics amp Gynecology vol 43 no 3 pp 365ndash3692016

[34] H Wang Y Huo Y Zhao et al ldquoClinical rehabilitation effectof postoperative lower-limb training on the patients under-going olif surgery a retrospective studyrdquo Pain Research ampManagement vol 2020 Article ID 1065202 2020

Journal of Healthcare Engineering 9

explained and demonstrated to patients (3) e patientswere allowed to continue to watch the health exercise videosfrom their beds and were guided through the exercises eindividual pain threshold and psychological characteristicsof patients were determined the flow chart of the bed healthexercise training plan was formulated the purpose andmethod of health exercise were explained to patients andtheir families by the intervention nurse and a targeteddemonstration of the operation and guidance was providedto patients (4) e patients were guided and encouraged toput the acquired knowledge into action and to play the videotwice a day with ldquoone-to-onerdquo guidance and training as-sistance e nurse often evaluated and guided the patientsrsquorehabilitation training again urging them to conduct thetraining according to the programme

In the third stage (from the 5th day after operation todischarge) the educational theme was to implement andevaluate health education e details were as follows (1)Based on the theoretical framework of the HBM questionsand answers were formulated to help patients establishhealth beliefs and engage in healthy behaviours to promotepostoperative rehabilitation For patients with incorrectanswers and training the intervention nurse provided ad-ditional explanations and demonstrations until most of thepatients answered more than 80 of the questions correctly(2) On the day of discharge the intervention nurse reas-sessed the patientrsquos mastery of the content of healthy be-haviours and patiently answered the questions raised by thepatient Further striving for the cooperation and support ofrelatives and society patients were urged to continue toestablish health beliefs and adopt healthy behaviours andwere directed to review the material regularly and to en-hance their self-care ability (3) e nurse made a rehabil-itation training plan for the discharged patients and thefamily members urged the patients to complete the planepatients were followed up 1ndash2 timesweek by telephone

24 Evaluating Indicators of Intervention EffectIndicators included compliance with training psychologicalresilience self-care ability self-efficacy psychological flex-ibility and incidence of LEDVT All the indicator ques-tionnaires have been used in China and their validity andreliability have been verified [15ndash19] We once again in-vestigated the validity and reliability of HBM index ques-tionnaires among all our participants To evaluate thevalidity we invited 6 senior nursing physicians to carry outthe item-content validity index (I-CVI) for each item using aLikert scoring system e average I-CVI for all items wascalculated as the scale-content validity index (S-CVI) einternal consistency was assessed with Cronbachrsquos alphacoefficients of each subscale All participants were evaluatedby highly trained senior nurses twice before the interventionand one day before discharge To ensure the consistency ofthe results only one observer (senior nursing physician) wasused to evaluate the indicators of all participants

Training compliance was assessed as follows (a) com-plete compliance patients actively participated in the ex-ercise and actively completed more than 80 of the

rehabilitation exercises after being reminded (b) Partialcompliance patients actively participated in the exercise butthey needed the supervision and inspection of nursing staffor family members to complete 31ndash79 of the rehabilitationexercises (c) Noncompliance patients did not activelyparticipate in exercise or chose to reduce exercise time andthey completed only 30 or less of the rehabilitation exercisecontent Partial compliance and noncompliance representedlow compliance Psychological resilience was assessed asfollows e Chinese version of the Connor DavidsonResilience Scale (CD-RISC) was used to assess the level ofpsychological resilience of patients [15] Psychologicalresilience included three factors including tenacitystrength and optimism e CD-RISC consisted of 25 itemsand was categorized into 5 levels For each item ldquo0 (never) to4 (always)rdquo was chosen in response to the item and the totalscore was 100 e self-care ability scale was used as follows[16 17] the scale included 11 items assessing various do-mains such as self-care skills self-concept self-care re-sponsibility and self-care knowledge Each item had a scoreof 0ndash4 points e better the self-care ability the higher thescore Self-efficacy was assessed as follows e self-efficacyscale (GSE) [18 20] was developed by the German scholarSchwarzer ere are 10 items in the GSE with a scoreranging from 1 (not at all true) to four (exactly true) a highscore represents high self-efficacy e scale has good reli-ability and validity in our country Psychological flexibilitywas assessed as follows e PsyFlex questionnaire [19 21]was used to assess the psychological flexibility includingcontacting the present moment diffusion acceptance self-as-context values and committed action of an individual (6items 5-point Likert scale) An example item is ldquoEven if I amsomewhere else with my thoughts in important moments Ican focus on what is going on at that timerdquo Each item isscored from one (very often) to five (very seldom) e totalscore was reversed so that a higher score was indicative ofgreater psychological flexibility e PsyFlex question itemsshowed good internal consistency in our study sample(α 083) e incidence of postoperative LEDVT wasassessed as follows [22] From the first day after the oper-ation LEDVT was evaluated daily on the patientsrsquo lowerextremities and the circumference changes at 15 cm abovethe patella and 15 cm below the patella were measured with aruler to evaluate the tenderness of the gastrocnemius musclemuscular tension Homans sign limb temperature the skincolour of extremities and pulsation of the dorsalis pedisartery In the case of one or more abnormalities colourDoppler ultrasonography in the double lower extremity veinwas performed to determine whether LEDVT existed

25 Statistical Analysis Statistical analysis was performedusing SPSS 200 software (IBM Armonk NY USA) In thestatistical analysis of the difference between the two groups anormality test was first performed for the measurement dataa T-test was used for those with a normal distribution and anonparametric test was used for those with nonnormaldistribution e X2 test or Fisherrsquos test was used to analysethe differences in enumeration data Categorical data are

4 Journal of Healthcare Engineering

expressed as percentages and measurement data are de-scribed as the meansplusmn standard deviations (SDs) e dif-ferences were considered statistically significant whenPlt 005

3 Results

31General Information of Participants e study originallyrecruited 301 participants 33 were excluded based on theexclusion criteria and 268 eligible participants (including137 patients with cervical cancer 82 patients with endo-metrial cancer and 48 patients with ovarian cancer) wereeventually included in the study According to the ran-domized comparison table we divided 268 eligible partic-ipants into two groups 134 women were included in theHBM education intervention group and 134 women wereincluded in the basic nursing group One woman in the basicnursing group was lost to follow-up and 133 women wereeventually included in the basic nursing group analysis Weanalysed the characteristics of participants between the twogroups As shown in Table 1 there were no significantdifferences in age (P 0603) BMI (P 0656) educationallevel (P 0475) marital status (P 0509) medical expenses(P 0715) tumour type (P 0755) International Federa-tion of Gynecology and Obstetrics (FIGO) stage (P 0668)hospitalization time (P 0614) or basic venous thrombo-embolism (VTE) risk (P 002) between the two groupseI-CVI of the HBM indicator ranged from 082 to 096 andthe S-CVI was 093 Cronbachrsquos alpha coefficients of eachsubscale ranged from 072 to 093 and the values for the totalscore were 086 and 085 in the HBM group and controlgroup respectively

32 Comparison of HBM Indicator Scores between the HBMEducation Group and the Basic Nursing Group before Edu-cational Intervention Before the educational interventionHBM indicator scores were compared between the twogroups (Table 2) and the complete compliance of trainingpsychological resilience score psychological flexibility self-care knowledge self-concept self-care responsibility self-care skills and self-efficacy were 284 (38134)5043plusmn 329 4898plusmn 345 3422plusmn 747 2087plusmn 4342044plusmn 458 2278plusmn 671 and 2649plusmn 526 respectivelyere were no differences compared to the basic nursinggroup (all Pgt 005)

33 Comparison of HBM Indicator Scores between the TwoGroups after the Educational Intervention e results inTable 3 show that after the HBM educational interventionwomen in the HBM education group had higher trainingcompliance (806 vs 301 Plt 0001) psychologicalresilience scores (5547plusmn 501 vs 5046plusmn 262 Plt 0001)psychological flexibility scores (5653plusmn 451 vs 4913plusmn 362Plt 0001) self-care knowledge scores (4336plusmn 760 vs3405plusmn 699 Plt 0001) self-concept scores (2957plusmn 567 vs2011plusmn 386 Plt 0001) self-care responsibility scores(2754plusmn 509 vs 2086plusmn 453 Plt 0001) self-care skillsscores (3451plusmn 562 vs 2162plusmn 564 Plt 0001) and self-

efficacy scores (3079plusmn 456 vs 2641plusmn 637 Plt 0001) thanthose in the basic nursing group Additionally the incidenceof LEDVT decreased (22 vs 83 P 0027)

34ComparisonofHBMScoresbetween theTwoGroupsbeforeand after the Intervention In the HBM education groupwomen had higher training compliance (806 vs 284Plt 0001) psychological resilience scores (5547plusmn 501 vs5043plusmn 329 Plt 0001) psychological flexibility scores(5653plusmn 451 vs 4898plusmn 345 Plt 0001) self-care knowledgescores (4336plusmn 760 vs 3422plusmn 747 Plt 0001) self-conceptscores (2957plusmn 567 vs 2087plusmn 434 Plt 0001) self-careresponsibility scores (2754plusmn 509 vs 2044plusmn 458Plt 0001) self-care skills scores (3451plusmn 562 vs2278plusmn 671 Plt 0001) and self-efficacy scores (3079plusmn 456vs 2649plusmn 526 Plt 0001) after the educational interventionthan before the intervention However there was no suchchange in the basic nursing group (Table 4)

4 Discussion

Elderly patientsrsquo cognition is relatively poor and theirpsychological flexibility level is low When confronted withdisease challenges they often cannot fully and correctlyunderstand the disease and make reasonable and positiveself-adjustments in time [23] Gynaecological cancer surgeryand postoperative life place a substantial amount of pressureon patients When elderly patients know that they aresuffering from gynaecological malignant tumours they alsoexperience high levels of psychological distress Moreoverhigh medical costs curative effects and adverse reactionswill also cause patients to experience fear which leads pa-tients to experience depression anxiety negative and pes-simistic psychological issues and pessimism [24] ereforereasonable rehabilitation intervention based on the HBMwill allow patients to develop new mechanisms of cognitionand evaluation of their disease construct new psychologicaldefences change their coping style and improve theirquality of life [25]

In this study according to the characteristics of cognitivebias and a low level of psychological flexibility of elderlypatients with gynaecological cancer rehabilitation educationbased on the HBM and positive psychological counsellingwere used to improve their cognition of the disease alleviatetheir negative emotions realize their potential and play thesubjective and active role of patients in the treatmentprocess Moreover by actively organizing and continuouslyguiding patients to perform health exercise training in bedwe consolidated and deepened patientsrsquo grasp of interven-tion information and skills which allowed patients togradually establish a positive psychological state and activelyparticipate in and cooperate with rehabilitation treatmentOur results indicated that the level of psychological resil-ience of elderly patients with gynaecological cancer wassignificantly increased after rehabilitation based on theHBM which suggested that rehabilitation based on theHBM was an important measure to improve the psycho-logical resilience of patients with gynaecological cancer

Journal of Healthcare Engineering 5

Table 1 Comparison of individual characteristics in the two groups

Characteristics HBM education group (n 134) Basic nursing group (n 133) P valueAge (years plusmnSD) 6690plusmn 725 6735plusmn 686 0603BMI (plusmnSD) 2477plusmn 329 2458plusmn 345 0656Educational level (n ())le junior middle school 98 (731) 92 (692) 0475ge senior high school 36 (269) 41 (308)Marital status (n ())Married 112 (836) 115 (865) 0509Unmarried 22 (164) 18 (135)Medical expenses (n ())Medical insurance 118 (881) 119 (895) 0715Self-paying 16 (119) 14 (105)Tumour types (n ())Cervical cancer 66 (493) 71 (534)

0755Endometrial cancer 42 (313) 40 (301)Ovarian cancer 26 (194) 22 (165)FIGO stages (n ())I 66 (493) 69 (519) 0668geII 68 (507) 64 (481)Hospitalization times (n ())lt3 126 (940) 123 (925) 0614ge3 8 (60) 10 (75)Basic VTE risk (n ())Middle risk 56 (418) 61 (459) 0502Extremely high risk 78 (582) 72 (541)HBM health belief mode SD standard deviation FIGO International Federation of Gynecology and Obstetrics VTE venous thrombus embolism

Table 2 Comparison of HBM indicator scores between the HBM education group and the basic nursing group before educationalintervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of trainingComplete compliance (n ()) 38 (284) 37 (278) 0922Low compliance (n ()) 96 (716) 96 (722)Psychological resilience score (xplusmnSD) 5043plusmn 329 5055plusmn 229 0738Psychological flexibility (xplusmnSD) 4898plusmn 345 4929plusmn 359 0465Self-care knowledge (xplusmnSD) 3422plusmn 747 3377plusmn 705 0614Self-concept (xplusmnSD) 2087plusmn 434 2022plusmn 410 0206Self-care responsibility (xplusmnSD) 2044plusmn 458 2064plusmn 471 0727Self-care skills (xplusmnSD) 2278plusmn 671 2177plusmn 582 0190Self-efficacy (xplusmnSD) 2649plusmn 526 2629plusmn 641 0781HBM health belief model x mean SD standard deviation

Table 3 Comparison of HBM indicator scores between the two groups after the educational intervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of training (n ())Complete compliance 108 (806) 40 (301) lt0001Low compliance 26 (194) 93 (699)Psychological resilience score (xplusmnSD) 5547plusmn 501 5046plusmn 262 lt0001Psychological flexibility (xplusmnSD) 5653plusmn 451 4913plusmn 362 lt0001Self-care knowledge (xplusmnSD) 4336plusmn 760 3405plusmn 699 lt0001Self-concept (xplusmnSD) 2957plusmn 567 2011plusmn 386 lt0001Self-care responsibility (xplusmnSD) 2754plusmn 509 2086plusmn 453 lt0001Self-care skills (xplusmnSD) 3451plusmn 562 2162plusmn 564 lt0001Self-efficacy (xplusmnSD) 3079plusmn 456 2641plusmn 637 lt0001Incidence of LEDVT (n ())Yes 3 (22) 11 (83) 0027No 131 (978) 122 (917)HBM health belief model x mean SD standard deviation LEDVT lower extremity deep vein thrombosis

6 Journal of Healthcare Engineering

Rehabilitation based on the HBM can enhance the psy-chological resilience and rehabilitation compliance of pa-tients leading patients to actively participate inpostoperative rehabilitation treatment and achieve a moreideal rehabilitation effect Previous studies [26 27] have alsoshown that psychological interventions can improve survivalin cancer patients is evidence further proves the value ofHBM psychological intervention in elderly gynaecologicalcancer patients in improving survival

ere is likely to be a certain correlation betweenphysical health and treatment compliance Early psycho-logical intervention can improve treatment compliance incancer patients [28] Patients with a high level of mentalflexibility and good mental health are able to actively par-ticipate in and cooperate with treatment so they have highercompliance with rehabilitation training [29] Our studyshows that the level of patientsrsquo psychological resilience andcompliance can be increased through positivity HBM ed-ucation HBM education can help patients face their diseasepositively rebuild their confidence adopt healthy behav-iours and enhance their psychological immunity increasingtheir level of psychological resilience [25]

Self-efficacy is an important factor in maintaining orchanging health behaviours e higher the level of self-efficacy the higher the level of adopting maintaining andstriving for healthy behaviours and the stronger the self-nursing ability [30] According to Wen Yrsquos [31] study theearly self-nursing ability of patients affects later outcomeserefore perioperative rehabilitation education based onthe HBM can not only strengthen the self-nursing ability ofpatients with malignant tumours but also increase the self-nursing ability and quality of life after discharge

e decline in the learning and memory abilities ofelderly patients can impact their self-efficacy and self-nursing abilities In the context of special diseases patients

can build and strengthen their self-efficacy and self-nursingskills only through active intervention reconstruction oftheir self-confidence to overcome difficulties and contin-uous demonstrative learning [32] In light of the decline inlearning and memory ability of elderly patients withgynaecological malignant tumours during HBM-basedhealth education the patients were trained in the diaphragmand lower extremity movements through the guidance ofprofessional nurses and video demonstrations and weresupervised in the hospital and during follow-up after dis-charge in this study e results indicated that the self-ef-ficacy and self-nursing ability in the intervention group weremuch higher than those in the control group after the ap-plication of rehabilitation education based on the HBMsuggesting that rehabilitation education based on the HBMcan help elderly patients with gynaecological cancer masterdisease-related knowledge and skills enhance their self-ef-ficacy adopt good rehabilitation behaviour and self-nursingability and improve rehabilitation

LEDVT is one of the most common complications ingynaecological patients [33] It can cause pain swelling anddysfunction of the lower limbs rombus detachment ofLEDVT can induce pulmonary embolism and is even life-threatening Elderly patients with gynaecological cancerrequire a wide range of operations a long duration of bedrest after the operation and a low willingness to performactivities due to lower limb dysfunction Moreover elderlypatients with gynaecological cancer have high-risk factorssuch as old age malignant tumours and other vasculardiseases [33] which makes the probability of LEDVT higherthan that among general patients Based on the individualdifferences in elderly patients with gynaecological malignanttumours rehabilitation intervention based on the HBM canhelp patients fully understand the mechanism and severityand the importance of cooperative treatment and health

Table 4 Comparison of HBM scores between the two groups before and after intervention

Groups Variables Before intervention After intervention P value

HBM education group (n 134)

Compliance of training (n) lt0001Complete compliance 38 108

Low compliance 96 26Psychological resilience score (xplusmnSD) 5043plusmn 329 5547plusmn 501 lt0001

Psychological flexibility (xplusmnSD) 4898plusmn 345 5653plusmn 451 lt0001Self-care knowledge (xplusmnSD) 3422plusmn 747 4336plusmn 760 lt0001

Self-concept (xplusmnSD) 2087plusmn 434 2957plusmn 567 lt0001Self-care responsibility (xplusmnSD) 2044plusmn 458 2754plusmn 509 lt0001

Self-care skills (xplusmnSD) 2278plusmn 671 3451plusmn 562 lt0001Self-efficacy (xplusmnSD) 2649plusmn 526 3079plusmn 456 lt0001

Basic nursing group (n 133)

Compliance of training (n) 0685Complete compliance 37 40

Low compliance 96 93Psychological resilience score (xplusmnSD) 5055plusmn 229 5046plusmn 262 0467

Psychological flexibility (xplusmnSD) 4929plusmn 359 4913plusmn 362 0124Self-care knowledge (xplusmnSD) 3377plusmn 705 3405plusmn 699 0076

Self-concept (xplusmnSD) 2022plusmn 410 2011plusmn 386 0527Self-care responsibility (xplusmnSD) 2064plusmn 471 2086plusmn 453 0181

Self-care skills (xplusmnSD) 2177plusmn 582 2162plusmn 564 0519Self-efficacy (xplusmnSD) 2629plusmn 641 2641plusmn 637 0404

HBM health belief model x mean SD standard deviation

Journal of Healthcare Engineering 7

exercise training for LEDVTand enhance their health beliefsand active participation consciousness Postoperative re-habilitation training can effectively reduce the occurrence ofdeep vein thrombosis (DVT) [34] One-on-one guidancefrom the intervention nurse can promote the patientsrsquotransition from passive exercise to active routine exerciseimprove the prognosis of patients and effectively reduce theincidence of LEDVT [22] e results of this study showedthat the incidence of LEDVT in elderly patients withgynaecological cancer decreased significantly after receivingHBM-based rehabilitation education indicating thatstrengthening HBM rehabilitation interventions can pro-mote the postoperative rehabilitation of elderly patients withgynaecological cancer especially by effectively preventingLEDVT

ere are still some potential limitations to this studyFirst the number of participants in this study was small andwe will add more participants in the next stage to furtherverify the effectiveness of the HBM education interventionSecond this study was conducted in a single centre and thereproducibility of the results is still unclear so it will beextended to multiple centres to verify the applicability of theHBM in the future Finally the follow-up data of the par-ticipants were not analysed in this study because our follow-up work is ongoing and we will analyse the results after thefollow-up is completed

5 Conclusion

Evidence from this study suggests that perioperative HBM-based educational interventions benefit mental health anddisease outcomes in elderly women with gynaecologicalmalignancies by improving self-efficacy self-care ability andcompliance

Data Availability

e data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

All authors declare that they have no conflicts of interest

Authorsrsquo Contributions

All authors made substantial contributions to conceptionand design acquisition of data or analysis and interpreta-tion of data took part in drafting the article or revising itcritically for important intellectual content agreed to submitthe article to the current journal gave final approval of theversion to be published and agree to be accountable for allaspects of the work

Acknowledgments

e authors would like to thank the investigators for theircontributions to this trial Above all the authors are gratefulto all patients who participated in this study

References

[1] X Jiang H Tang and T Chen ldquoEpidemiology of gynecologiccancers in Chinardquo Journal of gynecologic oncology vol 29no 1 p e7 2018

[2] Y Yoshida and D Inoue ldquoClinical management of chemo-therapy for elderly gynecological cancer patientsrdquo Journal ofObstetrics and Gynaecology Research vol 47 no 7pp 2261ndash2270 2021

[3] E Reiser N Potsch V Seebacher et al ldquoImpact of frailty onthe management of patients with gynecological cancer aged 80years and olderrdquo Archives of Gynecology and Obstetricsvol 303 no 2 pp 557ndash563 2021

[4] F N Lupo P Arnaboldi L Santoro et al ldquoe effects of amultimodal training program on burnout syndrome in gy-necologic oncology nurses and on the multidisciplinarypsychosocial care of gynecologic cancer patients an Italianexperiencerdquo Palliative amp Supportive Care vol 11 no 3pp 199ndash203 2013

[5] N E Avis A Colvin R Hess and J T Bromberger ldquoMidlifefactors related to psychological well-being at an older agestudy of womenrsquos health across the nationrdquo Journal ofWomenrsquos Health vol 30 no 3 pp 332ndash340 2021

[6] A Abusalehi M Vahedian-Shahroodi H Esmaily A Jafariand H Tehrani ldquoMental health promotion of the elderly innursing homes a social-cognitive interventionrdquo InternationalJournal of Gerontology vol 15 no 3 pp 221ndash227 2021

[7] S-L Oh H-j Kim S Woo et al ldquoEffects of an integratedhealth education and elastic band resistance training programon physical function and muscle strength in community-dwelling elderly women healthy Aging and Happy Aging IIstudyrdquoGeriatrics and Gerontology International vol 17 no 5pp 825ndash833 2017

[8] I M Rosenstock ldquoHistorical origins of the health beliefmodelrdquo Health Education Monographs vol 24 pp 238ndash3351974

[9] T N Maseko H C Huang and K C Lin ldquoCervical cancerscreening behavior of African women the Rosenstock healthbelief model assessmentrdquo Health Care for Women Interna-tional vol 28 pp 1ndash16 2019

[10] A Cal Z Bahar and I Gorken ldquoEffects of Health BeliefModel based nursing interventions offered at home visits onlymphedema prevention in women with breast cancer arandomised controlled trialrdquo Journal of Clinical Nursingvol 29 no 13-14 pp 2521ndash2534 2020

[11] M Damghanian H Mahmoodzadeh Z KhakbazanB Khorsand and M Motaharinezhad ldquoSelf-care behaviors inhigh-risk women for breast cancer a randomized clinical trialusing health belief model educationrdquo Journal of Educationand Health Promotion vol 9 p 265 2020

[12] M Simbar M Ghazanfarpour and S Abdolahian ldquoEffects oftraining based on the health belief model on Iranian womenrsquosperformance about cervical screening a systematic review andmeta-analysisrdquo Journal of Education and Health Promotionvol 9 p 179 2020

[13] S B Eghbal M Karimy P Kasmaei Z A RoshanR Valipour and S M Attari ldquoEvaluating the effect of aneducational program on increasing cervical cancer screeningbehavior among rural women in Guilan Iranrdquo BMCWomenrsquosHealth vol 20 no 1 p 149 2020

[14] B E Azriful E Bujawati F Nildawati R RamdanF Mallapiang and S Suyuti ldquoHealth Belief Model on womenrsquoscancer recovery (a phenomenological study on cancer survi-vors)rdquo Gaceta Sanitaria vol 35 no 1 pp S9ndashS11 2021

8 Journal of Healthcare Engineering

[15] L Wu Y Tan and Y Liu ldquoFactor structure and psychometricevaluation of the Connor-Davidson resilience scale in a newemployee population of Chinardquo BMC Psychiatry vol 17no 1 p 49 2017

[16] Y Han X Han and X Xu ldquoIntervention effect of healtheducation pathway on self-care ability and health behavior ofpatients with chronic obstructive pulmonary diseaserdquo Chinaclinical nursing vol 8 no 5 pp 438ndash440 2016

[17] X-J Fu S-D Hu Y-F Peng L-Y Zhou T Shu andD-D Song ldquoObservation of the effect of one-to-one edu-cation on high-risk cases of diabetic footrdquo World Journal ofClinical Cases vol 9 no 14 pp 3265ndash3272 2021

[18] Y Xia H Zhang Y Xia H Li L Zhai and H Wang ldquoeself-psychological safety maintenance and its influencingfactors of community frontline staff during COVID-19pandemicrdquoMedicine vol 100 no 3 Article ID e24140 2021

[19] Y Y Chong W T Chien H Y Cheng A P KassianosA T Gloster and M Karekla ldquoCan psychological flexibilityand prosociality mitigate illness perceptions toward COVID-19 on mental health A cross-sectional study among HongKong adultsrdquo Globalization and Health vol 17 no 1 p 432021

[20] S M ompson L K Low L Bude R de Vries andM Nieuwenhuijze ldquoEvaluating the effect of an educationalintervention on student midwife self-efficacy for their role asphysiological childbirth advocatesrdquo Nurse Education Todayvol 96 Article ID 104628 2021

[21] J Villanueva A H Meyer M T B Rinner et al ldquoldquoChoosechangerdquo design and methods of an acceptance and com-mitment therapy effectiveness trial for transdiagnostictreatment-resistant patientsrdquo BMC Psychiatry vol 19 no 1p 173 2019

[22] L Hu and G Liu ldquoEffects of early rehabilitation nursing onneurological functions and quality of life of patients withischemic stroke hemiplegiardquo American Journal of TourismResearch vol 13 no 4 pp 3811ndash3818 2021

[23] E Parpa E Tsilika V Gennimata and K MystakidouldquoElderly cancer patientsrsquo psychopathology a systematic re-viewrdquo Archives of Gerontology and Geriatrics vol 60 no 1pp 9ndash15 2015

[24] J Chen H Xiao Y Chen H Sun S Chen and J ZhengldquoEffect of reminiscence therapy based on positive psychologytheory (RTBPPT) on the positive feelings of the spousalcaregivers of elderly patients with advanced cancer in ChinardquoEuropean Journal of Cancer Care vol 29 no 6 Article IDe13324 2020

[25] S Folkman R S Lazarus S Pimley and J Novacek ldquoAgedifferences in stress and coping processesrdquo Psychology andAging vol 2 no 2 pp 171ndash184 1987

[26] Y Zheng F Lei and B Liu ldquoCancer diagnosis disclosure andquality of life in elderly cancer patientsrdquo Healthcare vol 7no 4 p 163 2019

[27] F Hejazi M Bahrami M Keshvari and M Alavi ldquoe effectof a communicational program on psychological distress inthe elderly suffering from cancerrdquo Iranian Journal of Nursingand Midwifery Research vol 22 no 3 pp 201ndash207 2017

[28] T Naito S Mitsunaga S Miura et al ldquoFeasibility of earlymultimodal interventions for elderly patients with advancedpancreatic and non-small-cell lung cancerrdquo Journal of Ca-chexia Sarcopenia and Muscle vol 10 no 1 pp 73ndash83 2019

[29] H Kukihara N Yamawaki M Ando M Nishio H Kimuraand Y Tamura ldquoe mediating effect of resilience betweenfamily functioning and mental well-being in hemodialysis

patients in Japan a cross-sectional designrdquo Health andQuality of Life Outcomes vol 18 no 1 p 233 2020

[30] R Prieto B Ferrell J Kim and V Sun ldquoSelf-managementcoaching promoting postoperative recovery and caregivingpreparedness for patients with lung cancer and their familycaregiversrdquo Clinical Journal of Oncology Nursing vol 25no 3 pp 290ndash296 2021

[31] Y Wen J Ma X Jiang G Gao H Xie and P Lu ldquoInflu-encing factors of holistic nursing intervention under a socialmedical model on the psychology and quality of life of patientswith advanced gastric cancerrdquo American Journal of TourismResearch vol 13 no 4 pp 3369ndash3379 2021

[32] A Bandura ldquoHealth promotion by social cognitive meansrdquoHealth Educationamp Behavior vol 31 no 2 pp 143ndash164 2004

[33] Z Li and Z Zhang ldquoe incidence and risk factors of venousthromboembolism following elective gynecological surgerieswithout systemic thromboprophylaxis--an observational co-hort study in a Chinese tertiary hospitalrdquo Clinical amp Exper-imental Obstetrics amp Gynecology vol 43 no 3 pp 365ndash3692016

[34] H Wang Y Huo Y Zhao et al ldquoClinical rehabilitation effectof postoperative lower-limb training on the patients under-going olif surgery a retrospective studyrdquo Pain Research ampManagement vol 2020 Article ID 1065202 2020

Journal of Healthcare Engineering 9

expressed as percentages and measurement data are de-scribed as the meansplusmn standard deviations (SDs) e dif-ferences were considered statistically significant whenPlt 005

3 Results

31General Information of Participants e study originallyrecruited 301 participants 33 were excluded based on theexclusion criteria and 268 eligible participants (including137 patients with cervical cancer 82 patients with endo-metrial cancer and 48 patients with ovarian cancer) wereeventually included in the study According to the ran-domized comparison table we divided 268 eligible partic-ipants into two groups 134 women were included in theHBM education intervention group and 134 women wereincluded in the basic nursing group One woman in the basicnursing group was lost to follow-up and 133 women wereeventually included in the basic nursing group analysis Weanalysed the characteristics of participants between the twogroups As shown in Table 1 there were no significantdifferences in age (P 0603) BMI (P 0656) educationallevel (P 0475) marital status (P 0509) medical expenses(P 0715) tumour type (P 0755) International Federa-tion of Gynecology and Obstetrics (FIGO) stage (P 0668)hospitalization time (P 0614) or basic venous thrombo-embolism (VTE) risk (P 002) between the two groupseI-CVI of the HBM indicator ranged from 082 to 096 andthe S-CVI was 093 Cronbachrsquos alpha coefficients of eachsubscale ranged from 072 to 093 and the values for the totalscore were 086 and 085 in the HBM group and controlgroup respectively

32 Comparison of HBM Indicator Scores between the HBMEducation Group and the Basic Nursing Group before Edu-cational Intervention Before the educational interventionHBM indicator scores were compared between the twogroups (Table 2) and the complete compliance of trainingpsychological resilience score psychological flexibility self-care knowledge self-concept self-care responsibility self-care skills and self-efficacy were 284 (38134)5043plusmn 329 4898plusmn 345 3422plusmn 747 2087plusmn 4342044plusmn 458 2278plusmn 671 and 2649plusmn 526 respectivelyere were no differences compared to the basic nursinggroup (all Pgt 005)

33 Comparison of HBM Indicator Scores between the TwoGroups after the Educational Intervention e results inTable 3 show that after the HBM educational interventionwomen in the HBM education group had higher trainingcompliance (806 vs 301 Plt 0001) psychologicalresilience scores (5547plusmn 501 vs 5046plusmn 262 Plt 0001)psychological flexibility scores (5653plusmn 451 vs 4913plusmn 362Plt 0001) self-care knowledge scores (4336plusmn 760 vs3405plusmn 699 Plt 0001) self-concept scores (2957plusmn 567 vs2011plusmn 386 Plt 0001) self-care responsibility scores(2754plusmn 509 vs 2086plusmn 453 Plt 0001) self-care skillsscores (3451plusmn 562 vs 2162plusmn 564 Plt 0001) and self-

efficacy scores (3079plusmn 456 vs 2641plusmn 637 Plt 0001) thanthose in the basic nursing group Additionally the incidenceof LEDVT decreased (22 vs 83 P 0027)

34ComparisonofHBMScoresbetween theTwoGroupsbeforeand after the Intervention In the HBM education groupwomen had higher training compliance (806 vs 284Plt 0001) psychological resilience scores (5547plusmn 501 vs5043plusmn 329 Plt 0001) psychological flexibility scores(5653plusmn 451 vs 4898plusmn 345 Plt 0001) self-care knowledgescores (4336plusmn 760 vs 3422plusmn 747 Plt 0001) self-conceptscores (2957plusmn 567 vs 2087plusmn 434 Plt 0001) self-careresponsibility scores (2754plusmn 509 vs 2044plusmn 458Plt 0001) self-care skills scores (3451plusmn 562 vs2278plusmn 671 Plt 0001) and self-efficacy scores (3079plusmn 456vs 2649plusmn 526 Plt 0001) after the educational interventionthan before the intervention However there was no suchchange in the basic nursing group (Table 4)

4 Discussion

Elderly patientsrsquo cognition is relatively poor and theirpsychological flexibility level is low When confronted withdisease challenges they often cannot fully and correctlyunderstand the disease and make reasonable and positiveself-adjustments in time [23] Gynaecological cancer surgeryand postoperative life place a substantial amount of pressureon patients When elderly patients know that they aresuffering from gynaecological malignant tumours they alsoexperience high levels of psychological distress Moreoverhigh medical costs curative effects and adverse reactionswill also cause patients to experience fear which leads pa-tients to experience depression anxiety negative and pes-simistic psychological issues and pessimism [24] ereforereasonable rehabilitation intervention based on the HBMwill allow patients to develop new mechanisms of cognitionand evaluation of their disease construct new psychologicaldefences change their coping style and improve theirquality of life [25]

In this study according to the characteristics of cognitivebias and a low level of psychological flexibility of elderlypatients with gynaecological cancer rehabilitation educationbased on the HBM and positive psychological counsellingwere used to improve their cognition of the disease alleviatetheir negative emotions realize their potential and play thesubjective and active role of patients in the treatmentprocess Moreover by actively organizing and continuouslyguiding patients to perform health exercise training in bedwe consolidated and deepened patientsrsquo grasp of interven-tion information and skills which allowed patients togradually establish a positive psychological state and activelyparticipate in and cooperate with rehabilitation treatmentOur results indicated that the level of psychological resil-ience of elderly patients with gynaecological cancer wassignificantly increased after rehabilitation based on theHBM which suggested that rehabilitation based on theHBM was an important measure to improve the psycho-logical resilience of patients with gynaecological cancer

Journal of Healthcare Engineering 5

Table 1 Comparison of individual characteristics in the two groups

Characteristics HBM education group (n 134) Basic nursing group (n 133) P valueAge (years plusmnSD) 6690plusmn 725 6735plusmn 686 0603BMI (plusmnSD) 2477plusmn 329 2458plusmn 345 0656Educational level (n ())le junior middle school 98 (731) 92 (692) 0475ge senior high school 36 (269) 41 (308)Marital status (n ())Married 112 (836) 115 (865) 0509Unmarried 22 (164) 18 (135)Medical expenses (n ())Medical insurance 118 (881) 119 (895) 0715Self-paying 16 (119) 14 (105)Tumour types (n ())Cervical cancer 66 (493) 71 (534)

0755Endometrial cancer 42 (313) 40 (301)Ovarian cancer 26 (194) 22 (165)FIGO stages (n ())I 66 (493) 69 (519) 0668geII 68 (507) 64 (481)Hospitalization times (n ())lt3 126 (940) 123 (925) 0614ge3 8 (60) 10 (75)Basic VTE risk (n ())Middle risk 56 (418) 61 (459) 0502Extremely high risk 78 (582) 72 (541)HBM health belief mode SD standard deviation FIGO International Federation of Gynecology and Obstetrics VTE venous thrombus embolism

Table 2 Comparison of HBM indicator scores between the HBM education group and the basic nursing group before educationalintervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of trainingComplete compliance (n ()) 38 (284) 37 (278) 0922Low compliance (n ()) 96 (716) 96 (722)Psychological resilience score (xplusmnSD) 5043plusmn 329 5055plusmn 229 0738Psychological flexibility (xplusmnSD) 4898plusmn 345 4929plusmn 359 0465Self-care knowledge (xplusmnSD) 3422plusmn 747 3377plusmn 705 0614Self-concept (xplusmnSD) 2087plusmn 434 2022plusmn 410 0206Self-care responsibility (xplusmnSD) 2044plusmn 458 2064plusmn 471 0727Self-care skills (xplusmnSD) 2278plusmn 671 2177plusmn 582 0190Self-efficacy (xplusmnSD) 2649plusmn 526 2629plusmn 641 0781HBM health belief model x mean SD standard deviation

Table 3 Comparison of HBM indicator scores between the two groups after the educational intervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of training (n ())Complete compliance 108 (806) 40 (301) lt0001Low compliance 26 (194) 93 (699)Psychological resilience score (xplusmnSD) 5547plusmn 501 5046plusmn 262 lt0001Psychological flexibility (xplusmnSD) 5653plusmn 451 4913plusmn 362 lt0001Self-care knowledge (xplusmnSD) 4336plusmn 760 3405plusmn 699 lt0001Self-concept (xplusmnSD) 2957plusmn 567 2011plusmn 386 lt0001Self-care responsibility (xplusmnSD) 2754plusmn 509 2086plusmn 453 lt0001Self-care skills (xplusmnSD) 3451plusmn 562 2162plusmn 564 lt0001Self-efficacy (xplusmnSD) 3079plusmn 456 2641plusmn 637 lt0001Incidence of LEDVT (n ())Yes 3 (22) 11 (83) 0027No 131 (978) 122 (917)HBM health belief model x mean SD standard deviation LEDVT lower extremity deep vein thrombosis

6 Journal of Healthcare Engineering

Rehabilitation based on the HBM can enhance the psy-chological resilience and rehabilitation compliance of pa-tients leading patients to actively participate inpostoperative rehabilitation treatment and achieve a moreideal rehabilitation effect Previous studies [26 27] have alsoshown that psychological interventions can improve survivalin cancer patients is evidence further proves the value ofHBM psychological intervention in elderly gynaecologicalcancer patients in improving survival

ere is likely to be a certain correlation betweenphysical health and treatment compliance Early psycho-logical intervention can improve treatment compliance incancer patients [28] Patients with a high level of mentalflexibility and good mental health are able to actively par-ticipate in and cooperate with treatment so they have highercompliance with rehabilitation training [29] Our studyshows that the level of patientsrsquo psychological resilience andcompliance can be increased through positivity HBM ed-ucation HBM education can help patients face their diseasepositively rebuild their confidence adopt healthy behav-iours and enhance their psychological immunity increasingtheir level of psychological resilience [25]

Self-efficacy is an important factor in maintaining orchanging health behaviours e higher the level of self-efficacy the higher the level of adopting maintaining andstriving for healthy behaviours and the stronger the self-nursing ability [30] According to Wen Yrsquos [31] study theearly self-nursing ability of patients affects later outcomeserefore perioperative rehabilitation education based onthe HBM can not only strengthen the self-nursing ability ofpatients with malignant tumours but also increase the self-nursing ability and quality of life after discharge

e decline in the learning and memory abilities ofelderly patients can impact their self-efficacy and self-nursing abilities In the context of special diseases patients

can build and strengthen their self-efficacy and self-nursingskills only through active intervention reconstruction oftheir self-confidence to overcome difficulties and contin-uous demonstrative learning [32] In light of the decline inlearning and memory ability of elderly patients withgynaecological malignant tumours during HBM-basedhealth education the patients were trained in the diaphragmand lower extremity movements through the guidance ofprofessional nurses and video demonstrations and weresupervised in the hospital and during follow-up after dis-charge in this study e results indicated that the self-ef-ficacy and self-nursing ability in the intervention group weremuch higher than those in the control group after the ap-plication of rehabilitation education based on the HBMsuggesting that rehabilitation education based on the HBMcan help elderly patients with gynaecological cancer masterdisease-related knowledge and skills enhance their self-ef-ficacy adopt good rehabilitation behaviour and self-nursingability and improve rehabilitation

LEDVT is one of the most common complications ingynaecological patients [33] It can cause pain swelling anddysfunction of the lower limbs rombus detachment ofLEDVT can induce pulmonary embolism and is even life-threatening Elderly patients with gynaecological cancerrequire a wide range of operations a long duration of bedrest after the operation and a low willingness to performactivities due to lower limb dysfunction Moreover elderlypatients with gynaecological cancer have high-risk factorssuch as old age malignant tumours and other vasculardiseases [33] which makes the probability of LEDVT higherthan that among general patients Based on the individualdifferences in elderly patients with gynaecological malignanttumours rehabilitation intervention based on the HBM canhelp patients fully understand the mechanism and severityand the importance of cooperative treatment and health

Table 4 Comparison of HBM scores between the two groups before and after intervention

Groups Variables Before intervention After intervention P value

HBM education group (n 134)

Compliance of training (n) lt0001Complete compliance 38 108

Low compliance 96 26Psychological resilience score (xplusmnSD) 5043plusmn 329 5547plusmn 501 lt0001

Psychological flexibility (xplusmnSD) 4898plusmn 345 5653plusmn 451 lt0001Self-care knowledge (xplusmnSD) 3422plusmn 747 4336plusmn 760 lt0001

Self-concept (xplusmnSD) 2087plusmn 434 2957plusmn 567 lt0001Self-care responsibility (xplusmnSD) 2044plusmn 458 2754plusmn 509 lt0001

Self-care skills (xplusmnSD) 2278plusmn 671 3451plusmn 562 lt0001Self-efficacy (xplusmnSD) 2649plusmn 526 3079plusmn 456 lt0001

Basic nursing group (n 133)

Compliance of training (n) 0685Complete compliance 37 40

Low compliance 96 93Psychological resilience score (xplusmnSD) 5055plusmn 229 5046plusmn 262 0467

Psychological flexibility (xplusmnSD) 4929plusmn 359 4913plusmn 362 0124Self-care knowledge (xplusmnSD) 3377plusmn 705 3405plusmn 699 0076

Self-concept (xplusmnSD) 2022plusmn 410 2011plusmn 386 0527Self-care responsibility (xplusmnSD) 2064plusmn 471 2086plusmn 453 0181

Self-care skills (xplusmnSD) 2177plusmn 582 2162plusmn 564 0519Self-efficacy (xplusmnSD) 2629plusmn 641 2641plusmn 637 0404

HBM health belief model x mean SD standard deviation

Journal of Healthcare Engineering 7

exercise training for LEDVTand enhance their health beliefsand active participation consciousness Postoperative re-habilitation training can effectively reduce the occurrence ofdeep vein thrombosis (DVT) [34] One-on-one guidancefrom the intervention nurse can promote the patientsrsquotransition from passive exercise to active routine exerciseimprove the prognosis of patients and effectively reduce theincidence of LEDVT [22] e results of this study showedthat the incidence of LEDVT in elderly patients withgynaecological cancer decreased significantly after receivingHBM-based rehabilitation education indicating thatstrengthening HBM rehabilitation interventions can pro-mote the postoperative rehabilitation of elderly patients withgynaecological cancer especially by effectively preventingLEDVT

ere are still some potential limitations to this studyFirst the number of participants in this study was small andwe will add more participants in the next stage to furtherverify the effectiveness of the HBM education interventionSecond this study was conducted in a single centre and thereproducibility of the results is still unclear so it will beextended to multiple centres to verify the applicability of theHBM in the future Finally the follow-up data of the par-ticipants were not analysed in this study because our follow-up work is ongoing and we will analyse the results after thefollow-up is completed

5 Conclusion

Evidence from this study suggests that perioperative HBM-based educational interventions benefit mental health anddisease outcomes in elderly women with gynaecologicalmalignancies by improving self-efficacy self-care ability andcompliance

Data Availability

e data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

All authors declare that they have no conflicts of interest

Authorsrsquo Contributions

All authors made substantial contributions to conceptionand design acquisition of data or analysis and interpreta-tion of data took part in drafting the article or revising itcritically for important intellectual content agreed to submitthe article to the current journal gave final approval of theversion to be published and agree to be accountable for allaspects of the work

Acknowledgments

e authors would like to thank the investigators for theircontributions to this trial Above all the authors are gratefulto all patients who participated in this study

References

[1] X Jiang H Tang and T Chen ldquoEpidemiology of gynecologiccancers in Chinardquo Journal of gynecologic oncology vol 29no 1 p e7 2018

[2] Y Yoshida and D Inoue ldquoClinical management of chemo-therapy for elderly gynecological cancer patientsrdquo Journal ofObstetrics and Gynaecology Research vol 47 no 7pp 2261ndash2270 2021

[3] E Reiser N Potsch V Seebacher et al ldquoImpact of frailty onthe management of patients with gynecological cancer aged 80years and olderrdquo Archives of Gynecology and Obstetricsvol 303 no 2 pp 557ndash563 2021

[4] F N Lupo P Arnaboldi L Santoro et al ldquoe effects of amultimodal training program on burnout syndrome in gy-necologic oncology nurses and on the multidisciplinarypsychosocial care of gynecologic cancer patients an Italianexperiencerdquo Palliative amp Supportive Care vol 11 no 3pp 199ndash203 2013

[5] N E Avis A Colvin R Hess and J T Bromberger ldquoMidlifefactors related to psychological well-being at an older agestudy of womenrsquos health across the nationrdquo Journal ofWomenrsquos Health vol 30 no 3 pp 332ndash340 2021

[6] A Abusalehi M Vahedian-Shahroodi H Esmaily A Jafariand H Tehrani ldquoMental health promotion of the elderly innursing homes a social-cognitive interventionrdquo InternationalJournal of Gerontology vol 15 no 3 pp 221ndash227 2021

[7] S-L Oh H-j Kim S Woo et al ldquoEffects of an integratedhealth education and elastic band resistance training programon physical function and muscle strength in community-dwelling elderly women healthy Aging and Happy Aging IIstudyrdquoGeriatrics and Gerontology International vol 17 no 5pp 825ndash833 2017

[8] I M Rosenstock ldquoHistorical origins of the health beliefmodelrdquo Health Education Monographs vol 24 pp 238ndash3351974

[9] T N Maseko H C Huang and K C Lin ldquoCervical cancerscreening behavior of African women the Rosenstock healthbelief model assessmentrdquo Health Care for Women Interna-tional vol 28 pp 1ndash16 2019

[10] A Cal Z Bahar and I Gorken ldquoEffects of Health BeliefModel based nursing interventions offered at home visits onlymphedema prevention in women with breast cancer arandomised controlled trialrdquo Journal of Clinical Nursingvol 29 no 13-14 pp 2521ndash2534 2020

[11] M Damghanian H Mahmoodzadeh Z KhakbazanB Khorsand and M Motaharinezhad ldquoSelf-care behaviors inhigh-risk women for breast cancer a randomized clinical trialusing health belief model educationrdquo Journal of Educationand Health Promotion vol 9 p 265 2020

[12] M Simbar M Ghazanfarpour and S Abdolahian ldquoEffects oftraining based on the health belief model on Iranian womenrsquosperformance about cervical screening a systematic review andmeta-analysisrdquo Journal of Education and Health Promotionvol 9 p 179 2020

[13] S B Eghbal M Karimy P Kasmaei Z A RoshanR Valipour and S M Attari ldquoEvaluating the effect of aneducational program on increasing cervical cancer screeningbehavior among rural women in Guilan Iranrdquo BMCWomenrsquosHealth vol 20 no 1 p 149 2020

[14] B E Azriful E Bujawati F Nildawati R RamdanF Mallapiang and S Suyuti ldquoHealth Belief Model on womenrsquoscancer recovery (a phenomenological study on cancer survi-vors)rdquo Gaceta Sanitaria vol 35 no 1 pp S9ndashS11 2021

8 Journal of Healthcare Engineering

[15] L Wu Y Tan and Y Liu ldquoFactor structure and psychometricevaluation of the Connor-Davidson resilience scale in a newemployee population of Chinardquo BMC Psychiatry vol 17no 1 p 49 2017

[16] Y Han X Han and X Xu ldquoIntervention effect of healtheducation pathway on self-care ability and health behavior ofpatients with chronic obstructive pulmonary diseaserdquo Chinaclinical nursing vol 8 no 5 pp 438ndash440 2016

[17] X-J Fu S-D Hu Y-F Peng L-Y Zhou T Shu andD-D Song ldquoObservation of the effect of one-to-one edu-cation on high-risk cases of diabetic footrdquo World Journal ofClinical Cases vol 9 no 14 pp 3265ndash3272 2021

[18] Y Xia H Zhang Y Xia H Li L Zhai and H Wang ldquoeself-psychological safety maintenance and its influencingfactors of community frontline staff during COVID-19pandemicrdquoMedicine vol 100 no 3 Article ID e24140 2021

[19] Y Y Chong W T Chien H Y Cheng A P KassianosA T Gloster and M Karekla ldquoCan psychological flexibilityand prosociality mitigate illness perceptions toward COVID-19 on mental health A cross-sectional study among HongKong adultsrdquo Globalization and Health vol 17 no 1 p 432021

[20] S M ompson L K Low L Bude R de Vries andM Nieuwenhuijze ldquoEvaluating the effect of an educationalintervention on student midwife self-efficacy for their role asphysiological childbirth advocatesrdquo Nurse Education Todayvol 96 Article ID 104628 2021

[21] J Villanueva A H Meyer M T B Rinner et al ldquoldquoChoosechangerdquo design and methods of an acceptance and com-mitment therapy effectiveness trial for transdiagnostictreatment-resistant patientsrdquo BMC Psychiatry vol 19 no 1p 173 2019

[22] L Hu and G Liu ldquoEffects of early rehabilitation nursing onneurological functions and quality of life of patients withischemic stroke hemiplegiardquo American Journal of TourismResearch vol 13 no 4 pp 3811ndash3818 2021

[23] E Parpa E Tsilika V Gennimata and K MystakidouldquoElderly cancer patientsrsquo psychopathology a systematic re-viewrdquo Archives of Gerontology and Geriatrics vol 60 no 1pp 9ndash15 2015

[24] J Chen H Xiao Y Chen H Sun S Chen and J ZhengldquoEffect of reminiscence therapy based on positive psychologytheory (RTBPPT) on the positive feelings of the spousalcaregivers of elderly patients with advanced cancer in ChinardquoEuropean Journal of Cancer Care vol 29 no 6 Article IDe13324 2020

[25] S Folkman R S Lazarus S Pimley and J Novacek ldquoAgedifferences in stress and coping processesrdquo Psychology andAging vol 2 no 2 pp 171ndash184 1987

[26] Y Zheng F Lei and B Liu ldquoCancer diagnosis disclosure andquality of life in elderly cancer patientsrdquo Healthcare vol 7no 4 p 163 2019

[27] F Hejazi M Bahrami M Keshvari and M Alavi ldquoe effectof a communicational program on psychological distress inthe elderly suffering from cancerrdquo Iranian Journal of Nursingand Midwifery Research vol 22 no 3 pp 201ndash207 2017

[28] T Naito S Mitsunaga S Miura et al ldquoFeasibility of earlymultimodal interventions for elderly patients with advancedpancreatic and non-small-cell lung cancerrdquo Journal of Ca-chexia Sarcopenia and Muscle vol 10 no 1 pp 73ndash83 2019

[29] H Kukihara N Yamawaki M Ando M Nishio H Kimuraand Y Tamura ldquoe mediating effect of resilience betweenfamily functioning and mental well-being in hemodialysis

patients in Japan a cross-sectional designrdquo Health andQuality of Life Outcomes vol 18 no 1 p 233 2020

[30] R Prieto B Ferrell J Kim and V Sun ldquoSelf-managementcoaching promoting postoperative recovery and caregivingpreparedness for patients with lung cancer and their familycaregiversrdquo Clinical Journal of Oncology Nursing vol 25no 3 pp 290ndash296 2021

[31] Y Wen J Ma X Jiang G Gao H Xie and P Lu ldquoInflu-encing factors of holistic nursing intervention under a socialmedical model on the psychology and quality of life of patientswith advanced gastric cancerrdquo American Journal of TourismResearch vol 13 no 4 pp 3369ndash3379 2021

[32] A Bandura ldquoHealth promotion by social cognitive meansrdquoHealth Educationamp Behavior vol 31 no 2 pp 143ndash164 2004

[33] Z Li and Z Zhang ldquoe incidence and risk factors of venousthromboembolism following elective gynecological surgerieswithout systemic thromboprophylaxis--an observational co-hort study in a Chinese tertiary hospitalrdquo Clinical amp Exper-imental Obstetrics amp Gynecology vol 43 no 3 pp 365ndash3692016

[34] H Wang Y Huo Y Zhao et al ldquoClinical rehabilitation effectof postoperative lower-limb training on the patients under-going olif surgery a retrospective studyrdquo Pain Research ampManagement vol 2020 Article ID 1065202 2020

Journal of Healthcare Engineering 9

Table 1 Comparison of individual characteristics in the two groups

Characteristics HBM education group (n 134) Basic nursing group (n 133) P valueAge (years plusmnSD) 6690plusmn 725 6735plusmn 686 0603BMI (plusmnSD) 2477plusmn 329 2458plusmn 345 0656Educational level (n ())le junior middle school 98 (731) 92 (692) 0475ge senior high school 36 (269) 41 (308)Marital status (n ())Married 112 (836) 115 (865) 0509Unmarried 22 (164) 18 (135)Medical expenses (n ())Medical insurance 118 (881) 119 (895) 0715Self-paying 16 (119) 14 (105)Tumour types (n ())Cervical cancer 66 (493) 71 (534)

0755Endometrial cancer 42 (313) 40 (301)Ovarian cancer 26 (194) 22 (165)FIGO stages (n ())I 66 (493) 69 (519) 0668geII 68 (507) 64 (481)Hospitalization times (n ())lt3 126 (940) 123 (925) 0614ge3 8 (60) 10 (75)Basic VTE risk (n ())Middle risk 56 (418) 61 (459) 0502Extremely high risk 78 (582) 72 (541)HBM health belief mode SD standard deviation FIGO International Federation of Gynecology and Obstetrics VTE venous thrombus embolism

Table 2 Comparison of HBM indicator scores between the HBM education group and the basic nursing group before educationalintervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of trainingComplete compliance (n ()) 38 (284) 37 (278) 0922Low compliance (n ()) 96 (716) 96 (722)Psychological resilience score (xplusmnSD) 5043plusmn 329 5055plusmn 229 0738Psychological flexibility (xplusmnSD) 4898plusmn 345 4929plusmn 359 0465Self-care knowledge (xplusmnSD) 3422plusmn 747 3377plusmn 705 0614Self-concept (xplusmnSD) 2087plusmn 434 2022plusmn 410 0206Self-care responsibility (xplusmnSD) 2044plusmn 458 2064plusmn 471 0727Self-care skills (xplusmnSD) 2278plusmn 671 2177plusmn 582 0190Self-efficacy (xplusmnSD) 2649plusmn 526 2629plusmn 641 0781HBM health belief model x mean SD standard deviation

Table 3 Comparison of HBM indicator scores between the two groups after the educational intervention

Variables HBM education group (n 134) Basic nursing group (n 133) P valueCompliance of training (n ())Complete compliance 108 (806) 40 (301) lt0001Low compliance 26 (194) 93 (699)Psychological resilience score (xplusmnSD) 5547plusmn 501 5046plusmn 262 lt0001Psychological flexibility (xplusmnSD) 5653plusmn 451 4913plusmn 362 lt0001Self-care knowledge (xplusmnSD) 4336plusmn 760 3405plusmn 699 lt0001Self-concept (xplusmnSD) 2957plusmn 567 2011plusmn 386 lt0001Self-care responsibility (xplusmnSD) 2754plusmn 509 2086plusmn 453 lt0001Self-care skills (xplusmnSD) 3451plusmn 562 2162plusmn 564 lt0001Self-efficacy (xplusmnSD) 3079plusmn 456 2641plusmn 637 lt0001Incidence of LEDVT (n ())Yes 3 (22) 11 (83) 0027No 131 (978) 122 (917)HBM health belief model x mean SD standard deviation LEDVT lower extremity deep vein thrombosis

6 Journal of Healthcare Engineering

Rehabilitation based on the HBM can enhance the psy-chological resilience and rehabilitation compliance of pa-tients leading patients to actively participate inpostoperative rehabilitation treatment and achieve a moreideal rehabilitation effect Previous studies [26 27] have alsoshown that psychological interventions can improve survivalin cancer patients is evidence further proves the value ofHBM psychological intervention in elderly gynaecologicalcancer patients in improving survival

ere is likely to be a certain correlation betweenphysical health and treatment compliance Early psycho-logical intervention can improve treatment compliance incancer patients [28] Patients with a high level of mentalflexibility and good mental health are able to actively par-ticipate in and cooperate with treatment so they have highercompliance with rehabilitation training [29] Our studyshows that the level of patientsrsquo psychological resilience andcompliance can be increased through positivity HBM ed-ucation HBM education can help patients face their diseasepositively rebuild their confidence adopt healthy behav-iours and enhance their psychological immunity increasingtheir level of psychological resilience [25]

Self-efficacy is an important factor in maintaining orchanging health behaviours e higher the level of self-efficacy the higher the level of adopting maintaining andstriving for healthy behaviours and the stronger the self-nursing ability [30] According to Wen Yrsquos [31] study theearly self-nursing ability of patients affects later outcomeserefore perioperative rehabilitation education based onthe HBM can not only strengthen the self-nursing ability ofpatients with malignant tumours but also increase the self-nursing ability and quality of life after discharge

e decline in the learning and memory abilities ofelderly patients can impact their self-efficacy and self-nursing abilities In the context of special diseases patients

can build and strengthen their self-efficacy and self-nursingskills only through active intervention reconstruction oftheir self-confidence to overcome difficulties and contin-uous demonstrative learning [32] In light of the decline inlearning and memory ability of elderly patients withgynaecological malignant tumours during HBM-basedhealth education the patients were trained in the diaphragmand lower extremity movements through the guidance ofprofessional nurses and video demonstrations and weresupervised in the hospital and during follow-up after dis-charge in this study e results indicated that the self-ef-ficacy and self-nursing ability in the intervention group weremuch higher than those in the control group after the ap-plication of rehabilitation education based on the HBMsuggesting that rehabilitation education based on the HBMcan help elderly patients with gynaecological cancer masterdisease-related knowledge and skills enhance their self-ef-ficacy adopt good rehabilitation behaviour and self-nursingability and improve rehabilitation

LEDVT is one of the most common complications ingynaecological patients [33] It can cause pain swelling anddysfunction of the lower limbs rombus detachment ofLEDVT can induce pulmonary embolism and is even life-threatening Elderly patients with gynaecological cancerrequire a wide range of operations a long duration of bedrest after the operation and a low willingness to performactivities due to lower limb dysfunction Moreover elderlypatients with gynaecological cancer have high-risk factorssuch as old age malignant tumours and other vasculardiseases [33] which makes the probability of LEDVT higherthan that among general patients Based on the individualdifferences in elderly patients with gynaecological malignanttumours rehabilitation intervention based on the HBM canhelp patients fully understand the mechanism and severityand the importance of cooperative treatment and health

Table 4 Comparison of HBM scores between the two groups before and after intervention

Groups Variables Before intervention After intervention P value

HBM education group (n 134)

Compliance of training (n) lt0001Complete compliance 38 108

Low compliance 96 26Psychological resilience score (xplusmnSD) 5043plusmn 329 5547plusmn 501 lt0001

Psychological flexibility (xplusmnSD) 4898plusmn 345 5653plusmn 451 lt0001Self-care knowledge (xplusmnSD) 3422plusmn 747 4336plusmn 760 lt0001

Self-concept (xplusmnSD) 2087plusmn 434 2957plusmn 567 lt0001Self-care responsibility (xplusmnSD) 2044plusmn 458 2754plusmn 509 lt0001

Self-care skills (xplusmnSD) 2278plusmn 671 3451plusmn 562 lt0001Self-efficacy (xplusmnSD) 2649plusmn 526 3079plusmn 456 lt0001

Basic nursing group (n 133)

Compliance of training (n) 0685Complete compliance 37 40

Low compliance 96 93Psychological resilience score (xplusmnSD) 5055plusmn 229 5046plusmn 262 0467

Psychological flexibility (xplusmnSD) 4929plusmn 359 4913plusmn 362 0124Self-care knowledge (xplusmnSD) 3377plusmn 705 3405plusmn 699 0076

Self-concept (xplusmnSD) 2022plusmn 410 2011plusmn 386 0527Self-care responsibility (xplusmnSD) 2064plusmn 471 2086plusmn 453 0181

Self-care skills (xplusmnSD) 2177plusmn 582 2162plusmn 564 0519Self-efficacy (xplusmnSD) 2629plusmn 641 2641plusmn 637 0404

HBM health belief model x mean SD standard deviation

Journal of Healthcare Engineering 7

exercise training for LEDVTand enhance their health beliefsand active participation consciousness Postoperative re-habilitation training can effectively reduce the occurrence ofdeep vein thrombosis (DVT) [34] One-on-one guidancefrom the intervention nurse can promote the patientsrsquotransition from passive exercise to active routine exerciseimprove the prognosis of patients and effectively reduce theincidence of LEDVT [22] e results of this study showedthat the incidence of LEDVT in elderly patients withgynaecological cancer decreased significantly after receivingHBM-based rehabilitation education indicating thatstrengthening HBM rehabilitation interventions can pro-mote the postoperative rehabilitation of elderly patients withgynaecological cancer especially by effectively preventingLEDVT

ere are still some potential limitations to this studyFirst the number of participants in this study was small andwe will add more participants in the next stage to furtherverify the effectiveness of the HBM education interventionSecond this study was conducted in a single centre and thereproducibility of the results is still unclear so it will beextended to multiple centres to verify the applicability of theHBM in the future Finally the follow-up data of the par-ticipants were not analysed in this study because our follow-up work is ongoing and we will analyse the results after thefollow-up is completed

5 Conclusion

Evidence from this study suggests that perioperative HBM-based educational interventions benefit mental health anddisease outcomes in elderly women with gynaecologicalmalignancies by improving self-efficacy self-care ability andcompliance

Data Availability

e data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

All authors declare that they have no conflicts of interest

Authorsrsquo Contributions

All authors made substantial contributions to conceptionand design acquisition of data or analysis and interpreta-tion of data took part in drafting the article or revising itcritically for important intellectual content agreed to submitthe article to the current journal gave final approval of theversion to be published and agree to be accountable for allaspects of the work

Acknowledgments

e authors would like to thank the investigators for theircontributions to this trial Above all the authors are gratefulto all patients who participated in this study

References

[1] X Jiang H Tang and T Chen ldquoEpidemiology of gynecologiccancers in Chinardquo Journal of gynecologic oncology vol 29no 1 p e7 2018

[2] Y Yoshida and D Inoue ldquoClinical management of chemo-therapy for elderly gynecological cancer patientsrdquo Journal ofObstetrics and Gynaecology Research vol 47 no 7pp 2261ndash2270 2021

[3] E Reiser N Potsch V Seebacher et al ldquoImpact of frailty onthe management of patients with gynecological cancer aged 80years and olderrdquo Archives of Gynecology and Obstetricsvol 303 no 2 pp 557ndash563 2021

[4] F N Lupo P Arnaboldi L Santoro et al ldquoe effects of amultimodal training program on burnout syndrome in gy-necologic oncology nurses and on the multidisciplinarypsychosocial care of gynecologic cancer patients an Italianexperiencerdquo Palliative amp Supportive Care vol 11 no 3pp 199ndash203 2013

[5] N E Avis A Colvin R Hess and J T Bromberger ldquoMidlifefactors related to psychological well-being at an older agestudy of womenrsquos health across the nationrdquo Journal ofWomenrsquos Health vol 30 no 3 pp 332ndash340 2021

[6] A Abusalehi M Vahedian-Shahroodi H Esmaily A Jafariand H Tehrani ldquoMental health promotion of the elderly innursing homes a social-cognitive interventionrdquo InternationalJournal of Gerontology vol 15 no 3 pp 221ndash227 2021

[7] S-L Oh H-j Kim S Woo et al ldquoEffects of an integratedhealth education and elastic band resistance training programon physical function and muscle strength in community-dwelling elderly women healthy Aging and Happy Aging IIstudyrdquoGeriatrics and Gerontology International vol 17 no 5pp 825ndash833 2017

[8] I M Rosenstock ldquoHistorical origins of the health beliefmodelrdquo Health Education Monographs vol 24 pp 238ndash3351974

[9] T N Maseko H C Huang and K C Lin ldquoCervical cancerscreening behavior of African women the Rosenstock healthbelief model assessmentrdquo Health Care for Women Interna-tional vol 28 pp 1ndash16 2019

[10] A Cal Z Bahar and I Gorken ldquoEffects of Health BeliefModel based nursing interventions offered at home visits onlymphedema prevention in women with breast cancer arandomised controlled trialrdquo Journal of Clinical Nursingvol 29 no 13-14 pp 2521ndash2534 2020

[11] M Damghanian H Mahmoodzadeh Z KhakbazanB Khorsand and M Motaharinezhad ldquoSelf-care behaviors inhigh-risk women for breast cancer a randomized clinical trialusing health belief model educationrdquo Journal of Educationand Health Promotion vol 9 p 265 2020

[12] M Simbar M Ghazanfarpour and S Abdolahian ldquoEffects oftraining based on the health belief model on Iranian womenrsquosperformance about cervical screening a systematic review andmeta-analysisrdquo Journal of Education and Health Promotionvol 9 p 179 2020

[13] S B Eghbal M Karimy P Kasmaei Z A RoshanR Valipour and S M Attari ldquoEvaluating the effect of aneducational program on increasing cervical cancer screeningbehavior among rural women in Guilan Iranrdquo BMCWomenrsquosHealth vol 20 no 1 p 149 2020

[14] B E Azriful E Bujawati F Nildawati R RamdanF Mallapiang and S Suyuti ldquoHealth Belief Model on womenrsquoscancer recovery (a phenomenological study on cancer survi-vors)rdquo Gaceta Sanitaria vol 35 no 1 pp S9ndashS11 2021

8 Journal of Healthcare Engineering

[15] L Wu Y Tan and Y Liu ldquoFactor structure and psychometricevaluation of the Connor-Davidson resilience scale in a newemployee population of Chinardquo BMC Psychiatry vol 17no 1 p 49 2017

[16] Y Han X Han and X Xu ldquoIntervention effect of healtheducation pathway on self-care ability and health behavior ofpatients with chronic obstructive pulmonary diseaserdquo Chinaclinical nursing vol 8 no 5 pp 438ndash440 2016

[17] X-J Fu S-D Hu Y-F Peng L-Y Zhou T Shu andD-D Song ldquoObservation of the effect of one-to-one edu-cation on high-risk cases of diabetic footrdquo World Journal ofClinical Cases vol 9 no 14 pp 3265ndash3272 2021

[18] Y Xia H Zhang Y Xia H Li L Zhai and H Wang ldquoeself-psychological safety maintenance and its influencingfactors of community frontline staff during COVID-19pandemicrdquoMedicine vol 100 no 3 Article ID e24140 2021

[19] Y Y Chong W T Chien H Y Cheng A P KassianosA T Gloster and M Karekla ldquoCan psychological flexibilityand prosociality mitigate illness perceptions toward COVID-19 on mental health A cross-sectional study among HongKong adultsrdquo Globalization and Health vol 17 no 1 p 432021

[20] S M ompson L K Low L Bude R de Vries andM Nieuwenhuijze ldquoEvaluating the effect of an educationalintervention on student midwife self-efficacy for their role asphysiological childbirth advocatesrdquo Nurse Education Todayvol 96 Article ID 104628 2021

[21] J Villanueva A H Meyer M T B Rinner et al ldquoldquoChoosechangerdquo design and methods of an acceptance and com-mitment therapy effectiveness trial for transdiagnostictreatment-resistant patientsrdquo BMC Psychiatry vol 19 no 1p 173 2019

[22] L Hu and G Liu ldquoEffects of early rehabilitation nursing onneurological functions and quality of life of patients withischemic stroke hemiplegiardquo American Journal of TourismResearch vol 13 no 4 pp 3811ndash3818 2021

[23] E Parpa E Tsilika V Gennimata and K MystakidouldquoElderly cancer patientsrsquo psychopathology a systematic re-viewrdquo Archives of Gerontology and Geriatrics vol 60 no 1pp 9ndash15 2015

[24] J Chen H Xiao Y Chen H Sun S Chen and J ZhengldquoEffect of reminiscence therapy based on positive psychologytheory (RTBPPT) on the positive feelings of the spousalcaregivers of elderly patients with advanced cancer in ChinardquoEuropean Journal of Cancer Care vol 29 no 6 Article IDe13324 2020

[25] S Folkman R S Lazarus S Pimley and J Novacek ldquoAgedifferences in stress and coping processesrdquo Psychology andAging vol 2 no 2 pp 171ndash184 1987

[26] Y Zheng F Lei and B Liu ldquoCancer diagnosis disclosure andquality of life in elderly cancer patientsrdquo Healthcare vol 7no 4 p 163 2019

[27] F Hejazi M Bahrami M Keshvari and M Alavi ldquoe effectof a communicational program on psychological distress inthe elderly suffering from cancerrdquo Iranian Journal of Nursingand Midwifery Research vol 22 no 3 pp 201ndash207 2017

[28] T Naito S Mitsunaga S Miura et al ldquoFeasibility of earlymultimodal interventions for elderly patients with advancedpancreatic and non-small-cell lung cancerrdquo Journal of Ca-chexia Sarcopenia and Muscle vol 10 no 1 pp 73ndash83 2019

[29] H Kukihara N Yamawaki M Ando M Nishio H Kimuraand Y Tamura ldquoe mediating effect of resilience betweenfamily functioning and mental well-being in hemodialysis

patients in Japan a cross-sectional designrdquo Health andQuality of Life Outcomes vol 18 no 1 p 233 2020

[30] R Prieto B Ferrell J Kim and V Sun ldquoSelf-managementcoaching promoting postoperative recovery and caregivingpreparedness for patients with lung cancer and their familycaregiversrdquo Clinical Journal of Oncology Nursing vol 25no 3 pp 290ndash296 2021

[31] Y Wen J Ma X Jiang G Gao H Xie and P Lu ldquoInflu-encing factors of holistic nursing intervention under a socialmedical model on the psychology and quality of life of patientswith advanced gastric cancerrdquo American Journal of TourismResearch vol 13 no 4 pp 3369ndash3379 2021

[32] A Bandura ldquoHealth promotion by social cognitive meansrdquoHealth Educationamp Behavior vol 31 no 2 pp 143ndash164 2004

[33] Z Li and Z Zhang ldquoe incidence and risk factors of venousthromboembolism following elective gynecological surgerieswithout systemic thromboprophylaxis--an observational co-hort study in a Chinese tertiary hospitalrdquo Clinical amp Exper-imental Obstetrics amp Gynecology vol 43 no 3 pp 365ndash3692016

[34] H Wang Y Huo Y Zhao et al ldquoClinical rehabilitation effectof postoperative lower-limb training on the patients under-going olif surgery a retrospective studyrdquo Pain Research ampManagement vol 2020 Article ID 1065202 2020

Journal of Healthcare Engineering 9

Rehabilitation based on the HBM can enhance the psy-chological resilience and rehabilitation compliance of pa-tients leading patients to actively participate inpostoperative rehabilitation treatment and achieve a moreideal rehabilitation effect Previous studies [26 27] have alsoshown that psychological interventions can improve survivalin cancer patients is evidence further proves the value ofHBM psychological intervention in elderly gynaecologicalcancer patients in improving survival

ere is likely to be a certain correlation betweenphysical health and treatment compliance Early psycho-logical intervention can improve treatment compliance incancer patients [28] Patients with a high level of mentalflexibility and good mental health are able to actively par-ticipate in and cooperate with treatment so they have highercompliance with rehabilitation training [29] Our studyshows that the level of patientsrsquo psychological resilience andcompliance can be increased through positivity HBM ed-ucation HBM education can help patients face their diseasepositively rebuild their confidence adopt healthy behav-iours and enhance their psychological immunity increasingtheir level of psychological resilience [25]

Self-efficacy is an important factor in maintaining orchanging health behaviours e higher the level of self-efficacy the higher the level of adopting maintaining andstriving for healthy behaviours and the stronger the self-nursing ability [30] According to Wen Yrsquos [31] study theearly self-nursing ability of patients affects later outcomeserefore perioperative rehabilitation education based onthe HBM can not only strengthen the self-nursing ability ofpatients with malignant tumours but also increase the self-nursing ability and quality of life after discharge

e decline in the learning and memory abilities ofelderly patients can impact their self-efficacy and self-nursing abilities In the context of special diseases patients

can build and strengthen their self-efficacy and self-nursingskills only through active intervention reconstruction oftheir self-confidence to overcome difficulties and contin-uous demonstrative learning [32] In light of the decline inlearning and memory ability of elderly patients withgynaecological malignant tumours during HBM-basedhealth education the patients were trained in the diaphragmand lower extremity movements through the guidance ofprofessional nurses and video demonstrations and weresupervised in the hospital and during follow-up after dis-charge in this study e results indicated that the self-ef-ficacy and self-nursing ability in the intervention group weremuch higher than those in the control group after the ap-plication of rehabilitation education based on the HBMsuggesting that rehabilitation education based on the HBMcan help elderly patients with gynaecological cancer masterdisease-related knowledge and skills enhance their self-ef-ficacy adopt good rehabilitation behaviour and self-nursingability and improve rehabilitation

LEDVT is one of the most common complications ingynaecological patients [33] It can cause pain swelling anddysfunction of the lower limbs rombus detachment ofLEDVT can induce pulmonary embolism and is even life-threatening Elderly patients with gynaecological cancerrequire a wide range of operations a long duration of bedrest after the operation and a low willingness to performactivities due to lower limb dysfunction Moreover elderlypatients with gynaecological cancer have high-risk factorssuch as old age malignant tumours and other vasculardiseases [33] which makes the probability of LEDVT higherthan that among general patients Based on the individualdifferences in elderly patients with gynaecological malignanttumours rehabilitation intervention based on the HBM canhelp patients fully understand the mechanism and severityand the importance of cooperative treatment and health

Table 4 Comparison of HBM scores between the two groups before and after intervention

Groups Variables Before intervention After intervention P value

HBM education group (n 134)

Compliance of training (n) lt0001Complete compliance 38 108

Low compliance 96 26Psychological resilience score (xplusmnSD) 5043plusmn 329 5547plusmn 501 lt0001

Psychological flexibility (xplusmnSD) 4898plusmn 345 5653plusmn 451 lt0001Self-care knowledge (xplusmnSD) 3422plusmn 747 4336plusmn 760 lt0001

Self-concept (xplusmnSD) 2087plusmn 434 2957plusmn 567 lt0001Self-care responsibility (xplusmnSD) 2044plusmn 458 2754plusmn 509 lt0001

Self-care skills (xplusmnSD) 2278plusmn 671 3451plusmn 562 lt0001Self-efficacy (xplusmnSD) 2649plusmn 526 3079plusmn 456 lt0001

Basic nursing group (n 133)

Compliance of training (n) 0685Complete compliance 37 40

Low compliance 96 93Psychological resilience score (xplusmnSD) 5055plusmn 229 5046plusmn 262 0467

Psychological flexibility (xplusmnSD) 4929plusmn 359 4913plusmn 362 0124Self-care knowledge (xplusmnSD) 3377plusmn 705 3405plusmn 699 0076

Self-concept (xplusmnSD) 2022plusmn 410 2011plusmn 386 0527Self-care responsibility (xplusmnSD) 2064plusmn 471 2086plusmn 453 0181

Self-care skills (xplusmnSD) 2177plusmn 582 2162plusmn 564 0519Self-efficacy (xplusmnSD) 2629plusmn 641 2641plusmn 637 0404

HBM health belief model x mean SD standard deviation

Journal of Healthcare Engineering 7

exercise training for LEDVTand enhance their health beliefsand active participation consciousness Postoperative re-habilitation training can effectively reduce the occurrence ofdeep vein thrombosis (DVT) [34] One-on-one guidancefrom the intervention nurse can promote the patientsrsquotransition from passive exercise to active routine exerciseimprove the prognosis of patients and effectively reduce theincidence of LEDVT [22] e results of this study showedthat the incidence of LEDVT in elderly patients withgynaecological cancer decreased significantly after receivingHBM-based rehabilitation education indicating thatstrengthening HBM rehabilitation interventions can pro-mote the postoperative rehabilitation of elderly patients withgynaecological cancer especially by effectively preventingLEDVT

ere are still some potential limitations to this studyFirst the number of participants in this study was small andwe will add more participants in the next stage to furtherverify the effectiveness of the HBM education interventionSecond this study was conducted in a single centre and thereproducibility of the results is still unclear so it will beextended to multiple centres to verify the applicability of theHBM in the future Finally the follow-up data of the par-ticipants were not analysed in this study because our follow-up work is ongoing and we will analyse the results after thefollow-up is completed

5 Conclusion

Evidence from this study suggests that perioperative HBM-based educational interventions benefit mental health anddisease outcomes in elderly women with gynaecologicalmalignancies by improving self-efficacy self-care ability andcompliance

Data Availability

e data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

All authors declare that they have no conflicts of interest

Authorsrsquo Contributions

All authors made substantial contributions to conceptionand design acquisition of data or analysis and interpreta-tion of data took part in drafting the article or revising itcritically for important intellectual content agreed to submitthe article to the current journal gave final approval of theversion to be published and agree to be accountable for allaspects of the work

Acknowledgments

e authors would like to thank the investigators for theircontributions to this trial Above all the authors are gratefulto all patients who participated in this study

References

[1] X Jiang H Tang and T Chen ldquoEpidemiology of gynecologiccancers in Chinardquo Journal of gynecologic oncology vol 29no 1 p e7 2018

[2] Y Yoshida and D Inoue ldquoClinical management of chemo-therapy for elderly gynecological cancer patientsrdquo Journal ofObstetrics and Gynaecology Research vol 47 no 7pp 2261ndash2270 2021

[3] E Reiser N Potsch V Seebacher et al ldquoImpact of frailty onthe management of patients with gynecological cancer aged 80years and olderrdquo Archives of Gynecology and Obstetricsvol 303 no 2 pp 557ndash563 2021

[4] F N Lupo P Arnaboldi L Santoro et al ldquoe effects of amultimodal training program on burnout syndrome in gy-necologic oncology nurses and on the multidisciplinarypsychosocial care of gynecologic cancer patients an Italianexperiencerdquo Palliative amp Supportive Care vol 11 no 3pp 199ndash203 2013

[5] N E Avis A Colvin R Hess and J T Bromberger ldquoMidlifefactors related to psychological well-being at an older agestudy of womenrsquos health across the nationrdquo Journal ofWomenrsquos Health vol 30 no 3 pp 332ndash340 2021

[6] A Abusalehi M Vahedian-Shahroodi H Esmaily A Jafariand H Tehrani ldquoMental health promotion of the elderly innursing homes a social-cognitive interventionrdquo InternationalJournal of Gerontology vol 15 no 3 pp 221ndash227 2021

[7] S-L Oh H-j Kim S Woo et al ldquoEffects of an integratedhealth education and elastic band resistance training programon physical function and muscle strength in community-dwelling elderly women healthy Aging and Happy Aging IIstudyrdquoGeriatrics and Gerontology International vol 17 no 5pp 825ndash833 2017

[8] I M Rosenstock ldquoHistorical origins of the health beliefmodelrdquo Health Education Monographs vol 24 pp 238ndash3351974

[9] T N Maseko H C Huang and K C Lin ldquoCervical cancerscreening behavior of African women the Rosenstock healthbelief model assessmentrdquo Health Care for Women Interna-tional vol 28 pp 1ndash16 2019

[10] A Cal Z Bahar and I Gorken ldquoEffects of Health BeliefModel based nursing interventions offered at home visits onlymphedema prevention in women with breast cancer arandomised controlled trialrdquo Journal of Clinical Nursingvol 29 no 13-14 pp 2521ndash2534 2020

[11] M Damghanian H Mahmoodzadeh Z KhakbazanB Khorsand and M Motaharinezhad ldquoSelf-care behaviors inhigh-risk women for breast cancer a randomized clinical trialusing health belief model educationrdquo Journal of Educationand Health Promotion vol 9 p 265 2020

[12] M Simbar M Ghazanfarpour and S Abdolahian ldquoEffects oftraining based on the health belief model on Iranian womenrsquosperformance about cervical screening a systematic review andmeta-analysisrdquo Journal of Education and Health Promotionvol 9 p 179 2020

[13] S B Eghbal M Karimy P Kasmaei Z A RoshanR Valipour and S M Attari ldquoEvaluating the effect of aneducational program on increasing cervical cancer screeningbehavior among rural women in Guilan Iranrdquo BMCWomenrsquosHealth vol 20 no 1 p 149 2020

[14] B E Azriful E Bujawati F Nildawati R RamdanF Mallapiang and S Suyuti ldquoHealth Belief Model on womenrsquoscancer recovery (a phenomenological study on cancer survi-vors)rdquo Gaceta Sanitaria vol 35 no 1 pp S9ndashS11 2021

8 Journal of Healthcare Engineering

[15] L Wu Y Tan and Y Liu ldquoFactor structure and psychometricevaluation of the Connor-Davidson resilience scale in a newemployee population of Chinardquo BMC Psychiatry vol 17no 1 p 49 2017

[16] Y Han X Han and X Xu ldquoIntervention effect of healtheducation pathway on self-care ability and health behavior ofpatients with chronic obstructive pulmonary diseaserdquo Chinaclinical nursing vol 8 no 5 pp 438ndash440 2016

[17] X-J Fu S-D Hu Y-F Peng L-Y Zhou T Shu andD-D Song ldquoObservation of the effect of one-to-one edu-cation on high-risk cases of diabetic footrdquo World Journal ofClinical Cases vol 9 no 14 pp 3265ndash3272 2021

[18] Y Xia H Zhang Y Xia H Li L Zhai and H Wang ldquoeself-psychological safety maintenance and its influencingfactors of community frontline staff during COVID-19pandemicrdquoMedicine vol 100 no 3 Article ID e24140 2021

[19] Y Y Chong W T Chien H Y Cheng A P KassianosA T Gloster and M Karekla ldquoCan psychological flexibilityand prosociality mitigate illness perceptions toward COVID-19 on mental health A cross-sectional study among HongKong adultsrdquo Globalization and Health vol 17 no 1 p 432021

[20] S M ompson L K Low L Bude R de Vries andM Nieuwenhuijze ldquoEvaluating the effect of an educationalintervention on student midwife self-efficacy for their role asphysiological childbirth advocatesrdquo Nurse Education Todayvol 96 Article ID 104628 2021

[21] J Villanueva A H Meyer M T B Rinner et al ldquoldquoChoosechangerdquo design and methods of an acceptance and com-mitment therapy effectiveness trial for transdiagnostictreatment-resistant patientsrdquo BMC Psychiatry vol 19 no 1p 173 2019

[22] L Hu and G Liu ldquoEffects of early rehabilitation nursing onneurological functions and quality of life of patients withischemic stroke hemiplegiardquo American Journal of TourismResearch vol 13 no 4 pp 3811ndash3818 2021

[23] E Parpa E Tsilika V Gennimata and K MystakidouldquoElderly cancer patientsrsquo psychopathology a systematic re-viewrdquo Archives of Gerontology and Geriatrics vol 60 no 1pp 9ndash15 2015

[24] J Chen H Xiao Y Chen H Sun S Chen and J ZhengldquoEffect of reminiscence therapy based on positive psychologytheory (RTBPPT) on the positive feelings of the spousalcaregivers of elderly patients with advanced cancer in ChinardquoEuropean Journal of Cancer Care vol 29 no 6 Article IDe13324 2020

[25] S Folkman R S Lazarus S Pimley and J Novacek ldquoAgedifferences in stress and coping processesrdquo Psychology andAging vol 2 no 2 pp 171ndash184 1987

[26] Y Zheng F Lei and B Liu ldquoCancer diagnosis disclosure andquality of life in elderly cancer patientsrdquo Healthcare vol 7no 4 p 163 2019

[27] F Hejazi M Bahrami M Keshvari and M Alavi ldquoe effectof a communicational program on psychological distress inthe elderly suffering from cancerrdquo Iranian Journal of Nursingand Midwifery Research vol 22 no 3 pp 201ndash207 2017

[28] T Naito S Mitsunaga S Miura et al ldquoFeasibility of earlymultimodal interventions for elderly patients with advancedpancreatic and non-small-cell lung cancerrdquo Journal of Ca-chexia Sarcopenia and Muscle vol 10 no 1 pp 73ndash83 2019

[29] H Kukihara N Yamawaki M Ando M Nishio H Kimuraand Y Tamura ldquoe mediating effect of resilience betweenfamily functioning and mental well-being in hemodialysis

patients in Japan a cross-sectional designrdquo Health andQuality of Life Outcomes vol 18 no 1 p 233 2020

[30] R Prieto B Ferrell J Kim and V Sun ldquoSelf-managementcoaching promoting postoperative recovery and caregivingpreparedness for patients with lung cancer and their familycaregiversrdquo Clinical Journal of Oncology Nursing vol 25no 3 pp 290ndash296 2021

[31] Y Wen J Ma X Jiang G Gao H Xie and P Lu ldquoInflu-encing factors of holistic nursing intervention under a socialmedical model on the psychology and quality of life of patientswith advanced gastric cancerrdquo American Journal of TourismResearch vol 13 no 4 pp 3369ndash3379 2021

[32] A Bandura ldquoHealth promotion by social cognitive meansrdquoHealth Educationamp Behavior vol 31 no 2 pp 143ndash164 2004

[33] Z Li and Z Zhang ldquoe incidence and risk factors of venousthromboembolism following elective gynecological surgerieswithout systemic thromboprophylaxis--an observational co-hort study in a Chinese tertiary hospitalrdquo Clinical amp Exper-imental Obstetrics amp Gynecology vol 43 no 3 pp 365ndash3692016

[34] H Wang Y Huo Y Zhao et al ldquoClinical rehabilitation effectof postoperative lower-limb training on the patients under-going olif surgery a retrospective studyrdquo Pain Research ampManagement vol 2020 Article ID 1065202 2020

Journal of Healthcare Engineering 9

exercise training for LEDVTand enhance their health beliefsand active participation consciousness Postoperative re-habilitation training can effectively reduce the occurrence ofdeep vein thrombosis (DVT) [34] One-on-one guidancefrom the intervention nurse can promote the patientsrsquotransition from passive exercise to active routine exerciseimprove the prognosis of patients and effectively reduce theincidence of LEDVT [22] e results of this study showedthat the incidence of LEDVT in elderly patients withgynaecological cancer decreased significantly after receivingHBM-based rehabilitation education indicating thatstrengthening HBM rehabilitation interventions can pro-mote the postoperative rehabilitation of elderly patients withgynaecological cancer especially by effectively preventingLEDVT

ere are still some potential limitations to this studyFirst the number of participants in this study was small andwe will add more participants in the next stage to furtherverify the effectiveness of the HBM education interventionSecond this study was conducted in a single centre and thereproducibility of the results is still unclear so it will beextended to multiple centres to verify the applicability of theHBM in the future Finally the follow-up data of the par-ticipants were not analysed in this study because our follow-up work is ongoing and we will analyse the results after thefollow-up is completed

5 Conclusion

Evidence from this study suggests that perioperative HBM-based educational interventions benefit mental health anddisease outcomes in elderly women with gynaecologicalmalignancies by improving self-efficacy self-care ability andcompliance

Data Availability

e data used to support the findings of this study areavailable from the corresponding author upon request

Conflicts of Interest

All authors declare that they have no conflicts of interest

Authorsrsquo Contributions

All authors made substantial contributions to conceptionand design acquisition of data or analysis and interpreta-tion of data took part in drafting the article or revising itcritically for important intellectual content agreed to submitthe article to the current journal gave final approval of theversion to be published and agree to be accountable for allaspects of the work

Acknowledgments

e authors would like to thank the investigators for theircontributions to this trial Above all the authors are gratefulto all patients who participated in this study

References

[1] X Jiang H Tang and T Chen ldquoEpidemiology of gynecologiccancers in Chinardquo Journal of gynecologic oncology vol 29no 1 p e7 2018

[2] Y Yoshida and D Inoue ldquoClinical management of chemo-therapy for elderly gynecological cancer patientsrdquo Journal ofObstetrics and Gynaecology Research vol 47 no 7pp 2261ndash2270 2021

[3] E Reiser N Potsch V Seebacher et al ldquoImpact of frailty onthe management of patients with gynecological cancer aged 80years and olderrdquo Archives of Gynecology and Obstetricsvol 303 no 2 pp 557ndash563 2021

[4] F N Lupo P Arnaboldi L Santoro et al ldquoe effects of amultimodal training program on burnout syndrome in gy-necologic oncology nurses and on the multidisciplinarypsychosocial care of gynecologic cancer patients an Italianexperiencerdquo Palliative amp Supportive Care vol 11 no 3pp 199ndash203 2013

[5] N E Avis A Colvin R Hess and J T Bromberger ldquoMidlifefactors related to psychological well-being at an older agestudy of womenrsquos health across the nationrdquo Journal ofWomenrsquos Health vol 30 no 3 pp 332ndash340 2021

[6] A Abusalehi M Vahedian-Shahroodi H Esmaily A Jafariand H Tehrani ldquoMental health promotion of the elderly innursing homes a social-cognitive interventionrdquo InternationalJournal of Gerontology vol 15 no 3 pp 221ndash227 2021

[7] S-L Oh H-j Kim S Woo et al ldquoEffects of an integratedhealth education and elastic band resistance training programon physical function and muscle strength in community-dwelling elderly women healthy Aging and Happy Aging IIstudyrdquoGeriatrics and Gerontology International vol 17 no 5pp 825ndash833 2017

[8] I M Rosenstock ldquoHistorical origins of the health beliefmodelrdquo Health Education Monographs vol 24 pp 238ndash3351974

[9] T N Maseko H C Huang and K C Lin ldquoCervical cancerscreening behavior of African women the Rosenstock healthbelief model assessmentrdquo Health Care for Women Interna-tional vol 28 pp 1ndash16 2019

[10] A Cal Z Bahar and I Gorken ldquoEffects of Health BeliefModel based nursing interventions offered at home visits onlymphedema prevention in women with breast cancer arandomised controlled trialrdquo Journal of Clinical Nursingvol 29 no 13-14 pp 2521ndash2534 2020

[11] M Damghanian H Mahmoodzadeh Z KhakbazanB Khorsand and M Motaharinezhad ldquoSelf-care behaviors inhigh-risk women for breast cancer a randomized clinical trialusing health belief model educationrdquo Journal of Educationand Health Promotion vol 9 p 265 2020

[12] M Simbar M Ghazanfarpour and S Abdolahian ldquoEffects oftraining based on the health belief model on Iranian womenrsquosperformance about cervical screening a systematic review andmeta-analysisrdquo Journal of Education and Health Promotionvol 9 p 179 2020

[13] S B Eghbal M Karimy P Kasmaei Z A RoshanR Valipour and S M Attari ldquoEvaluating the effect of aneducational program on increasing cervical cancer screeningbehavior among rural women in Guilan Iranrdquo BMCWomenrsquosHealth vol 20 no 1 p 149 2020

[14] B E Azriful E Bujawati F Nildawati R RamdanF Mallapiang and S Suyuti ldquoHealth Belief Model on womenrsquoscancer recovery (a phenomenological study on cancer survi-vors)rdquo Gaceta Sanitaria vol 35 no 1 pp S9ndashS11 2021

8 Journal of Healthcare Engineering

[15] L Wu Y Tan and Y Liu ldquoFactor structure and psychometricevaluation of the Connor-Davidson resilience scale in a newemployee population of Chinardquo BMC Psychiatry vol 17no 1 p 49 2017

[16] Y Han X Han and X Xu ldquoIntervention effect of healtheducation pathway on self-care ability and health behavior ofpatients with chronic obstructive pulmonary diseaserdquo Chinaclinical nursing vol 8 no 5 pp 438ndash440 2016

[17] X-J Fu S-D Hu Y-F Peng L-Y Zhou T Shu andD-D Song ldquoObservation of the effect of one-to-one edu-cation on high-risk cases of diabetic footrdquo World Journal ofClinical Cases vol 9 no 14 pp 3265ndash3272 2021

[18] Y Xia H Zhang Y Xia H Li L Zhai and H Wang ldquoeself-psychological safety maintenance and its influencingfactors of community frontline staff during COVID-19pandemicrdquoMedicine vol 100 no 3 Article ID e24140 2021

[19] Y Y Chong W T Chien H Y Cheng A P KassianosA T Gloster and M Karekla ldquoCan psychological flexibilityand prosociality mitigate illness perceptions toward COVID-19 on mental health A cross-sectional study among HongKong adultsrdquo Globalization and Health vol 17 no 1 p 432021

[20] S M ompson L K Low L Bude R de Vries andM Nieuwenhuijze ldquoEvaluating the effect of an educationalintervention on student midwife self-efficacy for their role asphysiological childbirth advocatesrdquo Nurse Education Todayvol 96 Article ID 104628 2021

[21] J Villanueva A H Meyer M T B Rinner et al ldquoldquoChoosechangerdquo design and methods of an acceptance and com-mitment therapy effectiveness trial for transdiagnostictreatment-resistant patientsrdquo BMC Psychiatry vol 19 no 1p 173 2019

[22] L Hu and G Liu ldquoEffects of early rehabilitation nursing onneurological functions and quality of life of patients withischemic stroke hemiplegiardquo American Journal of TourismResearch vol 13 no 4 pp 3811ndash3818 2021

[23] E Parpa E Tsilika V Gennimata and K MystakidouldquoElderly cancer patientsrsquo psychopathology a systematic re-viewrdquo Archives of Gerontology and Geriatrics vol 60 no 1pp 9ndash15 2015

[24] J Chen H Xiao Y Chen H Sun S Chen and J ZhengldquoEffect of reminiscence therapy based on positive psychologytheory (RTBPPT) on the positive feelings of the spousalcaregivers of elderly patients with advanced cancer in ChinardquoEuropean Journal of Cancer Care vol 29 no 6 Article IDe13324 2020

[25] S Folkman R S Lazarus S Pimley and J Novacek ldquoAgedifferences in stress and coping processesrdquo Psychology andAging vol 2 no 2 pp 171ndash184 1987

[26] Y Zheng F Lei and B Liu ldquoCancer diagnosis disclosure andquality of life in elderly cancer patientsrdquo Healthcare vol 7no 4 p 163 2019

[27] F Hejazi M Bahrami M Keshvari and M Alavi ldquoe effectof a communicational program on psychological distress inthe elderly suffering from cancerrdquo Iranian Journal of Nursingand Midwifery Research vol 22 no 3 pp 201ndash207 2017

[28] T Naito S Mitsunaga S Miura et al ldquoFeasibility of earlymultimodal interventions for elderly patients with advancedpancreatic and non-small-cell lung cancerrdquo Journal of Ca-chexia Sarcopenia and Muscle vol 10 no 1 pp 73ndash83 2019

[29] H Kukihara N Yamawaki M Ando M Nishio H Kimuraand Y Tamura ldquoe mediating effect of resilience betweenfamily functioning and mental well-being in hemodialysis

patients in Japan a cross-sectional designrdquo Health andQuality of Life Outcomes vol 18 no 1 p 233 2020

[30] R Prieto B Ferrell J Kim and V Sun ldquoSelf-managementcoaching promoting postoperative recovery and caregivingpreparedness for patients with lung cancer and their familycaregiversrdquo Clinical Journal of Oncology Nursing vol 25no 3 pp 290ndash296 2021

[31] Y Wen J Ma X Jiang G Gao H Xie and P Lu ldquoInflu-encing factors of holistic nursing intervention under a socialmedical model on the psychology and quality of life of patientswith advanced gastric cancerrdquo American Journal of TourismResearch vol 13 no 4 pp 3369ndash3379 2021

[32] A Bandura ldquoHealth promotion by social cognitive meansrdquoHealth Educationamp Behavior vol 31 no 2 pp 143ndash164 2004

[33] Z Li and Z Zhang ldquoe incidence and risk factors of venousthromboembolism following elective gynecological surgerieswithout systemic thromboprophylaxis--an observational co-hort study in a Chinese tertiary hospitalrdquo Clinical amp Exper-imental Obstetrics amp Gynecology vol 43 no 3 pp 365ndash3692016

[34] H Wang Y Huo Y Zhao et al ldquoClinical rehabilitation effectof postoperative lower-limb training on the patients under-going olif surgery a retrospective studyrdquo Pain Research ampManagement vol 2020 Article ID 1065202 2020

Journal of Healthcare Engineering 9

[15] L Wu Y Tan and Y Liu ldquoFactor structure and psychometricevaluation of the Connor-Davidson resilience scale in a newemployee population of Chinardquo BMC Psychiatry vol 17no 1 p 49 2017

[16] Y Han X Han and X Xu ldquoIntervention effect of healtheducation pathway on self-care ability and health behavior ofpatients with chronic obstructive pulmonary diseaserdquo Chinaclinical nursing vol 8 no 5 pp 438ndash440 2016

[17] X-J Fu S-D Hu Y-F Peng L-Y Zhou T Shu andD-D Song ldquoObservation of the effect of one-to-one edu-cation on high-risk cases of diabetic footrdquo World Journal ofClinical Cases vol 9 no 14 pp 3265ndash3272 2021

[18] Y Xia H Zhang Y Xia H Li L Zhai and H Wang ldquoeself-psychological safety maintenance and its influencingfactors of community frontline staff during COVID-19pandemicrdquoMedicine vol 100 no 3 Article ID e24140 2021

[19] Y Y Chong W T Chien H Y Cheng A P KassianosA T Gloster and M Karekla ldquoCan psychological flexibilityand prosociality mitigate illness perceptions toward COVID-19 on mental health A cross-sectional study among HongKong adultsrdquo Globalization and Health vol 17 no 1 p 432021

[20] S M ompson L K Low L Bude R de Vries andM Nieuwenhuijze ldquoEvaluating the effect of an educationalintervention on student midwife self-efficacy for their role asphysiological childbirth advocatesrdquo Nurse Education Todayvol 96 Article ID 104628 2021

[21] J Villanueva A H Meyer M T B Rinner et al ldquoldquoChoosechangerdquo design and methods of an acceptance and com-mitment therapy effectiveness trial for transdiagnostictreatment-resistant patientsrdquo BMC Psychiatry vol 19 no 1p 173 2019

[22] L Hu and G Liu ldquoEffects of early rehabilitation nursing onneurological functions and quality of life of patients withischemic stroke hemiplegiardquo American Journal of TourismResearch vol 13 no 4 pp 3811ndash3818 2021

[23] E Parpa E Tsilika V Gennimata and K MystakidouldquoElderly cancer patientsrsquo psychopathology a systematic re-viewrdquo Archives of Gerontology and Geriatrics vol 60 no 1pp 9ndash15 2015

[24] J Chen H Xiao Y Chen H Sun S Chen and J ZhengldquoEffect of reminiscence therapy based on positive psychologytheory (RTBPPT) on the positive feelings of the spousalcaregivers of elderly patients with advanced cancer in ChinardquoEuropean Journal of Cancer Care vol 29 no 6 Article IDe13324 2020

[25] S Folkman R S Lazarus S Pimley and J Novacek ldquoAgedifferences in stress and coping processesrdquo Psychology andAging vol 2 no 2 pp 171ndash184 1987

[26] Y Zheng F Lei and B Liu ldquoCancer diagnosis disclosure andquality of life in elderly cancer patientsrdquo Healthcare vol 7no 4 p 163 2019

[27] F Hejazi M Bahrami M Keshvari and M Alavi ldquoe effectof a communicational program on psychological distress inthe elderly suffering from cancerrdquo Iranian Journal of Nursingand Midwifery Research vol 22 no 3 pp 201ndash207 2017

[28] T Naito S Mitsunaga S Miura et al ldquoFeasibility of earlymultimodal interventions for elderly patients with advancedpancreatic and non-small-cell lung cancerrdquo Journal of Ca-chexia Sarcopenia and Muscle vol 10 no 1 pp 73ndash83 2019

[29] H Kukihara N Yamawaki M Ando M Nishio H Kimuraand Y Tamura ldquoe mediating effect of resilience betweenfamily functioning and mental well-being in hemodialysis

patients in Japan a cross-sectional designrdquo Health andQuality of Life Outcomes vol 18 no 1 p 233 2020

[30] R Prieto B Ferrell J Kim and V Sun ldquoSelf-managementcoaching promoting postoperative recovery and caregivingpreparedness for patients with lung cancer and their familycaregiversrdquo Clinical Journal of Oncology Nursing vol 25no 3 pp 290ndash296 2021

[31] Y Wen J Ma X Jiang G Gao H Xie and P Lu ldquoInflu-encing factors of holistic nursing intervention under a socialmedical model on the psychology and quality of life of patientswith advanced gastric cancerrdquo American Journal of TourismResearch vol 13 no 4 pp 3369ndash3379 2021

[32] A Bandura ldquoHealth promotion by social cognitive meansrdquoHealth Educationamp Behavior vol 31 no 2 pp 143ndash164 2004

[33] Z Li and Z Zhang ldquoe incidence and risk factors of venousthromboembolism following elective gynecological surgerieswithout systemic thromboprophylaxis--an observational co-hort study in a Chinese tertiary hospitalrdquo Clinical amp Exper-imental Obstetrics amp Gynecology vol 43 no 3 pp 365ndash3692016

[34] H Wang Y Huo Y Zhao et al ldquoClinical rehabilitation effectof postoperative lower-limb training on the patients under-going olif surgery a retrospective studyrdquo Pain Research ampManagement vol 2020 Article ID 1065202 2020

Journal of Healthcare Engineering 9