# Outcome of Nursing Based on Health Belief United with Knowledge, Belief, and Practice Mode on Gastroscopy of Patients with Gastric Cancer

Authors: Junna Yang; Jing Yang; Dongmei Guo; Qingchao Zhao; Yang Chen
Journal: Computational and Mathematical Methods in Medicine
 (2022)

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## Abstract

Aim. If gastric cancer can be detected through early screening, and scientific and reasonable intervention methods can be selected in time, the condition can be effectively controlled. Routine nursing has been unable to obtain satisfactory results, and the effect on improving the compliance of the examiner is not outstanding. The research aims to estimate the outcome of nursing based on health belief combined with knowledge, belief, and practice on gastroscopy in patients with gastric cancer. Methods. 126 patients with clinically diagnosed gastric cancer in the Number Two Hospital of Baoding from May 2020 to May 2022 were randomly divided into belief guidance group and mode group, with 63 instances each. The mode group was intervened via the mode of knowledge, belief, and practice, and the belief guidance group was intervened via the nursing based on health belief on the basis of the mode group. Before and after the nursing, the health belief, examination compliance, inappropriateness, and negative emotion in different time periods were contrasted between the two groups. Results. After the nursing, the scores of health belief scale in the belief guidance group were enhanced than those in the mode group; the compliance rate of the belief guidance group was markedly enhanced than that of the mode group, and the inappropriateness during the insertion and examination was lower than that of the mode group; the scores of self-rating anxiety scale (SAS) and self-rating depression scale (SDS) in the two groups preinsertion and postnursing were markedly lower than those in the mode group. Conclusion. Nursing based on health belief guidance united with knowledge, belief, and practice mode nursing can advance the health belief and compliance of gastroscopy in patients with gastric cancer, reduce discomfort, and effectively advance the negative emotions of patients. It is worthy of clinical application.


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## Body

## 1. Introduction

Clinical studies have found that gastric ulcer, gastric polyp, atrophic gastritis, and partial gastrectomy are all high-risk groups of gastric cancer and may be caused by irregular diet and bad living habits. If diagnosed as soon as possible and provided with effective treatment in time, the survival rate of high-risk groups can be effectively prolonged. Therefore, the clinic gradually attaches importance to the screening and prevention of gastric cancer [1, 2]. Early screening and diagnosis of gastric cancer are conducive to illness treatment, and gastroscopy is an important means to advance the diagnostic accuracy. However, it is an invasive operation, and a little carelessness may cause more adverse reactions, so it is a high-risk group. The low compliance of cooperative examination directly hinders the development of early gastric cancer screening [3, 4]. Therefore, how to advance the compliance of gastric cancer patients with gastroscopy is an urgent problem. Nursing based on health belief can advance patients’ health awareness, help to alleviate patients’ psychological resistance, and achieve good results in the nursing application of patients [5]. The knowledge, belief, and practice mode includes three processes of acquiring knowledge, generating beliefs, and forming behaviors. It is a nursing mode to change patients’ health-related behaviors [6, 7]. The purpose of this study is to estimate the outcome of nursing of health belief-based nursing united with knowledge, belief, and practice mode in patients with gastric cancer, and to provide a basis for the diversity of nursing methods of gastroscopy in patients with gastric cancer.


## 2. General Information

### 2.1. Data and Methods

126 patients with clinically diagnosed gastric cancer in the Number Two Hospital of Baoding from May 2020 to May 2022 were selected as the study subjects. During the study period, there were no instances in the two groups. Inclusion criteria: (a) first gastroscopy; (b) all were aware of the study and voluntarily participated; (c) the instance data of all patients are complete. Exclusion criteria: (a) patients united with infectious illnesses; (b) gastrointestinal bleeding; (c) communication barrier; (4) patients with serious cardiovascular illness and immune system illness. The patients were randomly divided into belief guidance group and mode group, 63 instances each. The gender, age, education level, adverse life history, and chronic gastritis history of the two groups were similar (P>0.05), and the comparability was strong, as shown in Table 1. The mode group utilized the mode of knowledge, belief, and practice. The specific methods were as follows: (a) before the examination, the patient should be informed of the necessity of the examination, and then explained the examination steps and precautions to the patient. For instance, when the gastroscope entered the oral cavity, the tongue should not rub against the mirror. When the gastroscope was in the throat, the swallowing action should be performed. When the gastroscope entered the esophagus, the patient should exhale with the nasal inhalation mouth; (b) in the course of examination, instructed patients to maintain proper posture, put on braces, and patted patients on the back, encouraged patients, and paid attention to gentle language and positive attitude; (c) after the examination, took off the braces and handed the paper towels to the patients to clean their faces, and reassured the patients again. At the same time, the patients were instructed not to eat or drink water within 4 hours after the examination and to eat warm and liquid food within 24 hours.Table 1
Diversity of two groups of general data.
Belief guidance group (n=63)Mode group (n=63)t/χ2/Z valueP valueGender [n (%)]Male31 (49.21)30 (47.62)0.0320.859Female32 (50.79)33 (52.38)Age (years)Education level [n (%)]57.34±7.8158.38±6.93Primary school18 (28.57)17 (26.98)0.1440.930Junior high school20 (31.75)22 (34.92)High school and above25 (39.68)24 (38.10)Adverse life history [n (%)]Yes43 (68.25)45 (71.43)0.1510.698No20 (31.75)18 (28.57)History of chronic gastritis [n (%)]Yes39 (53.42)41 (65.08)1.8960.168No24 (46.58)22 (34.92)The belief guidance group carried out nursing based on health belief guidance on the basis of the mode group. The specific methods were as follows: (a) established a health belief group, including the head nurse and the nurse. Under the leadership of the head nurse, the group held a meeting to jointly formulate the nursing content and the gastric cancer related knowledge questionnaire; (b) carried out health lectures and explained the prevention and treatment of gastric cancer, gastroscopy, adverse reactions, etc. To patients in plain language, pictures or videos actively corrected the patients’ incorrect diet and lifestyle and popularized the influence of diet and lifestyle on illnesses; (c) organized patients to visit the hospital environment and inspection equipment to eliminate the fear of patients; (d) kept in touch with patients via phone or Wechat, urged them to maintain good living habits, gave encouragement, and advanced their confidence in treatment. After the examination, assessed the patients’ knowledge of gastroscopy and gastric cancer through Wechat questioning and corrected the patients who had wrong ideas in time; (e) nursing before gastroscopy; (f) nursing after gastroscopy.


### 2.2. Observation Indicators

#### 2.2.1. Health Belief Evaluation

Before and after the nursing, the patients’ health beliefs were assessed with the health beliefs scale, which included five dimensions such as barriers, severity, benefits, susceptibility, and self-efficacy. The full score of each dimension was 20 points. The higher the score, the higher the patients’ health beliefs in this dimension [8].


#### 2.2.2. Inspection Compliance and Inappropriate Evaluation

The patient’s active cooperation during the examination was counted, and the compliance rate was calculated. After completing the examination, the patients were asked to recall the pain during the insertion and examination, and the pain degree was assessed via visual analog scoring method, with a score of 0-10. The higher the score, the stronger the pain degree and the lower the comfort [9].


#### 2.2.3. Negative Emotion Evaluation

Before the nursing, before the insertion and after the nursing, the patients’ negative emotions were assessed via self-rating anxiety scale(SAS) and self-rating depression scale (SDS). Each of the two scales had 20 items, and each item counted 0-4 points. After the rough score of the scale was accumulated, multiplied it via 1.25 to take an integer as the standard score of the scale. The full score was 100 points. The lower the score, the lighter the patient’s negative emotional symptoms [10, 11].


### 2.3. Statistical Methods

The data in this paper were estimated via SPSS 21.0 statistical software. The patient’s gender, compliance, and other counting data were revealed via the rate (%). The chi-squared test was utilized for the diversity between groups. The patient’s health belief scale score, inappropriateness score, and other measuring data were revealed via themean±standard deviation (x̅±s), which conformed to the normal distribution. The independent sample t-test was utilized for the diversity between groups, and the paired sample t-test was utilized for the diversity within groups; P<0.05 was statistically significant.


## 2.1. Data and Methods

126 patients with clinically diagnosed gastric cancer in the Number Two Hospital of Baoding from May 2020 to May 2022 were selected as the study subjects. During the study period, there were no instances in the two groups. Inclusion criteria: (a) first gastroscopy; (b) all were aware of the study and voluntarily participated; (c) the instance data of all patients are complete. Exclusion criteria: (a) patients united with infectious illnesses; (b) gastrointestinal bleeding; (c) communication barrier; (4) patients with serious cardiovascular illness and immune system illness. The patients were randomly divided into belief guidance group and mode group, 63 instances each. The gender, age, education level, adverse life history, and chronic gastritis history of the two groups were similar (P>0.05), and the comparability was strong, as shown in Table 1. The mode group utilized the mode of knowledge, belief, and practice. The specific methods were as follows: (a) before the examination, the patient should be informed of the necessity of the examination, and then explained the examination steps and precautions to the patient. For instance, when the gastroscope entered the oral cavity, the tongue should not rub against the mirror. When the gastroscope was in the throat, the swallowing action should be performed. When the gastroscope entered the esophagus, the patient should exhale with the nasal inhalation mouth; (b) in the course of examination, instructed patients to maintain proper posture, put on braces, and patted patients on the back, encouraged patients, and paid attention to gentle language and positive attitude; (c) after the examination, took off the braces and handed the paper towels to the patients to clean their faces, and reassured the patients again. At the same time, the patients were instructed not to eat or drink water within 4 hours after the examination and to eat warm and liquid food within 24 hours.Table 1
Diversity of two groups of general data.
Belief guidance group (n=63)Mode group (n=63)t/χ2/Z valueP valueGender [n (%)]Male31 (49.21)30 (47.62)0.0320.859Female32 (50.79)33 (52.38)Age (years)Education level [n (%)]57.34±7.8158.38±6.93Primary school18 (28.57)17 (26.98)0.1440.930Junior high school20 (31.75)22 (34.92)High school and above25 (39.68)24 (38.10)Adverse life history [n (%)]Yes43 (68.25)45 (71.43)0.1510.698No20 (31.75)18 (28.57)History of chronic gastritis [n (%)]Yes39 (53.42)41 (65.08)1.8960.168No24 (46.58)22 (34.92)The belief guidance group carried out nursing based on health belief guidance on the basis of the mode group. The specific methods were as follows: (a) established a health belief group, including the head nurse and the nurse. Under the leadership of the head nurse, the group held a meeting to jointly formulate the nursing content and the gastric cancer related knowledge questionnaire; (b) carried out health lectures and explained the prevention and treatment of gastric cancer, gastroscopy, adverse reactions, etc. To patients in plain language, pictures or videos actively corrected the patients’ incorrect diet and lifestyle and popularized the influence of diet and lifestyle on illnesses; (c) organized patients to visit the hospital environment and inspection equipment to eliminate the fear of patients; (d) kept in touch with patients via phone or Wechat, urged them to maintain good living habits, gave encouragement, and advanced their confidence in treatment. After the examination, assessed the patients’ knowledge of gastroscopy and gastric cancer through Wechat questioning and corrected the patients who had wrong ideas in time; (e) nursing before gastroscopy; (f) nursing after gastroscopy.


## 2.2. Observation Indicators

### 2.2.1. Health Belief Evaluation

Before and after the nursing, the patients’ health beliefs were assessed with the health beliefs scale, which included five dimensions such as barriers, severity, benefits, susceptibility, and self-efficacy. The full score of each dimension was 20 points. The higher the score, the higher the patients’ health beliefs in this dimension [8].


### 2.2.2. Inspection Compliance and Inappropriate Evaluation

The patient’s active cooperation during the examination was counted, and the compliance rate was calculated. After completing the examination, the patients were asked to recall the pain during the insertion and examination, and the pain degree was assessed via visual analog scoring method, with a score of 0-10. The higher the score, the stronger the pain degree and the lower the comfort [9].


### 2.2.3. Negative Emotion Evaluation

Before the nursing, before the insertion and after the nursing, the patients’ negative emotions were assessed via self-rating anxiety scale(SAS) and self-rating depression scale (SDS). Each of the two scales had 20 items, and each item counted 0-4 points. After the rough score of the scale was accumulated, multiplied it via 1.25 to take an integer as the standard score of the scale. The full score was 100 points. The lower the score, the lighter the patient’s negative emotional symptoms [10, 11].


## 2.2.1. Health Belief Evaluation

Before and after the nursing, the patients’ health beliefs were assessed with the health beliefs scale, which included five dimensions such as barriers, severity, benefits, susceptibility, and self-efficacy. The full score of each dimension was 20 points. The higher the score, the higher the patients’ health beliefs in this dimension [8].


## 2.2.2. Inspection Compliance and Inappropriate Evaluation

The patient’s active cooperation during the examination was counted, and the compliance rate was calculated. After completing the examination, the patients were asked to recall the pain during the insertion and examination, and the pain degree was assessed via visual analog scoring method, with a score of 0-10. The higher the score, the stronger the pain degree and the lower the comfort [9].


## 2.2.3. Negative Emotion Evaluation

Before the nursing, before the insertion and after the nursing, the patients’ negative emotions were assessed via self-rating anxiety scale(SAS) and self-rating depression scale (SDS). Each of the two scales had 20 items, and each item counted 0-4 points. After the rough score of the scale was accumulated, multiplied it via 1.25 to take an integer as the standard score of the scale. The full score was 100 points. The lower the score, the lighter the patient’s negative emotional symptoms [10, 11].


## 2.3. Statistical Methods

The data in this paper were estimated via SPSS 21.0 statistical software. The patient’s gender, compliance, and other counting data were revealed via the rate (%). The chi-squared test was utilized for the diversity between groups. The patient’s health belief scale score, inappropriateness score, and other measuring data were revealed via themean±standard deviation (x̅±s), which conformed to the normal distribution. The independent sample t-test was utilized for the diversity between groups, and the paired sample t-test was utilized for the diversity within groups; P<0.05 was statistically significant.


## 3. Results

### 3.1. Diversity of Health Belief Scale Scores between the Two Groups before and after Nursing

After the nursing, the scores of all dimensions of the health belief scale in the two groups increased, and the scores of the belief guidance group were markedly enhanced than those of the mode group (P<0.05), concluding obstacle (t=2.834, P=0.005), seriousness (t=3.603, P<0.001), benefit (t=5.920, P<0.001), susceptibility (t=5.410, P<0.001), and self-efficacy (t=5.241, P<0.001), as shown in Table 2.Table 2
Diversity of health belief scale scores between the two groups before and after nursing (x̅±s).
GroupObstacleSeriousnessBenefitSusceptibilitySelf-efficacyBefore nursingAfter nursingBefore nursingAfter nursingBefore nursingAfter nursingBefore nursingAfter nursingBefore nursingAfter nursingBelief guidance group (n=63)9.21±2.1213.22±3.16∗8.16±2.0913.09±3.47∗7.45±1.2413.87±3.24∗8.28±1.9315.68±4.01∗9.04±2.4215.19±4.56∗Mode group (n=63)9.25±2.0611.56±3.41∗8.25±2.0210.99±3.06∗7.54±1.3210.79±2.56∗8.54±1.9512.11±3.37∗9.10±2.5411.43±3.41∗t value0.1072.8340.2463.6030.3945.9200.7525.4100.1365.241P value0.9150.0050.806< 0.0010.694< 0.0010.453< 0.0010.892< 0.001Note: Contrasted to the same group before nursing,∗P<0.05.


### 3.2. Diversity of Compliance and Inappropriateness between the Two Groups

The compliance rate of the belief guidance group was markedly enhanced than that of the mode group (t=5.020, P=0.025), and the inappropriate insertion of endoscopy (t=4.039, P<0.001) and the inappropriateness of examination were markedly lower than those of the mode group (t=4.832, P<0.001), as shown in Table 3.Table 3
Diversity of inspection compliance and inappropriateness between the two groups (n, %/x̅±s).
GroupCompliance rate [n (%)]The gastroscope insertion was not appropriate (x̅±s, scores)Inappropriate in the process of inspection (x̅±s, scores)Belief guidance group (n=63)58 (92.06)2.76±0.652.57±0.55Mode group (n=63)49 (77.78)3.19±0.543.07±0.61χ2 value/t value5.0204.0394.832P value0.025< 0.001< 0.001


### 3.3. Diversity of Negative Emotions between the Two Groups in Different Time Periods

The scores of SAS and SDS in both groups decreased markedly before inserting the gastroscope and after nursing, and the SAS and SDS scores in the belief guidance group were markedly lower than those in the mode group before inserting the gastroscope (t=5.358, P<0.001) and after nursing (t=4.305, P<0.001). As shown in Table 4.Table 4
Diversity of negative emotions between the two groups in different time periods (x̅±s).
Belief guidance group (n=63)SASSDSBefore nursingBefore inserting the gastroscopeAfter nursingBefore nursingBefore inserting the gastroscopeAfter nursingBelief guidance group (n=63)62.67±6.4250.74±5.66∗43.29±5.17∗61.23±5.9349.76±5.62∗42.13±4.83∗Mode group (n=63)61.98±6.3656.12±5.61∗47.21±5.05∗60.81±6.0255.21±4.87∗46.49±4.77∗t value0.6065.3584.3050.3955.8175.098P value0.546< 0.001< 0.0010.694< 0.001< 0.001Note: Contrasted to the same group before nursing,∗P<0.05.


## 3.1. Diversity of Health Belief Scale Scores between the Two Groups before and after Nursing

After the nursing, the scores of all dimensions of the health belief scale in the two groups increased, and the scores of the belief guidance group were markedly enhanced than those of the mode group (P<0.05), concluding obstacle (t=2.834, P=0.005), seriousness (t=3.603, P<0.001), benefit (t=5.920, P<0.001), susceptibility (t=5.410, P<0.001), and self-efficacy (t=5.241, P<0.001), as shown in Table 2.Table 2
Diversity of health belief scale scores between the two groups before and after nursing (x̅±s).
GroupObstacleSeriousnessBenefitSusceptibilitySelf-efficacyBefore nursingAfter nursingBefore nursingAfter nursingBefore nursingAfter nursingBefore nursingAfter nursingBefore nursingAfter nursingBelief guidance group (n=63)9.21±2.1213.22±3.16∗8.16±2.0913.09±3.47∗7.45±1.2413.87±3.24∗8.28±1.9315.68±4.01∗9.04±2.4215.19±4.56∗Mode group (n=63)9.25±2.0611.56±3.41∗8.25±2.0210.99±3.06∗7.54±1.3210.79±2.56∗8.54±1.9512.11±3.37∗9.10±2.5411.43±3.41∗t value0.1072.8340.2463.6030.3945.9200.7525.4100.1365.241P value0.9150.0050.806< 0.0010.694< 0.0010.453< 0.0010.892< 0.001Note: Contrasted to the same group before nursing,∗P<0.05.


## 3.2. Diversity of Compliance and Inappropriateness between the Two Groups

The compliance rate of the belief guidance group was markedly enhanced than that of the mode group (t=5.020, P=0.025), and the inappropriate insertion of endoscopy (t=4.039, P<0.001) and the inappropriateness of examination were markedly lower than those of the mode group (t=4.832, P<0.001), as shown in Table 3.Table 3
Diversity of inspection compliance and inappropriateness between the two groups (n, %/x̅±s).
GroupCompliance rate [n (%)]The gastroscope insertion was not appropriate (x̅±s, scores)Inappropriate in the process of inspection (x̅±s, scores)Belief guidance group (n=63)58 (92.06)2.76±0.652.57±0.55Mode group (n=63)49 (77.78)3.19±0.543.07±0.61χ2 value/t value5.0204.0394.832P value0.025< 0.001< 0.001


## 3.3. Diversity of Negative Emotions between the Two Groups in Different Time Periods

The scores of SAS and SDS in both groups decreased markedly before inserting the gastroscope and after nursing, and the SAS and SDS scores in the belief guidance group were markedly lower than those in the mode group before inserting the gastroscope (t=5.358, P<0.001) and after nursing (t=4.305, P<0.001). As shown in Table 4.Table 4
Diversity of negative emotions between the two groups in different time periods (x̅±s).
Belief guidance group (n=63)SASSDSBefore nursingBefore inserting the gastroscopeAfter nursingBefore nursingBefore inserting the gastroscopeAfter nursingBelief guidance group (n=63)62.67±6.4250.74±5.66∗43.29±5.17∗61.23±5.9349.76±5.62∗42.13±4.83∗Mode group (n=63)61.98±6.3656.12±5.61∗47.21±5.05∗60.81±6.0255.21±4.87∗46.49±4.77∗t value0.6065.3584.3050.3955.8175.098P value0.546< 0.001< 0.0010.694< 0.001< 0.001Note: Contrasted to the same group before nursing,∗P<0.05.


## 4. Discussion

Gastroscopy plays an important role in gastric cancer screening, illness progress monitoring, and illness severity judgment [12–15]. Whereas, patients are often nervous and even afraid before the examination, resulting in low examination cooperation and inaccurate examination results, thus delaying the condition [16–19]. The causes of bad mood can be summarized as follows: (a) gastroscopy is an invasive examination, and patients who do not know much about it think that the operation will damage the throat and esophagus and are unwilling to cooperate with the examination; (b) in the process of examination, patients are prone to cough, nausea, and vomiting due to physical stimulation of gastroscope; (c) patients lack relevant knowledge about the monitoring of gastric cancer, the importance of gastroscopy, and the operation procedure of gastroscopy, especially for the first time. Therefore, during the nursing of gastroscopy, attention should be paid to the health guidance and emotional guidance of patients [20–24]. In this study, the mode group adopted the mode of knowledge, belief, and behavior nursing, which mainly applied the acquisition of knowledge, belief, and practice before the gastroscopy and process of gastroscopy and examination. Via explaining the examination steps and matters needing attention to the patients before the gastroscopy, let the patients acquire knowledge and beliefs, guide the patients to operate correctly and give encouragement during the examination, and promote the formation of correct behavior [25–27]. The belief guidance group united with nursing guided via health beliefs; in addition to knowledge, belief, and practice mode nursing, another health belief group was established to strengthen patients’ health beliefs through health lectures, Wechat, or telephone communication for a period of time before gastroscopy, so as to relieve nervousness, anxiety, and fear. The results corroborated that the scores of all dimensions of the health belief scale in the belief guidance group were markedly enhanced than those in the mode group, and the compliance rate and comfort in the belief guidance group were better than those in the mode group. It is implied that nursing based on health belief guidance plays an effective role in improving patients’ disorder, severity, benefit, susceptibility, and self-efficacy, and the improvement of patients’ overall health belief is beneficial to advance patients’ coordination. Make the patient take the initiative to accept the examination and reduce the pain and discomfort caused via improper cooperation [28–30]. The scores of SAS and SDS in the belief guidance group before and after gastroscopy were markedly lower than those in the mode group, implying that nursing based on health belief guidance can effectively alleviate patients’ negative emotions such as anxiety and depression. This is because health belief guidance makes patients have relevant knowledge reserve before examination, is well aware of the importance of gastroscopy, and has certain psychological expectations for examination, so the negative emotion before insertion is obviously alleviated. In the process of examination, patients with high degree of fit, advanced comfort, and after the completion of the examination, once again strengthen patients’ health awareness and correct patients’ misconceptions, so the improvement of patients’ negative emotion after the completion of nursing is also relatively good.All in all, on the basis of nursing based on knowledge, belief, and practice mode, nursing based on health belief guidance in patients with gastric cancer before and after gastroscopy can effectively advance patients’ health beliefs and cultivate patients’ health behavior, so as to advance patients’ examination compatibility, reduce discomfort, and alleviate patients’ negative emotions before and after treatment (Figure1). Whereas, the number of instances in this study is small, and the observation time is short, which still needs to be further verified via multicenter and large sample size studies. However, the number of studies included in this study is small, and the search for relevant factors is not comprehensive. In the follow-up study, it is necessary to increase the number of studies and multicenter samples for further in-depth research.Figure 1
Outcome of nursing based on health belief united with knowledge, belief, and practice mode on gastroscopy of patients with gastric cancer.



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*Source: 9491454-2022-10-03.xml*