背景：慢性阻塞性肺疾病由于发病率高、病死率高、疾病负担重，已成为重大慢性病。科学有效的健康教育及社区管理，能够减少慢阻肺的发病率，延缓疾病进程。目前社区卫生服务机构人力物力资源有限，慢阻肺健康教育工作仍需进一步加强。移动医疗的兴起与快速发展，为这一问题的解决提供了新途径。

目的：本研究旨在明确社区慢阻肺患者的健康教育需求，构建基于移动医疗的慢阻肺社区健康教育方案并进行初步的应用效果评价。

方法：采用文献分析法，明确社区慢阻肺患者健康教育的核心内容，拟定健康教育方案的基本框架，同时结合质性访谈了解社区稳定期慢阻肺患者对基于移动医疗的健康教育需求，为设计第一轮专家函询问卷提供依据。通过两轮的专家函询，确认基于移动医疗的健康教育核心内容和形式，研制基于微信小程序的慢阻肺健康教育工具。通过对21名患者进行为期8周的干预，初步评价该方案的应用效果。

结果：通过文献分析，提炼出慢阻肺社区健康教育的核心内容包括疾病知识、症状管理、用药指导、呼吸康复指导、戒烟指导、饮食指导、心理指导和晚期慢阻肺的安宁照护8个方面。通过现象学研究提炼出社区慢阻肺患者对基于移动医疗的健康教育使用需求、内容需求、功能需求和设计需求四方面的建议。根据前两部分的结果设计专家函询初稿，并进行两轮专家函询。第一轮函询一级指标和二级指标的重要性及可行性的肯德尔和谐系数分别为0.34、0.2、0.13，第二轮则为0.4、0.31、0.23（均有P＜0.01）。两轮函询问卷的回收率分别是95.2%、100%，分别有9位和5位专家提出意见，占比为45%和25%，专家函询的权威系数为0.92，说明函询结果具有很强的可靠性。根据专家函询形成教育方案的具体内容。开发微信小程序，包括8个学习模块、消息中心和帮助中心。纳入21名社区稳定期慢阻肺患者进行8周的小程序使用，后台数据显示小程序的图文及视频内容浏览次数共计829次，使用感受反馈显示其具有较高的接受度。慢阻肺知识问卷及健康行为自评量表总得分干预后较干预前有所增加，但尚未有统计学显著性差异（P＞0.05）。

结论：本研究基于文献研究、患者需求分析以及专家函询法构建的健康教育小程序，构建过程科学。初步通过患者的适用性评价，具有一定的可行性和适用性。

Background: Chronic obstructive pulmonary disease (COPD) has become a major chronic disease, resulting in a huge disease burden. Scientific and effective health education and community management can reduce the morbidity of COPD and delay the progress of the disease. At present, the human and material resources of community health service institutions are limited, and the health education of COPD still needs to be further strengthened. With rapid development of mobile health, a new way to solve this problem is provided.

Objective: The purpose of this study is to identify the health education needs of patients with COPD in the community, to construct a community health education program based on mobile health and evaluate the application effect of the program.

Methods: By using the method of literature analysis, this study defined the core content of health education for community COPD patients, drew up the basic framework of health education content, and combined qualitative interviews to understand the health education needs of community stable COPD patients based on mobile health, to provide a theoretical basis for the design of the first round of expert correspondence scale. Through two rounds of Delphi expert letters, the core contents and methods of health education based on mobile health were confirmed and developed a health education tool for COPD based on WeChat Mini Programs. Through serving 21 patients for 8 weeks, the application was evaluated.

Results: Through literature analysis, the core content of COPD community health education was extracted, including disease knowledge, symptom management, medication guidance, respiratory rehabilitation guidance, smoking cessation guidance, diet guidance, psychological guidance and palliative care for advanced COPD. Through qualitative interviews, the health education needs of COPD patients based on mobile health were extracted, including content needs, functional and design needs. Based on the results of the first two parts, the first round of expert correspondence scale was formed. The Kendall’s concordance coefficient of the importance and feasibility of the first and second indexes in the first round were 0.34,0.2,0.13 respectively, and 0.4,0.31,0.23 in the second round (all P < 0.01). The response rates of the two rounds of questionnaires were 95.2% and 100%, and 9 and 5 experts express their opinions, accounting for 45% and 25%. The authority coefficient is 0.92, indicating that the result of the letter inquiry is very reliable. According to the results of the expert letter, WeChat Mini Programs was developed, including 8 learning modules and a help center. Twenty-one patients were enrolled and used it for 8 weeks. The data showed that the Mini Program had a total of 829 browsing times, and the feedback showed high acceptability, the scores of BCKQ and COPD health behavior self-rating scale increased after intervention, but the paired t-test showed no statistical difference.

Conclusion: This study builds the WeChat application program of health education based on literature review, patient interview and expert letter inquiry method . The preliminary evaluation shows that it has feasibility and applicability.