Chronic disease management cultural wall

The core essence of the chronic disease management cultural wall has never been a "public health education bulletin board", but a low-cost soft carrier that connects doctors and patients, smooths the gap in chronic disease awareness, and promotes prevention and control consensus from "medical care requirements" to "mass initiative." A well-done cultural wall can indirectly help the jurisdiction reduce the rate of acute onset of chronic diseases by about 10% a year - this is the conclusion we came to after visiting 27 community health service centers and collecting data for three years.

When it was first proposed to launch a cultural wall at the grassroots level, the team argued for almost half a month: One group felt that it was purely formalism and the money spent on printing stickers and finding designs would be better than holding two more health lectures and giving more salt-restricted spoons to the elderly; the other group felt that the audience for the lectures was limited, young people did not have time to come, and the elderly would forget after listening. The cultural wall was placed next to the medicine window and the door of the clinic, which is a high-frequency access point. As long as the content is good enough, the effect is much stronger than a single lecture. Both sides have their own reasons. In the end, we simply found two communities with similar conditions to do a controlled experiment. After half a year, the data speaks for itself. In the community with a customized cultural wall, the proportion of elderly people who regularly measure their blood pressure is 23% higher than that in the control group.

What impressed me most was the wall in Qingbo Street, Shangcheng District, Hangzhou. There was not a single expert portrait on the entire wall, nor was there a large section of pathological explanation. The most prominent position was the daily life of three "chronic disease stars" in the district: 62-year-old Aunt Zhang had high blood pressure for 8 years, and her blood pressure is now stable at 130/80. Posted next to it is her handwritten salt control diary, accompanied by home photos of her cooking stir-fried shrimps and steamed fish. There is a QR code as big as a fingernail printed on the bottom of the video. When you scan it, you can see the short videos she recorded on "How to Reduce Salt in Sauce Duck" and "What to Use When You Can't Find a Salt-Restricted Spoon". The location at the base of the wall is also marked with a yellow line as "Wednesday Walking Meeting Point". Next to it is printed a 3-kilometer route around the lake that has been taken by sugar lovers in the same community. Even the number of rest chairs on the road and the public toilets at which corners are clearly marked. Don't tell me, during the half hour I was squatting, a dozen old people passed by and stopped to take a look. Some people took out their mobile phones to scan the video code and said, "Go back and show it to my old lady, she loves making pickles."

Of course, there are also many institutions that take the "professional and rigorous" route. I have seen it before in the chronic disease clinic of a tertiary hospital. The core points of China's guidelines for the prevention and treatment of hypertension and the early screening form for diabetes complications were printed on the entire wall. The fonts were neat and the data was accurate. Even the year of the cited guidelines was clearly marked. Many newly diagnosed patients took pictures with their mobile phones and said that it was more complete than what the doctor said. They could read it slowly when they got back. There is actually no difference between the two routes. Most of the tertiary hospitals deal with patients who have just been diagnosed and are in urgent need of accurate professional information. Rigorous content can help them avoid pseudoscientific rumors on the Internet. The community, on the other hand, deals with old patients who have been sick for many years and are tired of hearing basic knowledge points. Talking about big principles will only annoy people. It is better to take the empathy route and use the cases of people around you to get closer.

Oh, by the way, this thing is not just useful if you stick it on it. I saw a cultural wall in a suburban health center last year. The content was comprehensive and the design was good-looking. However, the characters were printed smaller than a newspaper, and there was no magnifying glass next to it. Most of the old people who came here had bad eyesight and could not see clearly when they stood close. After half a year, the wall was faded by the sun, and few people read more than half of the page. In some communities, the cultural wall is posted in a corner behind the outpatient building. Only nurses taking out garbage can pass by. Of course, it is in vain.

When I helped a community in Tongzhou renovate its cultural wall, it initially used a unified template given by the Centers for Disease Control and Prevention. No one looked at it for half a month after it was posted. Later, we found five elderly people who often came to take blood pressure measurements as consultants and changed the "daily salt intake no more than 5g" to "about the amount of a beer bottle cap, pickles, fermented bean curd, and meili." "Salt must be counted." "Regular monitoring of blood sugar" was changed to "Our community has free blood sugar testing every Tuesday morning, don't forget to come". Half the wall was also decorated with "Photos of smiling faces of celebrities who control blood pressure and sugar control." They were all elderly people in the area who insisted on regular medication and regular monitoring. In the first week after it was posted, elderly people came to look for their photos every day, and by the way, I showed the content next to them. Later, an uncle came to us specifically and said that he didn't know before that he couldn't touch grapefruit when taking nifedipine. After looking at the wall, he realized that the family had just bought two kilograms of grapefruit a few days ago and hurriedly gave them to his granddaughter, but she didn't dare to eat them. You see, with just one line of small words, the risk of acute hypotension might be avoided.

Now every time I go to a primary medical institution for research, the first thing I look at is the chronic disease management cultural wall. You don’t need to ask for data. Just stand there and look at it for 5 minutes to see if anyone stops and whether the content is commonplace. Then you can probably know whether the chronic disease management in this place is real. After all, culture is never just beautiful words printed on the wall. It is the hidden thoughts hidden between the lines, whether there is genuine consideration for patients.