摘要
目的分析自我管理小组干预后糖尿病患者自我效能的变化及其影响因素。方法于2014年8—11月,在北京市房山区开展了一项为期3个月的2型糖尿病患者自我管理干预研究,通过张贴海报、入户询问和电话通知等方式共招募510名2型糖尿病患者,采用单纯随机分组分为干预组(260名)和对照组(250名)。最终500名患者完成了研究,其中干预组259名,对照组241名。分别在干预前、干预结束时、干预后2年、干预后5年对其进行面对面的问卷调查,测量其糖尿病自我效能水平,建立两水平随机系数模型分析自我效能的长期变化趋势及其与小组干预的关系。结果糖尿病患者的文化程度、病程和治疗方式与其自我效能呈正相关而性别和年龄则不影响其自我效能。文化程度为初中、高中、大专及以上的糖尿病患者,其自我效能相对小学文化程度的患者分别高4.66分(P<0.05)、6.40分(P<0.05)和11.02分(P<0.05);糖尿病患者的病程每增加1年,其自我效能升高0.23分(P<0.05)。治疗方式对自我效能的影响主要体现在遵医嘱用药或注射胰岛素和血糖监测自我效能方面。在控制了性别、年龄、病程、文化程度、治疗方式等因素的影响后,经过自我管理小组干预,两组自我效能得分均较干预前有所升高,干预组比对照组高7.95分(P<0.05)。干预结束后,两组自我效能得分均逐年下降,干预组下降幅度较对照组更快,干预后2年较对照组降幅高5.41分(P<0.05),干预后5年较对照组降幅高8.94分(P<0.05)。结论社区糖尿病患者自我管理小组干预活动能够有效提升其自我效能,但在无后续干预的情况下自我效能呈现逐年下降的趋势。
Objective To analyze the changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention.Methods From August to November 2014,a 3-month community-based self-management intervention study of type 2 diabetes patients was implemented in Fangshan District,Beijing.510 patients were recruited through posters,household inquiries and telephone notification and then were randomly divided into intervention group(260 patients)and control group(250 patients).Finally,500 patients completed the study,including 259 in the intervention group and 241 in the control group.Self-efficacy score was measured through face-to-face interview at different time points,including pre-intervention,post-intervention,2 years after the intervention and 5 years after the intervention,respectively.A two-level random coefficient model was fitted to analyze the long-term trend of self-efficacy and its relationship with group intervention.Results Individual-level educational attainment,disease duration as well as their treatment plans had a positive correlation with self-efficacy of type 2 diabetic patients while gender and age did not affect their self-efficacy.Patients with junior middle school education,senior high school education and university and above education had 4.66(P<0.05),6.40(P<0.05)and 11.02(P<0.05)points higher than those with primary education,respectively.The self-efficacy of diabetic patients increased by 0.23(P<0.05)for each additional course year.The effect of treatment plan on self-efficacy was mainly reflected in the self-efficacy of taking medication or insulin injection as prescribed and blood glucose monitoring.After controlling for the confounding factors,i.e.,gender,age,disease duration,educational attainment,and treatment plan,self-efficacy scores at the post-intervention increased in both groups compared to those at the pre-intervention.The intervention group had 7.95 points higher than the control group(P<0.05).After the intervention,the self-efficacy scores of both groups decreased year by year while the intervention group declined faster,with 5.41 points(P<0.05)at 2 years after the intervention and 8.94 points(P<0.05)at 5 years after the intervention.Conclusion Community-based self-management group intervention could improve the self-efficacy of type 2 diabetic patients while the self-efficacy decreases year by year in the absence of follow-up intervention.
作者
毛凡
姜莹莹
夏章
何莹
董文兰
张伟伟
刘晓芬
张惺惺
董建群
Mao Fan;Jiang Yingying;Xia Zhang;He Ying;Dong Wenlan;Zhang Weiwei;Liu Xiaofen;Zhang Xingxing;Dong Jianqun(National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Fangshan District Center for Disease Control and Prevention,Beijing 102488,China;Beijing Center for Disease Control and Prevention,Beijing 100013,China)
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2022年第7期932-939,共8页
Chinese Journal of Preventive Medicine
基金
国家重点研发计划(2020YFC2006403)
中国疾控中心慢病中心青年基金(M-1-2019-10-005)。
关键词
糖尿病
2型
自我管理
自我效能
干预效果
随访研究
多水平模型
Diabetes mellitus,type 2
Self-management
Self-efficacy
Intervention effect
Follow-up studies
Multilevel model
