促进2型糖尿病患者行为的可持续性改变：澳大利亚美好生活俱乐部的自我健康管理计划的评价

Promoting Long Term Behaviour Change in Older People with Type 2 Diabetes:The Good Life Club Self-management Program

本文分析了澳大利亚美好生活俱乐部18个月的监测数据。美好生活俱乐部是澳大利亚联邦政府资助的"分担卫生服务项目"的一个研究项目,旨在促进50岁及以上糖尿病患者的慢性病自我管理。该项目的干预措施是跨理论行为改变模型和通过电话的动机谈话技术。在患者参加项目的基线、第6个月、第18个月收集数据。数据包括人口学信息、慢性病种类、健康行为、对健康的认识、锻炼程度、功能状态、自我效能、情绪状态、服务利用,以及9个目标行为的改变阶段。本文报告了150名接受18个月监测的患者数据。结果表明,在8个自我评价的症状中,有6个症状明显改善,差异有统计学意义。接受干预的患者对自我健康管理的信心在短期内明显增强。患者的卫生服务利用呈现减少趋势,但无统计学差异。卫生服务利用没有减少的原因,归因于参加者之间卫生服务利用方式的差异较大。参加项目第6个月时,患者行走的活动量增加,但第18个月时回到基线水平。这些发现表明,动机谈话技术能够在行为改变的最初阶段发挥作用,不过如果要长期地维持行为改变,则需要确定个体化和结构性的策略。

This paper reports on the18-month outcomes data from the Good Life Club （GLC）, a chronic disease self-management intervention for people with diabetes aged over 50 years. The GLC was a demonstration project funded under the Commonwealth Government of Australia＇ s Sharing Health Care Initiative. The Transtheoretical Model of Behaviour Change and motivational telephone interviewing provided the conceptual framework for the interventions delivered. Data were collected at baseline, six months and 18 months following program enrolment and included demographic information, type of chronic illness, health behaviours, health perceptions, activity levels, functional status, self efficacy, mood, service utilisation and stage of change for nine target behaviours. The analyses reported in this paper are based upon the data obtained from 150 participants at 18 months follow-up.The participants demonstrated statistically significant positive changes in six of eight self-rated symptom measures, and reported greater confidence in self management in the short term. No significant increases in health service use patterns were found, although there were trends towards a decrease in health service usage. The lack of significance decreases was attributed to high between-participant variability in usage patterns. Walking activity levels were increased at six months but tended to regress towards baseline levels at 18 months. The findings highlight the effectiveness of motivational interviewing for initial health behaviour changes, but that individual and structural strategies might be required to maintain engagement in behaviour change over time.