我国六省份社区糖尿病患者自我管理小组患者自我血糖监测水平及自我效能评价

Evaluation on the status quo of self monitoring of blood glucose and self-efficacy of diabetes patients in community

目的 调查参与社区糖尿病患者自我管理小组活动的糖尿病患者的自我血糖监测及自我效能水平,并分析其影响因素.方法 于2012年9-10月选择曾开展过慢性病患者自我管理工作、具备一定工作基础的北京市、上海市、重庆市、江苏省、广东省、浙江省的街道和乡镇为研究现场.以街道（社区）为单位,通过从街道（社区）健康档案中筛选、电话通知、张贴招募海报、发送招募邀请函等多种形式,共调查成年糖尿病患者1 401例,以调查问卷形式进行调查,收集其一般情况、患病情况、糖尿病知识的知晓情况、自测血糖及自我效能信息.采用多元线性回归方法,分析自我效能影响因素与自我效能得分之间关系.结果 1 401例糖尿病患者中,男性占37.0％ （519/1 401）,女性占63.0％ （882/1 401）,城市患者占48.0％ （672/1 401）,农村患者占52.0％ （729/1 401）,年龄为（64.9±8.9）岁.糖尿病患者自我血糖监测分析结果显示,79.9％（1 120/1 401）的患者进行过自我血糖监测,自测1～3次/月比例最高,为33.3％ （446/1 401）.其中,农村患者、小学文化程度患者、新型农村合作医疗覆盖患者从未进行过自我血糖监测的比例较高,分别为21.9％（160/729）、24.2％（160/662）、26.3％（125/475）.糖尿病患者自我效能得分分析结果显示,自我效能总分为（69.24±16.30）分（百分制）;其中,血糖监测和足部护理的得分最低,分别为（64.09 ±20.08）、（63.63±21.40）分,遵医嘱服药或注射胰岛素得分最高,为（76.10 ±22.00）分.自我效能影响因素与自我效能得分多元线性回归分析结果显示,患者居住地与自我效能得分呈负相关（β＇=-0.076）,患者文化程度、糖尿病知识知晓程度与自我效能得分呈正相关（β＇值分别为0.114、0.193）,均有统计学意义（t值分别为-2.46、3.71、7.18,P值均＜0.05）.结论 我国6省份社区糖尿病患者自我管理仍处于较低水平,经济和文化程度较低的患者自我管理水平更低.患者血糖监测和足部护理普遍表现较差,患者居住地、文化程度、糖尿病知识知晓程度是影响糖尿病患者自我效能的因素.

Objective To investigate the status quo and influence factors of self monitoring of blood glucose （SMBG） and self-efficacy of diabetes patients＇ that participated in community diabetes self management group.Methods Beijing,Shanghai,Chongqing,Jiangsu,Guangdong,and Zhejiang were selected as the study sites considering patients management experiences they had.1 401 adult diabetes patients were recruited from communities via health records system screening,telephone notification,poster advertisement,letters invitation ways.Face to face questionnaire survey was applied to obtain patients＇ general information,diabetes history,diabetes knowledge awareness,SMBG,and self-efficacy information.Multiple linear regression was used to analyze the relationship between factors and self efficacy.Results There were 519 male patients （37.0%） and 882 female patients （63.0%） with an average age of （64.9 ± 8.9）years old.Patients lived in city accounted for 48.0% （672/1 401）and rural patients accounted for 52.0% （729/1 401）.Patients who conducted SMBG accounted for 79.9% （1 120/1 401） and 33.3% （446/1 401）patients conducted blood glucose monitoring 1-3 times per month.Rural patients,primary school educated,and new rural cooperative medical system （NCMS） covered patients had a higher proportion of never conducting SMBG which were 21.9% （160/729）,24.2% （160/662）,and 26.3% （125/475）,respectively.Scores of self-efficacy was （69.24 ± 16.30） （hundred-mark system） with a relative lower score in monitoring of blood glucose （64.09 ± 20.08） and foot care （63.63 ± 21.40）,as well as a highest score in taking medicine and insulin injections （76.10-± 22.00）.Multiple regression analysis on self-efficacy and its related factors show a negative correlation between patients＇ place of residence and self-efficacy （β＇ =-0.076） and a positive correlation between education and self-efficacy （β＇ =0.114） as well as between diabetes knowledge awareness and self-efficacy （β＇ =0.193） （t =-2.46,3.71,7.18,P 〈 0.05）.Conclusion Community diabetes patients had a low self-efficacy and it was even lower among low economic and education degree patients.The worst parts were SMBG and foot care.Place of residence,education,and diabetes knowledge awareness are factors that influence patients＇ self efficacy.