健康自我管理对糖尿病患者不同自我效能的影响

Effect of health self-management on different self-efficacies in patients with diabetes mellitus

目的 了解健康自我管理对糖尿病患者不同自我效能的影响,为完善与推广健康自我管理提供建议。 方法 对重庆市九龙坡区与沙坪坝区12个社区招募确诊的221名糖尿病患者在参加健康自我管理活动前后进行问卷调查,调查内容包括人口学特征、糖尿病防治相关知识与行为,采用糖尿病自我效能量表评价自我效能得分。采用非参数wilcoxon检验比较管理前后自我效能的变化。 结果 招募的221名糖尿病患者中214名患者[平均年龄（65.8±7.5）岁]参加6次健康自我管理并接受问卷调查,随访率为96.8%。参加健康自我管理后自我效能、总饮食控制效能、运动效能、自我监测效能、护理效能与并发症应对效能均明显提高,差异有统计学意义（Z=-7.72、-4.44、-5.00、-5.89、-7.76与-6.67, 均P〈0.001）,药物治疗效能在管理前后差异无统计学意义（Z=-1.54,P=0.123）。 “在同一类食物中,我能够按热量进行食物替换”[2.0（1.0~3.0） vs. 3.0（2.0~4.0）]、“即使再忙,我都能特别抽出时间去做运动”[3.0（2.0~5.0）vs. 4.0（3.0~5.0）]、“当出门在外时,我仍照常测量血糖或尿糖”[3.0（2.0~4.0）vs.3.5（3.0~4.0）]、“能依照医生建议,进行正确的足部自我检查和护理”[2.0（1.0~4.0）vs.4.0（3.0~5.0）]条目管理前后均得分较低,但管理后高于管理前,差异有统计学意义（P〈0.05）。 结论 健康自我管理可以有效地提高患者的自我效能,但不同的效能存在差异,应针对得分较低的效能开展健康自我管理的培训。

Objective To investigate the impact of health self-management on different self-efficacies in diabetic patients, and to offer proposals for improving and promoting the health self-management. Methods Two hundred and twenty-one patients with confirmed diabetes mellitus and recruited from 12 communities in Jiulongpo District and Shapingba District, Chongqing were surveyed with the questionnaire before and after they participated in the activity of the health self-management. The contents of the questionnaire included demographic characteristics and diabetes-related prevention and treatment knowledge and behavior. Diabetes Management Self-efficacy Scale （DMSES） was employed to evaluate the scores of self-efficacies. The changes of self-efficacies before and after the health self-management were compared by non-parameter Wilcoxon test. Results Among the recruited 221 diabetes patients with average age of （65.8±7.5） years, 214 attended 6 health self-management activities and took part in the questionnaire survey, with the follow-up rate of 96.8%. After participating in the health self-management, the scores of total self-efficacy, self-efficacy total diet control and physical activity, self-monitoring, self-care and complication management were all significantly improved, with statistically significant differences （Z=-7.72, Z=-4.44, Z=-5.00, Z=-5.89, Z=-7.76, Z=-6.67; all P〈0.001）. But no statistically significant change was found in the score of self-efficacy about medication after the health self-management （Z=-1.54, P=0.123）. The scores of the items such as “I could replace the food in the same kind of food according to the calorie” （2.0（1.0-3.0） vs. 3.0（2.0-4.0））, “I could spare time to do exercise even if I was very busy” （3.0 （2.0-5.0） vs. 4.0（3.0-5.0））, “I could still monitor blood glucose or urine glucose when I went outside” （3.0（2.0-4.0）vs.3.5（3.0-4.0）） and “I could examine and nurse my foot correctly according to the doctor’s advice （2.0（1.0-4.0）vs. 4.0（3.0-5.0）） were all low before and after the health self-management, but the scores of these items after the health self-management were all higher than those of before the health self-management, with statistically significant differences （P〈0.05）. Conclusions The health self-management can effectively improve the patients’ self-efficacies, but there exists a diversity of different self-efficacies. It is necessary to conduct the targeted health self-management training against poor self-efficacies.