动机性访谈对1型糖尿病患儿自我效能及血糖的影响

Influence of Motivational Interviewing on Self-efficacy and Blood Sugar Level of Children with Type 1 Diabetes

目的探讨动机性访谈对1型糖尿病患儿的胰岛素笔注射技能、自我效能和血糖水平的影响。方法选取2016年7月-2017年6月在华中科技大学同济医学院附属同济医院儿童内分泌专科就诊入院的1型糖尿病患儿70例。按照随机数字表法分为观察组(n=35)、对照组(n=35)。对照组患儿接受由糖尿病专科护士主导的疾病相关知识和技能的常规健康教育(包括住院、出院2个阶段),观察组患儿在健康教育过程中接受基于行为分阶段转变理论的动机性访谈干预,在住院、出院2个阶段共接受5次干预。由护士在患儿出院时、出院1个月和3个月时使用胰岛素笔注射技能调查问卷评估患儿的胰岛素笔注射技能掌握情况;在出院时、出院3个月时测量患儿的自我效能和血糖水平。结果出院时两组患儿胰岛素笔注射技能得分、自我效能、血糖水平均无统计学差异(P>0.05)。出院3个月时,两组患儿自我效能得分均较同组出院时提高(P<0.05),但观察组自我效能得分高于对照组(P<0.05);观察组在出院1个月、出院3个月时的胰岛素笔注射技能得分均高于对照组(P<0.05),且时间与组别的交互作用有统计学意义(P<0.05);观察组出院3个月时的血糖水平均较出院时下降(P<0.05),且低于对照组(P<0.05)。结论与常规健康教育相比,基于行为分阶段转变理论的动机性访谈干预可以提高1型糖尿病患儿的胰岛素笔注射技能和自我效能水平,有助于患儿的血糖控制,值得临床推广应用。

Objective To investigate the influence of motivational interviewing on injection skills with insulin pen, self-efficacy and blood sugar level in children with type 1 diabetes. Methods From July 2016 to June 2017, 70 children with type 1 diabetes admitted to Pediatric Endocrinology Department in Tongji Hospital were selected. They were divided into the observation group(n=35) and control group(n=35) according to the random number table. Children in the control group received routine health education on disease-related knowledge and skills led by diabetes specialist nurses(covering the hospitalization and discharge stages).Children in the observation group received motivational interviews that were based on the transtheoretical model of behavior change in the health education process, including 5 interventions in the hospitalization and discharge stages. The mastery level of the children’s insulin pen injection skills was evaluated by the nurses using the insulin pen injection skills questionnaire at discharge as well as 1 month and 3 months after discharge. The self-efficacy and blood sugar level of children were measured at discharge and 3 months after discharge. Results There were no significant differences in the score of insulin pen injection skills, self-efficacy score and blood sugar level between the two groups at discharge(P>0.05). 3 months after discharge, the self-efficacy scores of the two groups were higher than those at discharge(P<0.05), but the score of the observation group was higher than the control group(P<0.05). The scores of insulin pen injection skills in the observation group 1 month and 3 months after discharge were both higher than the control group(P<0.05), and the interaction between time and group was statistically significant(P<0.05). The blood sugar level of the observation group 3 months after discharge was lower than that at discharge(P<0.05), and lower than that of the control group(P<0.05). Conclusion Compared with routine health education, motivational interviewing based on the transtheoretical model can improve the insulin pen injection skills and self-efficacy level in children with type 1 diabetes, beneficial to blood sugar control and is worthy of clinical promotion.