糖尿病患者自我管理效果及自我效能影响因素分析

Analysis on the effect of self-management and the influencing factors of self-efficacy among diabetic patients

目的分析糖尿病患者参加自我管理小组活动前后自我效能改变情况及其影响因素,为在社区推广应用患者自我管理小组活动提供依据。方法于2017年选择温州市12个县区的26家社区卫生服务中心为试点单位,通过电话预约和现场入户方式共招募糖尿病患者339例,采用调查问卷收集其一般情况、患病情况、糖尿病知识知晓情况及自我效能得分情况,采用t检验、秩和检验及多元线性回归方法进行分析。结果自我管理小组活动后,糖尿病患者总体糖尿病知识知晓率(72.35%)高于活动前(63.51%),差异有统计学意义(Z=-8.62,P<0.01)。干预后的饮食管理、运动管理、药物管理、血糖监测、足部护理、高低血糖预防和处理与总体效能得分均有提高(t值分别为12.26、5.74、10.11、9.35、14.66、13.79、22.38,P值均<0.01)。多元线性回归分析结果显示,居住地(b=-6.74)与自我效能得分呈负相关,差异有统计学意义(t=-4.60,P<0.01),文化程度(b=7.38)与自我效能得分呈正相关,差异有统计学意义(t=7.65,P<0.01)。结论自我管理小组活动可以提高糖尿病患者相关知识知晓率,但患者药物管理自我效能较低,农村和文化程度较低的患者自我管理水平需要进一步加强。

Objectives To analyze changes in self-efficacy of diabetic patients before and after self-management group activities and its influencing factors,provide evidences for the promotion and application of patient self-management group activities in the community.Methods Twenty-six community health centers in 12 counties and districts in Wenzhou were selected as pilot units and 339 diabetic patients were recruited by telephone booking and on-site admission.The general condition,disease condition,knowledge of diabetes and self-efficacy scores were collected by questionnaire.T-test,rank sum test and multiple linear regression method were used for analysis.Results The knowledge awareness rate of diabetic patients(72.35%)after the last activity of self-management group was significantly higher than that(63.51%) before the first activity(Z =-8.62,P<0.01).The scores of diet management(t =12.26,P<0.01),exercise management(t =5.74,P<0.01),drug management(t =10.11,P<0.01),monitored blood glucose(t=9.32,P<0.01),foot care(t =14.66,P<0.01),prevention and treatment of high and low blood sugar(t =13.79,P<0.01),and overall efficacy(t =22.38,P<0.01) were increased significantly after the intervention.Multiple regression analysis showed the negative correlation between patients’ place of residence and self-efficacy(b=-6.74),the difference was statistically significant(t=-4.60,P<0.01) and a positive correlation between education and serf-efficacy and self-efficacy(b=7.38),the difference was statistically significant(t=7.65,P<0.01).Conclusion Self-management group activities could improve knowledge awareness rate of diabetic patients.Community diabetes patients have the low drug management self-efficacy.The self-management level of patients with low education and rural areas needs to be further strengthened.