基于格林模式的健康教育对出院后2型糖尿病患者的影响

Effect of PRECEDE-PROCEED-based health care on post-discharge behavioral self-management,blood glucose control and quality of life of diabetes Ⅱ patients

目的探讨基于格林模式(predisposin,reinforcing and enabling constructs in educational/environmental diagnosis and evaluation-policy,regulatory and organizational constructs in educational and environmental development,PRECEDE-PROCEED)的健康教育对出院后2型糖尿病患者的影响,为2型糖尿病患者健康教育提供有效的模式。方法采用随机对照试验方法,将120例2型糖尿病患者随机分为干预组与对照组,分别60例,对照组给予常规健康教育管理,干预组实施PRECEDE-PROCEED模式的健康教育。分别于干预前、干预1个月、3个月、6个月检测患者空腹血糖、餐后2h血糖和糖化血红蛋白,采用糖尿病患者自我管理行为量表(summary of diabetes self careactivities,SDSCA)评价患者自我管理效能,糖尿病患者生存质量特异性量表(diabetes specific quality of life scale,DSQL)评价患者生活质量。结果干预1个月、3个月、6个月两组患者空腹血糖、餐后2h血糖、糖化血红蛋白重复测量结果显示,组间和时间有交互效应(P<0.05),干预1个月、3个月、6个月干预组空腹血糖、餐后2h血糖低于对照组,干预3个月、6个月干预组糖化血红蛋白低于对照组(均P<0.05)。干预1个月、3个月、6个月两组患者自我管理行为中饮食、足部护理维度得分及总分,生活质量各维度得分及总分重复测量结果显示,组间和时间有交互效应(均P<0.05),干预1个月、3个月、6个月干预组饮食、运动、血糖监测、足部护理维度得分及总分高于对照组,干预组生理功能、心理/精神、社会关系维度得分及总分低于对照组;干预3个月、6个月干预组治疗维度得分低于对照组(均P<0.05)。结论基于PRECEDE-PROCEED模式的健康教育可有效控制2型糖尿病患者血糖水平,提高患者自我管理效能和生活质量水平,是一种行之有效的社区健康教育服务模式。

Objective To explore the effect of the mode of PRECEDE-PROCEED-based health care on post-discharge behavioral self-management,blood glucose control and quality of life of diabetes II patients.Methods A total of 120 diabetes II patients were randomized into intervention and control groups equally,the former treated with the mode of PRECEDE-PROCEED and the latter with normal health management.The fasting blood glucose,2 hours postprandial blood glucose and glycosylated hemoglobin were tested before intervention,1 month,3 months and 6 months after intervention.The self-efficacy and quality of life of all patients were evaluated with the summary of diabetes self care activities(SDSCA)and the diabetes specific quality of life scale,respectively.Results The repetitive results of fasting blood glucose,2 hours postprandial blood glucose and glycosylated hemoglobin showed that there was significant interactive effect between the two groups in respect of time points(P<0.05)and the levels of fasting blood glucose and 2 hours postprandial blood glucose of the intervention group were significantly higher than those of the control group 1,3 and 6 months after intervention and the levels of glucosylated hemoglobin were significantly lower 3 and 6 months after intervention.The repetitive ones of the surveys with SDSCA and the diabetes specific quality of life scale showed that there was also interactive effect between the two groups in view of the respective scores on diets and foot care and the total score,as well as the respective scores of domains of quality of life and the total score,and the respective scores of dieting,exercises,blood glucose monitoring and foot care and the total score were significantly lower than those of the control group 1,3 and 6 months after intervention(P<0.05),the scores of physiological function,psychological/mental conditions and social relations were significantly lower than those of the control group 3 and 6 months after intervention(P<0.05),and the score of treatment was significantly lower as well 3 and 6 months after intervention(P<0.05).Conclusion PRECEDE-PROCEED-based health care is effective for the control of glucose of the diabetes II patients and the improvement of their self-care and quality of life.It can be used as a model for community health care service.