广州市社区2型糖尿病自我管理小组活动对患者自我效能的影响

Effect of Community-based health self-management group activities on Self-efficacy in patients with type 2 diabetes in Guangzhou

目的探讨社区自我管理小组活动对社区2型糖尿病患者自我效能的影响。方法 2018-08/2019-03在广州市11个区各选取1家社区卫生服务中心作为研究现场,每个中心分别招募12~15名确诊2型糖尿病患者作为干预组,同时招募与干预组年龄差±2岁、同性别、确诊2型糖尿病患者作为对照组。干预组参与自我管理小组活动,对照组不参加。在干预前和干预后1年对所有研究对象进行基本情况和糖尿病自我效能量表调查,分析干预对患者自我效能的影响。结果干预1年后,干预组自我效能各维度得分最高的为药物使用自我效能(86.67±19.89)分,得分最低的为运动自我效能(69.30±26.41)分,提升幅度最大的为足部护理自我效能(中位数8.00分);干预组总自我管理效能、饮食自我效能、药物使用自我效能、血糖监测自我效能、足部护理自我效能得分提升幅度均高于对照组(P=0.002、0.012、0.031、0.002、0.001);多因素分析显示,基线总自我效能得分低(β=-0.387,P<0.001)、病程≥7年(β=4.059,P=0.009)及干预组(β=4.528,P=0.001)的总自我管理效能得分增长更多。结论社区自我管理小组活动可提升2型糖尿病患者的自我效能,在糖尿病健康教育中需更强调非药物治疗的重要性。

Objective To evaluate the impact of community-based health self-management group activities on self-efficacy in patients with type 2 diabetes. Methods From August 2018 to March2019, one community healthcare center in each of 11 districts in Guangzhou was selected as the study site, and 12-15 patients diagnosed with type 2 diabetes were recruited as the intervention group in each study site. Patients with age difference of ±2 years from the intervention group,with the same gender and also diagnosed with type 2 diabetes were recruited as the control group at the same time. The intervention group participated in self-management group activities,while the control group did not. One year before and after the intervention, all the subjects were investigated with the basic information and diabetes self-efficacy scale to analyze the effect of the intervention on patients′ self-efficacy. Results After one year of the intervention,the highest score of self-efficacy of the intervention group in all dimensions was drug use(86.67 ± 19.89);the lowest score was exercise(69.30 ± 26.41);and the biggest improvement was foot care(median 8.00). The improvement of total self-management efficacy, diet, drug use, blood glucose monitoring and foot care self-efficacy of the intervention group were higher than those of the control group(P=0.002,0.012, 0.031, 0.002, 0.001, respectively). Multiple linear regression analysis showed that the lower baseline total self-efficacy score (β =-0.387, P<0.001), longer duration of disease (β =4.059,P=0.009) and intervention group (β=4.528,P<0.001) had a bigger improvement in total self-efficacy score. Conclusions The community-based health self-management group activities could effectively improve the self-efficacy of patients with type 2 diabetes. The importance of non-drug treatment should be emphasized in diabetes health education.