社区自我管理小组对糖尿病患者自我效能的远期影响研究

The long-term effects of community based self-management group activity on self-efficacy among diabetic patients

目的评价社区自我管理小组对糖尿病患者自我效能的远期影响,并分析影响因素。方法在浙江省3个地市选择620例城乡社区糖尿病患者开展自我管理小组活动,活动前和活动结束2年后分别进行问卷调查和自我效能评估。结果社区自我管理小组活动结束2年后,总自我效能得分[(75.25±15.07)vs(67.72±16.72)分,t=9.29,P<0.05]及饮食[(75.39±16.18)vs(68.84±18.50)分,t=7.57,P<0.05]、运动[(71.20±21.62)vs(63.41±23.57)分,t=6.90,P<0.05]、遵医用药[(84.34±19.35)vs(76.19±22.01)分,t=7.56,P<0.05]、血糖监测[(70.43±19.64)vs(64.29±19.55)分,t=6.02,P<0.05]、足部护理[(73.33±19.76)vs(65.85±20.39)分,t=7.14,P<0.05]、急症处理[(78.26±17.72)vs(68.97±20.47)分,t=8.99,P<0.05]6个维度的自我效能得分均明显高于活动前。多元线性回归结果显示,居住地、性别和活动前自我效能水平是影响远期效果的主要因素(t_(居住地)=6.03,t_(性别)=2.05,t_(活动前自我效能水平)=-25.77,P<0.05)。结论社区自我管理小组干预有较好的远期效果,可使糖尿病患者自我效能获得持续提升,在城乡社区推广应用要关注自我管理的薄弱环节和不同人群的特点丰富活动设计。

Objective To evaluate the long-term effects of community based self-management group on self-efficacy among diabetic patients.Methods A total of 620 diabetic patients recruited form communities in 3 cities of Zhejiang Province were selected to set up self-management groups.Questionnaire interview and self-efficacy evaluation were conducted before and 2 years after self-management group activities.Results After self-management group activities for two years,total self-efficacy scores[(75.25±15.07)vs(67.72±16.72),t=9.29,P<0.05]and 6 subscales scores including diet[(75.39±16.18)vs(68.84±18.50),t=7.57,P<0.05],physical activities[(71.20±21.62)vs(63.41±23.57),t=6.90,P<0.05],drug use[(84.34±19.35)vs(76.19±22.01),t=7.56,P<0.05],blood glucose monitoring[(70.43±19.64)vs(64.29±19.55),t=6.02,P<0.05],foot care[(73.33±19.76)vs(65.85±20.39),t=7.14,P<0.05]and emergency treatment[(78.26±17.72)vs(68.97±20.47),t=8.99,P<0.05]continued to be increased significantly.Multiple regression analysis showed that place of residence(t=6.03,P<0.05),gender(t=2.05,P<0.05)and baseline self-efficacy level(t=-25.77,P<0.05)were influencing factors of long-term effect on self-efficacy.Conclusion Community based self-management group activity had better long-term effects on self-efficacy among diabetic patients,and should be applied in urban and rural communities.