分级健康教育对社区2型糖尿病患者糖尿病足病防控知识的影响

Effects of graded health education on diabetic foot prevention and control knowledge among patients with type 2 diabetes mellitus in communities

目的了解分级健康教育对社区2型糖尿病患者糖尿病足病防控知识改善的效果及影响因素,为社区实施分级健康教育提供科学依据。方法于2015年8—9月,在江苏省常熟市和武汉市江岸区分别随机抽取3个社区为干预社区,1个社区为对照社区,在各社区卫生服务机构随机抽取符合纳入标准的2型糖尿病患者为研究对象。分级健康教育组(n=897)实施分级健康教育,基础健康教育组(n=256)实施基础健康教育,干预期为3年。干预前后两组患者均进行糖尿病足病防控知识问卷调查。采用SAS 9.4统计软件进行t检验、秩和检验、符号秩检验、χ^(2)检验、配对χ^(2)检验和非条件logistic回归。结果分级健康教育组和基础健康教育组干预前糖尿病足病防控知识标准化综合得分中位数分别为20.00分(P_(25)~P_(75):0.00~53.33分)和13.33分(P_(25)~P_(75):0.00~40.00分),干预后中位数分别为77.78分(P_(25)~P_(75):55.56~88.89分)和44.44分(P_(25)~P_(75):16.67~72.22分),均较干预前有明显提升,分级健康教育组得分增值[中位数为40.00分(P_(25)~P_(75):11.11~63.33分)]高于基础健康教育组[21.11分(P_(25)~P_(75):0.00~43.33分)],差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,与基础健康教育组相比,分级健康教育组DF防控知识综合得分增加的概率更高(OR=1.857,95%CI:1.019~3.384);与城乡居民基本医疗保险患者相比,城镇职工基本医疗保险患者DF防控知识综合得分增加的概率更高(OR=2.138,95%CI:1.192~3.834);学习过DF知识(OR=3.744,95%CI:2.198~6.376)、基线血糖控制达标(OR=1.795,95%CI:1.125~2.865)的患者DF防控知识综合得分增加的概率更高,基线知识综合得分高的患者DF防控知识综合得分增加的概率较低(OR=0.950,95%CI:0.941~0.958),均有统计学意义(P<0.05,P<0.01)。结论健康教育可改善糖尿病患者糖尿病足病防控知识水平,分级健康教育较常规基础教育效果更加显著,值得在社区中进行推广。

Objective To understand the effects and influencing factors of graded health education on improving the knowledge of diabetic foot(DF)prevention and control of type 2 diabetes mellitus(T2DM)in communities,and provide the scientific basis for the implementation of graded health education in the communities.Methods From August to September 2015,the random sampling method was used to select three communities(intervention group)and one community(control group)from Changshu city in Jiangsu Province and Jian'an district in Wuhan city respectively.T2DM patients meeting inclusion criteria were selected randomly from community health service centers as the subjects.Graded health education was used in graded health education groups(n=897)and basic health education was applied in basic health education groups(n=256)for 3 years.The investigation was performed with questionnaires of DF prevention and control knowledge before and after intervention for two groups.The t test,rank sum test,signed rank test,χ^(2) test,pairedχ^(2) test and unconditional logistic regression model were used to analyze the data.The used software was SAS 9.4.Results Before intervention,the median of standardized comprehensive scores of DF prevention and control knowledge in the graded health education group and the basic health education group were 20.00(P_(25)~P_(75):0.00-53.33)and 13.33(P_(25)~P_(75):0.00-40.00),respectively;and after intervention,the median of standardized comprehensive scores of DF prevention and control knowledge in the graded health education group and the basic health education group were 77.78(P_(25)~P_(75):55.56-88.89)and 44.44(P_(25)~P_(75):16.67-72.22),respectively,which increased significantly(P<0.05).The score increment median(40.00,P_(25)~P_(75):11.11-63.33)in the graded health education group was significantly higher than that(21.11,P_(25)~P_(75):0.00-43.33)of the basic health education group(P<0.05).Multivariate logistic regression analysis showed that as compared with the basic health education group,the graded health education group had a higher probability of increasing the comprehensive score of DF prevention and control knowledge(OR=1.857,95%CI:1.019-3.384);as comparing with patients with the urban and rural residents basic medical insurance,the patients with the urban worker basic medical insurance had a higher probability of increasing the comprehensive score of DF prevention and control knowledge(OR=2.138,95%CI:1.192-3.834);patients who learned DF knowledge(OR=3.744,95%CI:2.198-6.376),patients whose baseline blood glucose reached standard(OR=1.795,95%CI:1.125-2.865)had a higher probability of increasing comprehensive score of DF prevention and control knowledge;patients with higher baseline comprehensive knowledge score had the lower probability of increasing comprehensive score of DF prevention and control knowledge(OR=0.950,95%CI:0.941-0.958).Conclusion Health education can improve the knowledge level of DF prevention and control knowledge in T2DM patients,and graded health education is more effective than conventional basic education,which is worth promoting in the community.