分级健康教育对社区糖尿病患者足部护理行为的影响

Effects of graded health education on foot care behaviors among diabetic patients in communities

目的 探讨糖尿病足分级健康教育对糖尿病患者足部护理行为的效果及其影响因素,为实施针对糖尿病足护理的策略和措施提供依据。方法 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,根据糖尿病足危险程度将研究对象分为低危、中危、高危3级。干预社区实施分级健康教育(分级健康教育组,897例),对照社区实施基础健康教育(基础健康教育组,256例),干预期为3年。两组患者均进行糖尿病足护理行为的基线调查和终末调查。采用SAS 9.4软件进行Wilcoxon秩和检验、χ^(2)检验,并以综合得分是否增加为因变量,采用非条件logistic回归模型分析影响因素。结果 分级健康教育组干预后足部护理行为得分[(5.95±1.29)分]显著高于干预前[(5.82±1.46)分],差异有统计学意义(P<0.05);基础健康教育组干预后足部护理行为得分[(5.44±1.41)分]与干预前[(5.32±1.44)分]比较,差异无统计学意义(P>0.05)。分级健康教育组中高危患者得分增值[(0.30±1.69)分]显著高于基础健康教育组[(-0.07±1.50)分],分级健康教育组低危患者得分增值[(-0.17±1.71)分]显著低于基础健康教育组[(0.25±1.93)分],差异均有统计学意义(P<0.05)。单项行为得分显示,分级健康教育组每天洗脚后擦干水分、不穿有弹性袜腰或紧口袜子、剪趾甲从不伤及皮肤、过去1年去医院做足部检查行为得分增值显著高于基础健康教育组,差异均有统计学意义(P<0.05)。多因素分析显示,分级健康教育组(OR=1.71,95%CI:1.17~2.50)、65~74岁患者(OR=1.69,95%CI:1.23~2.34)、学习过糖尿病知识(OR=2.29,95%CI:1.66~3.16)者足部护理行为得分增加的概率更大,城乡居民医保患者(OR=0.68,95%CI:0.49~0.94)、基线足部护理行为得分较高(OR=0.31,95%CI:0.27~0.36)者足部护理行为得分增加的概率更小。结论 糖尿病足分级健康教育可改善糖尿病患者的足部护理行为,对糖尿病足高危患者的效果更显著,后续应加强对糖尿病足低危、无症状患者的健康教育。

Objective To explore the effects and influential factors of graded health education on foot care behaviors among diabetic patients,and provide the basis for the strategy and measures of foot care behaviors among diabetic patients.Methods From August to September 2015,the random sampling method was used to select three communities as the intervention communities and one community as the control community from Changshu in Jiangsu Province and Jiang'an district in Wuhan city,respectively.The type 2 diabetes mellitus(T2DM)patients who met inclusion criteria were selected randomly from every community health service center as the subjects,according to risk levels of diabetic foot,the subjects were divided into three grades of low risk,middle risk and high risk.The graded health education was used in intervention communities(897 cases)and the basic health education was applied in the control community(256 cases)for this three years-follow-up.The baseline investigation and terminal investigation were performed for foot care behaviors among diabetic patients of two groups.The Wilcoxon rank sum test andχ^(2) test were used to analyze the data.Whether the comprehensive score increase served as the variation,the unconditional logistics regression model was used to analyze the influencing factors.The used software was SAS 9.4.Results The score(5.95±1.29)of intervening the foot care behaviors in graded health education group was significantly higher than that(5.82±1.46)before intervention,P<0.05.There was no significant difference between the score(5.44±1.41)of intervening the foot care behaviors and that(5.32±1.44)before intervention in basic health education group,P>0.05.The score increase(0.30±1.69)of middle and high risk patients in graded health education group was significantly higher that that(-0.07±1.50)in basic health education group(P<0.05);the score increase(-0.17±1.71)of low risk patients in graded health education group was significantly lower that that (0.25±1.93) in basic health education group (P<0.05). Single behavior score showed that the score increase of drying feet afterwashing feet daily,not wearing elastic socks or tight socks,nail clipping never hurts the skin and going to the hospital for footexamination in the past 1 year in graded health education group was significantly higher that in basic health education group(P<0.05).The multivariate analysis showed that the graded health education group (OR=1.71,95%CI:1.17-2.50),65-74 yearsold group (OR=1.69,95%CI:1.23-2.34),learned diabetes knowledge (OR=2.29,95%CI:1.66-3.16) had a greater probability ofincreasing the score of foot care behavior;while the medical insurance for urban and rural residents (OR=0.68,95%CI:0.49-0.94),higher score of baseline foot care behavior (OR=0.31,95%CI:0.27-0.36) had lower probability of increasing the score offoot care behavior. Conclution The graded health education for diabetic foot can improve the foot care behaviors of diabeticpatients,and the effects on high risk patients can be more significant. In the future,health education for low-risk and asymptomaticpatients with diabetic foot should be strengthened.