心理韧性导向的青少年1型糖尿病患者结构化治疗与教育课程的开发及初步实践

Development and Preliminary Practice of Resilience-oriented Structured Treatment and Educational Program for Adolescents with Type 1 Diabetes

背景我国青少年1型糖尿病患者疾病控制不佳,给家庭和社会带来沉重负担。目前国内糖尿病教育主要面向2型糖尿病患者,缺乏针对青少年1型糖尿病患者的自我管理支持项目。目的开发心理韧性导向的青少年1型糖尿病患者结构化治疗与教育课程,并验证其在我国青少年1型糖尿病群体中的适用性和可行性。方法2020年1—5月,以心理韧性模型为切入点,通过文献分析和访谈对青少年1型糖尿病患者进行需求分析,借鉴现有1型糖尿病结构化教育模式,开发心理韧性导向的结构化治疗与教育课程,并通过专家会议进一步修订和完善心理韧性导向的青少年1型糖尿病患者结构化治疗与教育课程。采用门诊张贴海报和打电话的方式招募潜在参与者,在南京医科大学第一附属医院进行预试验,从招募应答率、真实性和可接受性3个方面评价课程可行性。结果心理韧性导向的青少年1型糖尿病患者结构化治疗与教育课程终稿涵盖认知、动作技能和情感3个领域,12项认知领域目标、14项动作技能领域目标及17项情感领域目标,共43项教学目标。课程采用小组式教学法,每组5~8名患者,1名医生和1名护士,6次课为1个课程周期。共招募8例1型糖尿病患者进行心理韧性导向的青少年1型糖尿病患者结构化治疗与教育课程的可行性评价,其中6例患者完成了所有课程。患者表示该课程内容全面、贴近生活、氛围轻松,参与后自我管理能力增强、对疾病接受度提高、情绪调节能力改善。结论心理韧性导向的青少年1型糖尿病患者结构化治疗与教育课程内容系统可行性高,值得进一步临床验证。

Background The poor control of type 1 diabetes in Chinese adolescents has brought a heavy burden to families and society.Diabetes education in China is mainly aimed at patients with type 2 diabetes,and there is a lack of selfmanagement support programs for adolescents with type 1 diabetes.Objective To develop a resilience-oriented structured treatment and educational program for type 1 diabetic adolescents,and to verify its applicability and feasibility among Chinese adolescents with type 1 diabetes.Methods This study was conducted during January to May 2020.Guided by the diabetes resilience model,the analysis of needs of adolescents with type 1 diabetes through literature analysis and interviews,and references obtained from the available structured educational model for type 1 diabetes,a draft resilience-oriented structured treatment and educational program for adolescents with type 1 diabetes was developed,then was revised and improved according to the results of the expert consultation.After wards,potential participants were recruited by posters posted in the outpatient department and telephone to attend a trial test conducted in the First Affiliated Hospital with Nanjing Medical University to evaluate the feasibility of the program from three aspects:recruitment response rate,authenticity and acceptability.Results The final program covers 43 teaching objectives in 3 fields,including 12 in the field of perceptions,14 in the behavioral field and 17 in the emotional field.The program adopts group teaching method,with 5-8 patients,1 doctor and 1 nurse in each group.There were 6 classes in a course cycle.A total of 8 adolescents were recruited in the feasibility analysis,of whom 6 adolescents completed all courses.Patients said that the course content was close to life and the class atmosphere was relaxed,and their levels of self-management ability,acceptance of diabetes and emotion regulation ability were all improved after learning the program.Conclusion The resilience-oriented structured treatment and educational program has systematic contents,standardized implementation process and high feasibility,which is worthy of further clinical verification.