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目的评估糖尿病患者参与社区自我管理小组活动前后自我管理行为的改变状况,分析其影响因素,为进一步加强社区糖尿病管理工作提供依据。方法 2013年选择江苏省淮安市、常熟市和盐城市社区中391例糖尿病患者为调查对象,进行问卷调查和自我管理小组活动。对参加活动的糖尿病患者,在每个小组第1次活动开始前和全部活动结束后,采用中国疾病预防控制中心设计的评估问卷进行基线和终期调查,比较糖尿病患者活动前后自我管理行为形成率和得分的变化。结果自我管理小组活动后,自我管理行为得分[(5.07±1.23)分]高于活动前[(3.63±1.48)分],差异有统计学意义(t=16.94,P<0.01)。除每周自测血糖和不吸烟外,糖尿病患者多数自我管理行为形成率活动后较活动前显著提高,差异均有统计学意义(P<0.01),每天足部检查和每月到医院复查血糖的行为形成率总体不高,活动后分别为28.0%和38.9%。家中缺少检测仪器和检测试纸价格贵是影响血糖监测频率最重要的因素。多因素分析结果显示,年龄越大(OR=1.87,95%CI:1.28~2.74)、有并发症(OR=2.16,95%CI:1.08~4.34)和城镇地区(OR=0.23,95%CI:0.10~0.51)的患者在自我管理小组活动后自我管理行为明显改善的比例低。结论社区自我管理小组活动能够提高糖尿病患者自我管理行为的形成率,活动中要强化血糖监测、足部检查和戒烟技能学习,同时应加强对年龄大、有并发症的糖尿病患者自我管理行为指导。
Objective To evaluate the changes of self-management behavior before and after participating in community self-management group activities in diabetic patients, analyze the influencing factors and provide the basis for further strengthening community diabetes management. Methods In 2013, 391 diabetic patients in Huaian City, Changshu City and Yancheng City of Jiangsu Province were selected as the survey subjects, and questionnaires and self-management group activities were conducted. Before and after the first activity of each group and the end of all the activities, diabetic patients participating in the activities were surveyed by using the evaluation questionnaire designed by China CDC. The baseline and final surveys were conducted to compare the rate of self-management behaviors before and after activities of diabetic patients And score changes. Results After self-management group activities, scores of self-management behavior [(5.07 ± 1.23) points] were higher than those before activities [(3.63 ± 1.48) points], the difference was statistically significant (t = 16.94, P <0.01). In addition to the weekly self-test of blood glucose and non-smoking, the majority of patients with diabetes mellitus formed a higher rate of self-management activities than those before activities, the differences were statistically significant (P <0.01), daily foot examination and monthly review of blood sugar The overall rate of behavior formation was not high, with 28.0% and 38.9% respectively after the activity. The lack of testing equipment at home and the price of test strips is the most important factor that affects the frequency of blood glucose monitoring. The results of multivariate analysis showed that the older the patients were (OR = 1.87,95% CI: 1.28-2.74), complications (OR = 2.16,95% CI: 1.08-4.34) and urban areas (OR = 0.23,95% CI : 0.10 ~ 0.51) patients with self-management group activities significantly improved self-management behavior of the low percentage. Conclusion Community self-management group activities can improve the rate of self-management of diabetes patients, to strengthen the activities of blood glucose monitoring, foot examination and smoking cessation skills learning, and should strengthen the older, with complications of diabetic self-management behavior guidance.