个性化健康教育对2型糖尿病患者自我管理行为及血糖控制效果的影响

目的 :探讨个性化健康教育对2型糖尿病患者自我管理行为及血糖控制效果的影响。方法 :本研究为随机对照试验,采用便利抽样的方法选取在我院糖尿病专科门诊建立档案的2型糖尿病患者80例为研究对象,将其随机分为干预组和对照组,每组40例。对照组患者给予一般的护理干预,干预组患者采取个性化健康教育。干预前及干预10个月后,分别评估两组患者的自我管理行为及空腹血糖、糖化血红蛋白值。结果:干预10个月后,干预组患者自我管理行为各项得分均优于对照组,差异均有统计学意义(P0.05);干预组患者的空腹血糖、糖化血红蛋白值指标也均较入组时下降,血糖值控制改善,与对照组各对应值比较,差异均有统计学意义(P0.05)。结论 :个性化健康教育能够提升2型糖尿病患者的自我管理行为及改善患者的血糖控制,提高患者的生活质量,是一种有效的糖尿病患者管理方法。     

Efficacy of a self-management education program for people with type 2 diabetes: Results of a 12 month trial

Aim:  Patient education that enhances one's self-management ability is of utmost importance for improving patient outcomes in chronic diseases. We developed a 12 month self-management education program for type 2 diabetes, based on a previous 6 month program, and examined its efficacy.
Methods:  A randomized controlled trial was carried out on outpatients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate. They were randomly divided into an intervention group that followed the program and a control group that followed usual clinical practise. The intervention group received <30 min of monthly interviews based on the program's textbook and biweekly telephone calls from a nurse educator throughout the 12 months.
Results:  Of the 50 participants in the intervention group and the 25 participants in the control group, 42 and 23, respectively, completed the program (a completion rate of 84.0%). The body weight, HbA1c, self-efficacy, dietary and exercise stages, quality of life, diastolic blood pressure, and total cholesterol level were significant by two-way repeated-measures anova . As for changes over time within the groups, only the intervention group showed significant differences by Friedman's test. The complication prevention behaviors showed a high implementation rate in the intervention group. The overall evaluation of this program by the participants was very high and, therefore, they highly recognized the need for this type of program.
Conclusions:  Self-management education works successfully in relation to patients' behavior modification skills, degree of goal attainment, and self-efficacy, consequently improving their health outcomes.     

糖尿病患者自我管理健康教育现状与对策

糖尿病患病率呈逐年上升的趋势,患者有效的自我管理对控制糖尿病发展至关重要,如何通过健康教育有效提高患者的自我管理能力需要深入探讨。对疾病自我管理方法的产生、应用和发展、国内外糖尿病自我管理健康教育的研究现状及在我国实施的意义进行综述,旨在提高护理人员对糖尿病自我管理的认识,促进其实施与推广。     

同伴情景式健康教育在老年糖尿病患者自我管理中的应用

目的：探讨由同伴参与的情景式健康教育在提高老年糖尿病患者自我管理技能中的应用与效果。方法：120例老年糖尿病患者随机分为观察组60例、对照组60例,两组均接受医院组织的糖尿病“同伴支持团队”支持教育。对照组接受同伴支持的“口头讲解式”健康教育方法,观察组进行同伴支持的情景式互动健康教育方法,完成健康教育6个模块内容后对健康教育效果进行比较。结果：观察组胰岛素笔自行注射技术、血糖自测技术、低血糖识别与处理、食品交换份法等糖尿病自我管理技能操作的掌握程度好于对照组（P〈0.05）;糖尿病常识的掌握程度两组无统计学差异。对授课方式内容满意度观察组高于对照组（P〈0.005）。结论：同伴参与的情景式互动健康教育具有形象性、参与性、趣味性,增加了老年糖尿病患者参加健康教育的主动性,明显提高患者自我管理技能操作水平。     

Teenagers with diabetes: self-management education and training on a big schooner

The aims of this study are to evaluate whether diabetic teenagers participating in a group educational programme, 'the schooner programme', differ from non-participants in attitudes towards diabetes and self-care, and to evaluate the impact on the attitudes, HbA1c and treatment of the programme. Ninety teenagers aged 14-18 years attended the programme. Attitudes towards diabetes and self-care were measured with a validated questionnaire. Medical data were collected from the medical records. The participants reported more positive attitudes towards diabetes and self-care and more frequent contacts with others with diabetes monitored blood glucose more often and felt less disturbed by diabetes than non-participants. The programme had positive impact on attitudes towards diabetes. There was no change in HbA1c, but the use of insulin pumps was more frequent among participants after the programme. To get teenagers attracted to group education, the diabetes care team needs to influence them towards more positive attitudes.     

自我管理教育用于妊娠期糖尿病病人的效果观察

[目的]探讨自我管理教育对妊娠期糖尿病病人血糖及母婴并发症的影响。[方法]选取86例妊娠期糖尿病病人,观察组43例,在常规指导下实施自我管理教育,对照组43例,采用常规指导,比较两组血糖控制值及并发症发生情况。[结果]观察组血糖控制值及母婴并发症明显低于对照组,并且有统计学意义。[结论]自我管理教育有利于妊娠期糖尿病病人血糖的控制,减少并发症,提高母婴健康水平。     

Randomized controlled trial of a psychoeducation program for the self-management of chronic cardiac pain

Cardiac pain arising from chronic stable angina (CSA) is a cardinal symptom of coronary artery disease and has a major negative impact on health-related quality of life (HRQL), including pain, poor general health status, and inability to self-manage. Current secondary prevention approaches lack adequate scope to address CSA as a multidimensional ischemic and persistent pain problem. This trial evaluated the impact of a low-cost six-week angina psychoeducation program, entitled The Chronic Angina Self-Management Program (CASMP), on HRQL, self-efficacy, and resourcefulness to self-manage anginal pain. One hundred thirty participants were randomized to the CASMP or three-month wait-list usual care; 117 completed the study. Measures were taken at baseline and three months. General HRQL was measured using the Medical Outcomes Study 36-Item Short Form and the disease-specific Seattle Angina Questionnaire (SAQ). Self-efficacy and resourcefulness were measured using the Self-Efficacy Scale and the Self-Control Schedule, respectively. The mean age of participants was 68 years, 80% were male. Analysis of variance of change scores yielded significant improvements in treatment group physical functioning [F = 11.75(1,114), P < 0.001] and general health [F = 10.94(1,114), P = 0.001] aspects of generic HRQL. Angina frequency [F = 5.57(1,115), P = 0.02], angina stability [F = 7.37(1,115), P = 0.001], and self-efficacy to manage disease [F = 8.45(1,115), P = 0.004] were also significantly improved at three months. The CASMP did not impact resourcefulness. These data indicate that the CASMP was effective for improving physical functioning, general health, anginal pain symptoms, and self-efficacy to manage pain at three months and provide a basis for long-term evaluation of the program.     

自我管理教育对维持性血液透析患者的影响

目的探讨维持性血液透析患者实施自我管理教育后对其生活质量的影响。方法将2010年12月--2011年11月在本中心接受维持性血液透析的124例患者设为观察组,2009年12月--2010年11月在本中心接受维持性血液透析的118例患者设为对照组。对照组实施常规健康知识宣教,观察组在健康教育的基础上进行自我管理教育。结果观察组行自我管理教育后其效果与对照组相比较具有统计学差异（P〈0．01）,观察组患者增强了自我保健意识,提高了自我管理能力,减少了并发症的发生。结论自我管理教育可以提高血液透析患者的自我管理能力,提高其生活质量及透析质量。     

Motivation for lifestyle changes to improve health in people with impaired glucose tolerance

Scand J Caring Sci; 2011; 25; 484–490
Motivation for lifestyle changes to improve health in people with impaired glucose tolerance Aim: To identify factors that could have motivational significance for lifestyle change to facilitate the reduction of Impaired Glucose Tolerance (IGT) and, consequently, the risk of having type 2 diabetes. Methods: Eighteen people living in a municipality in central Norway participated in the study. A large‐scale public health screening study had defined them as people with IGT. The participants took part in a semi‐structured interview that focused on four aspects of everyday lifestyle: (1) structure and rhythm, (2) physical health, (3) physical activity and (4) social relations. Results: The interviews showed that the participants in the study changed their priorities regarding daily living. Results indicated four domains of motivational factors that appeared as significant for lifestyle changes. The participants attributed great significance to their physical health and were strongly motivated to prevent disease development by improvement of everyday structure and rhythm, reduction of sickness risk, activity level and social relation. Research indicates, however, that lasting lifestyle changes take time and that health care support must be adapted to the individual in light of their social setting. Conclusion: Persons with IGT appear to benefit from lifestyle changes along four dimensions of motivational significance: Structure and rhythm, Sickness concerns, Activity levels, Social relations. This means that attention needs to be more carefully tailored the individual along these four dimensions than has been the case in traditional health care.     

健康教育对糖尿病病人自我管理能力的影响

[目的]探讨健康教育对糖尿病病人自我血糖监测管理能力的影响.[方法]采用问卷调查方法对95例住院糖尿病病人健康教育前后的糖尿病知识知晓情况、血糖水平、自我管理能力进行调查. [结果]实施糖尿病知识教育后糖尿病病人空腹血糖和餐后2 h血糖明显下降(P＜0.05);糖尿病知识知晓情况、自我管理能力均明显提高(P＜0.05).[结论]系统的健康教育可明显提高糖尿病病人自我血糖监测的管理能力.     

Quality of life and treatment satisfaction in the context of diabetes self-management education

The aim of this study is to identify and compare factors affecting quality of life and treatment satisfaction in people attending the structured educational programme for patients with intensified insulin therapy. A sample of 104 patients was recruited from diabetes specialized centre between November 2006 and March 2007. For measure patient's quality of life, the Audit Diabetes Dependent Quality of Life questionnaire and for measure patient's satisfaction with their treatment regimen, the Diabetes Treatment Satisfaction Questionnaire status version was used. Treatment satisfaction has different variables or predictors from quality of life. Quality of life was affected by the number of reported diabetic late complications, type of insulin regimen, age and diabetes duration. Type of insulin regimen, the frequency of blood glucose self-monitoring and perceived frequency of hyperglycaemia demonstrated the significant association with treatment satisfaction. Our findings might help health-care professionals have a deeper understanding of the factors affecting quality of life and treatment satisfaction and thereby aid in the design of strategies to maintain or improve quality of life and treatment satisfaction.     

延续性自我管理教育在糖尿病肾病患者康复中的应用

目的探讨延续性自我管理教育在糖尿病肾病患者康复过程中的作用。方法选取住院糖尿病肾病Ⅲ期患者110例随机分为干预组和对照组,2组均接受常规的健康教育,干预组在此基础上再接受综合管理教育。观察出院后6个月、12个月、18个月2组糖尿病肾病患者疾病知识知晓情况、糖尿病肾病危险因素控制情况。结果出院后6个月、12个月、18个月,干预组糖尿病肾病康复知识得分明显高于对照组(P<0.05),且干预组对多种糖尿病肾病危险因素的控制均好于对照组(P<0.05);干预组出院12个月、18个月的尿蛋白含量控制达标率明显高于对照组(P<0.01)。结论延续性自我管理教育有助于提高患者健康水平和疾病自我管理能力,是一种安全、有效、依从性高的疾病康复模式。     

Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes

Uncontrolled diabetes is a major health problem in Thailand. The objective of this study was to determine the effects of a diabetes self-management program on glycemic control, coronary heart disease (CHD) risk, and quality of life in 147 diabetic patients (aged 56.8 +/- 10.2 years). Type 2 diabetic patients who met the research criteria were randomized into two groups for a period of 6 months: the experimental group received the diabetes self-management program and the control group received the usual nursing care. The findings indicated that the experimental group demonstrated a significant decrease in the hemoglobin A(1c) level and CHD risk, with an increase in quality of life (QOL) compared to the control group. The diabetes self-management program was effective for improving metabolic control and the QOL for individuals with diabetes. Further studies should be replicated using larger groups over a longer time frame.     

互动式自我管理教育模式在2型糖尿病门诊患者自我管理行为中的应用

目的探讨互动式自我管理教育模式在门诊2型糖尿病患者自我管理行为中的应用效果。方法采用便利抽样法,选取2018年3月—2019年3月于长治医学院附属和平医院门诊治疗的98例2型糖尿病患者为研究对象,通过抽签法随机分为对照组和观察组,每组49例。在给予降血糖及基础疾病治疗的基础上,对照组采用常规自我管理教育模式,观察组采用互动式自我管理教育模式。比较两组患者干预前后糖尿病自我管理活动问卷(SDSCA)得分、空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、糖化血红蛋白(HbA1c)及干预后依从性以了解患者的自我管理行为、血糖控制情况及依从性。结果干预后,除吸烟维度外,观察组患者SDSCA各维度得分均高于对照组,差异有统计学意义(P<0.05)。干预后,观察组患者FBG为(5.11±0.62)mmol/L,2 hPBG为(6.83±0.59)mmol/L,HbA1c为(4.62±0.34)%,低于对照组的(7.28±0.73)mmol/L、(8.41±0.72)mmol/L、(7.23±0.35)%,差异均有统计学意义(t值分别为15.860、11.881、37.442;P<0.05)。干预后两组患者的依从性比较,差异有统计学意义(Z=7.170,P<0.05)。结论基于互动式自我管理教育模式可提高2型糖尿病患者的自我管理行为能力,有效控制患者血糖水平,值得临床推广。     

自我管理教育对老年抑郁症患者发生安全意外事件的影响

目的对住院老年抑郁症患者进行常规健康教育和自我管理教育的比较,旨在提高患者对安全教育和环境生活起居的重视,减少安全意外事件的发生。方法采用该院制订的健康调查表对符合标准的两组患者进行健康调查,一组患者采用自我管理的健康教育模式,另一组采用常规健康教育模式,比较两组患者安全意外事件发生有无差异。结果两组患者安全意外事件发生率比较差异有统计学意义(P<0.05)。结论自我管理教育后患者对安全教育及生活起居的重要性较常规安全教育后重视度明显提高,患者意外事件发生率明显降低。     

自我管理教育在军队肺结核患者康复中的应用

目的 探讨自我管理教育在军队肺结核患者康复过程中的应用.方法 对60例军队肺结核患者进行自我管理教育,并对患者入院当日、出院前1 d、出院后1个月采用疾病知识问卷及症状自评量表进行测评.结果 通过自我管理教育,出院后1个月患者对疾病康复知识已掌握,心理健康水平除躯体化、偏执和精神性因子外,其他各因子得分比较,差异具有统...     

An evaluation of Web-based education as an alternative to group lectures for diabetes self-management

This study evaluated the efficacy of Web-based diabetes self-management education for newly diagnosed patients with type II diabetes as an alternative to group lectures. Using a non-equivalent control group, pretest-post-test design, the participants in the Web group ( n  = 15) took part in a Web-based diabetes self-management program, while those in the lecture group ( n  = 16) attended 3 h of group lectures provided by health-care professionals specializing in diabetes care. The outcome variables were measured at the baseline (T0), and 6 weeks (T1) and 3 months (T2) after the interventions. The glycosylated hemoglobin (HbA1c) percentage and diabetes care knowledge in the Web group improved significantly from T0 to T1, while the diabetes care behavior improved significantly from T0 to T1 and from T1 to T2. The diabetes care knowledge and diabetes care behavior in the lecture group improved significantly from T0 to T1, but the HbA1c percentage did not change significantly between any times. These results show the potential of the Web-based program as an alternative to group lectures for diabetes self-management education.     

以自我管理为中心团体教育对精神分裂症患者自理、幸福度及自尊的影响

目的:探讨以自我管理为中心的团体教育干预对精神分裂症患者自理、幸福度及自尊的影响。方法:将112例精神分裂症患者随机均分为观察组和对照组,在两组均使用适量的抗精神病药物治疗及一般健康教育的基础上,仅对观察组进行以自我管理为中心的团体教育干预。在干预前及出院1年后采用自理行为问卷(SCBQ)、总体幸福感量表(GWB)、自尊量表(SES)、社会功能缺陷筛选量表(SDSS)对两组患者进行干预前后康复状态的评估。结果:干预后观察组患者SCBQ、GWB、SES评分显著提高,而SDSS评分均显著降低,与对照组相比差异具有统计学意义,P0.01。结论:以自我管理为中心的团体教育干预能明显提高患者的自理水平,改善其社会功能及幸福度,且自尊程度显著提高,是促进精神分裂症患者康复的有效途径。     

自我管理教育对腹膜透析病人容量状况的影响

[目的]了解腹膜透析病人经自我管理教育后水盐控制及容量改善状况。[方法]选择70例规律腹膜透析超过3个月的病人,进行为期6个月的自我管理教育,比较干预前后病人水盐控制及容量状况变化情况。[结果]接受自我管理6个月后,病人总液体清除量、总钠排出量、血清钠浓度均明显下降(P<0.01);且体重下降,细胞外液与细胞内液之比下降。[结论]对腹膜透析病人进行自我管理教育,可提高腹膜透析病人水盐控制的依从性,改善病人的容量状况。