摘要
近年来,糖尿病的发病率呈上升趋势,其并发症极大地增加了糖尿病的致残率和死亡率,严重影响患者的生活质量,并给社会造成了巨大的负担。糖尿病控制成功的关键在于良好的自我护理和自我管理,自我效能是影响患者自我护理、自我管理和治疗依从性的重要因素。而不同特征的糖尿病患者,其自我效能水平又有所差异。
研究目的:
1.评估和了解糖尿病患者的自我效能水平
2.分析糖尿病患者的个人基本资料、糖尿病知识掌握情况、心理状态、社会支持、疾病控制状况、治疗措施与自我效能的相关性,以探索提高糖尿病患者自我效能的可能途径。
研究方法:
2007年10月至2008年7月在齐鲁医院内分泌科病房进行方便抽样,抽取符合研究标准的糖尿病患者175例。使用糖尿病患者个人基本资料调查问卷、糖尿病疾病知识问卷、自评抑郁量表(SDS)、社会支持评定量表、慢性病自我效能量表、疾病代谢指标调查表、糖尿病患者治疗措施调查表。分别调查了糖尿病患者个人基本资料、糖尿病知识掌握情况、抑郁水平、社会支持情况、糖尿病各项代谢指标控制状况以及糖尿病患者治疗措施执行情况。研究数据采用SAS 9.1软件包进行统计分析。
研究结果:
1.本研究中调查对象的自我效能平均得分为6.68±2.30,糖尿病患者的总体自我效能处于中等以上水平。
2.个人基本资料与自我效能的单因素Logistic回归分析结果显示:自我效能水平高的有干部(OR=3.158,95%CI:1.462-6.821)、教师(OR=9.055,95%CI:1.753-46.769)、公费医疗(OR=3.422,95%CI:1.158-10.108),而且随着家庭人均月收入增加,自我效能增加;居住在城镇地区(OR=0.392,95%CI:0.200-0.769)、有三种以上并发症者(OR=0.264,95%CI:0.128-0.546),自我效能水平低。多因素Logistic回归分析结果显示:干部(OR=2.362,95%CI:1.052-5.304)、教师(OR=10.412,95%CI:1.644-65.927)、家庭人均月收入＞4000元者(OR=5.981,95%CI:1.106-32.357)自我效能高,初中以下文化程度者自我效能低(OR=0.445,95%CI:0.209-0.951)。
3.糖尿病疾病知识与自我效能的单因素Logistic回归分析结果显示,随着疾病知识水平的提高,自我效能水平也得到了提高(OR=1.125,95%CI:1.080-1.172)。
4.抑郁与自我效能的单因素Logistic回归分析结果显示,抑郁的存在明显地降低糖尿病患者的自我效能水平(OR=0.289;95%CI:0.203-0.411),经一般情况和社会支持调整后,这种影响仍然存在(OR=0.406;95%CI:0.276-0.597)。
5.社会支持与自我效能的单因素、多因素Logistic回归分析结果均显示社会支持能显著增强自我效能水平:客观支持(OR=1.263,95%CI:1.142-1.396;OR=1.125,95%CI:1.004-1.261)、主观支持(OR=1.142,95%CI:1.076-1.213;OR=1.075,95%CI:1.004-1.150)、支持利用度(OR=1.489,95%CI:1.277-1.737;OR=1.351,95%CI:1.147-1.592))。
6.治疗措施与自我效能的单因素Logistic回归分析结果显示,进行饮食控制(OR=1.863,95%CI:1.020-3.402)、运动治疗(OR=3.221,95%CI:1.746-5.939)、定期系统检查、接受糖尿病教育能提高患者的自我效能水平。多因素Logistic回归分析结果显示,运动治疗明显提高自我效能水平(OR=3.221,95%CI:1.746-5.939)。
7.代谢指标与自我效能的单因素Logistic回归分析结果显示,高空腹血糖(OR=0.867,95%CI:0.794-0.948)、高餐后2小时血糖(OR=0.900,95%CI:0.850-0.953)、高糖化血红蛋白(OR=0.840,95%CI:0.747-0.945)降低患者的自我效能。多因素Logistic回归分析结果显示,高餐后2小时血糖(OR=0.905,95%CI:0.854-0.958)降低患者的自我效能。
结论:
糖尿病患者总的自我效能水平处于中等偏上水平。其影响因素是多方面的。今后应对糖尿病患者进行有针对性的干预,加强心理护理、社会支持、健康教育等,提高患者的自我效能,落实治疗措施,提高治疗效果,延缓和控制并发症的发生,提高患者生命质量。
In the recent years,the incidence of diabetes mellitus has been increasing, paralleled with increased deformity rate and death rate as a result of the complications of the disease,which extremely devastates the quality of life of the patients and caused a heavy social burden.Favorable outcome of diabetes mellitus is determined by satisfying self-care and self-management.Self-efficacy is an important factor that can influence the self-care,self-management and compliance,which is varying with the characteristics of diabetes patients.
Aims
1.Investigate and evaluate the scale of self-efficacy of diabetes patients.
2.Explore the path to increase the self-efficacy by analyzing the correlations of self-efficacy and demographic data,knowledge on diabetes mellitus, psychological state,social supports,disease control state as well as treatment measures in diabetes patients.
Methods
Patients(n=175) were recruited from Qilu Hospital of Shandong University according to WHO type 2 diabetes mellitus diagnosis standard in 1999.Those with psychiatric disorders and malignant tumors were excluded in this study.The study was carried out by questionnaires,which included demographic data,diabetes related knowledge,self rating depressive scale,social supports rating scale and chronic disease self-efficacy.Additionally,BMI,WHR,blood pressure,FPG,2hPG,HbAlc, renal function and urinary albumin were examined.We calculated Odds Ratios and corresponding 95%confidence intervals(CIs) using the Logistic regression model (SAS version 9.1)
Results
1.The average scale of self-efficacy was 6.68+2.30 in this study.
2.Demographic data and self-efficacy:univariate logistic regression analysis showed that cadres(OR=3.158,95%CI:1.462-6.821),teachers(OR=9.055, 95%CI:1.753-46.769) and patients with state medicine(OR=3.422, 95%CI:1.158-10.108) had higher scale of self-efficacy,which was increased in families with higher per capita income.Residents from cities and towns (OR=0.392,95%CI:0.200-0.769) with at least three complications(OR=0.264, 95%CI:0.128-0.546) showed lower scale of self-efficacy.Further multi-variables logistic regression analysis showed that cadres(OR=2.362,95%CI:1.052-5.304), teachers(OR=10.412,95%CI:1.644-65.927) and patients with family monthly income over 4000 RMB(OR=5.981,95%CI:1.106-32.357) had higher scale of self-efficacy,while those with low-education below middle school(OR=0.445, 95%CI:0.209-0.951) were presented with lower scale of self-efficacy.
3.Knowledge of diabetes mellitus and self-efficacy:univariate logistic regression analysis showed that patients knowing more of DM had higher scale of self-efficacy(OR=1.125,95%CI:1.080-1.172).
4.Depression and self-efficacy:univariate logistic regression analysis showed that depression state could greatly damage the scale of self-efficacy regardless of given social supports(OR=0.289,95%CI:0.203-0.411;OR=0.406,95%CI:0.276-0.597)
5.Social supports and self-efficacy:univariate and multi-variable logistic regression analysis showed that social supports including objective and subjective supports contributed to the increased the scale of self-efficacy.
6.Treatment measures and self-efficacy:univariate logistic regression analysis showed that patients who were on diet control(OR=1.863,95%CI:1.020-3.402) and had physical exercises(OR=3.221,95%CI:1.746-5.939),regular physical examination as well as diabetes education were found with higher scale of self-efficacy.Multiple variables logistic regression analysis showed that physical exercises could significantly increased the scale of self-efficacy(OR=3.221, 95%CI:1.746-5.939).
7.Metabolism index and self-efficacy:univariate logistic regression analysis showed that high levels of fasting blood glucose,2h postprandial hyperglycemia and HbAlc decreased the scale of self-efficacy(OR=0.867,0.900,0.840).Multiple variables logistic regression analysis showed that 2h postprandial hyperglycemia decreased the scale of self-efficacy(OR=0.905,95%ACI:0.854-0.958).
Conclusions:
Overall,self-efficacy in the diabetes patients are above the medium level and it is affected by many factors.Therefore,increasing efforts on directly intervention, mental nursing,social supports and health education are necessary to improve the scale of self-efficacy,which could further contribute to the effective treatments, delayed and controlled complications and improved quality of life.
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