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目的评价社区糖尿病患者自我效能水平及影响因素,为后续的自我管理干预提供有力依据。方法于2015年9-11月采用多阶段整群随机抽样的方法,在上海市浦东、闵行、松江、长宁和宝山5个区(县)中,每个区(县)抽取1家社区卫生服务中心,包括了25个全科团队的糖尿病患者,每个团队所负责管理的T2DM患者库中随机抽取100例患者。经知情同意后进行问卷调查,共回收2 249份有效问卷。采用糖尿病自我效能量表评价患者自我效能水平,应用《密西根糖尿病自我管理行为问卷(SDSCA)》、欧洲健康素养6个条目的短卷(HLS-EU-Q6)等评价患者自我管理能力的各项指标并收集一般资料。用SPSS 20.0软件进行统计学分析,多组计量指标的比较用方差分析,患者自我效能水平的影响因素采用多重线性回归分析。结果患者总体自我效能平均得分为(3.42±0.82)分,其中以遵医服药维度得分最高,为(3.84±1.22)分,非药物治疗(饮食控制、规律锻炼、血糖监测、足部护理、低血糖预防)得分较低,分别为(3.57±0.95)、(3.30±1.20)、(3.07±1.07)、(3.24±1.11)和(3.47±1.03)分。多重线性回归分析显示,人口学特征中,性别、文化程度是自我效能的影响因素,差异有统计学意义(P<0.05,P<0.01)。自我管理能力指标中,健康素养得分(β=0.210)、社会支持得分(β=0.201)、自我管理行为得分(β=0.217)、血糖控制得分(β=0.088)均为自我效能的正向影响因素,差异均有统计学意义(P<0.05,P<0.01)。结论社区糖尿病患者的自我效能处于中上水平,在开展自我管理健康教育项目时,应考虑健康素养、社会支持、自我管理行为、血糖控制各要素水平的综合提升。
Objective To evaluate the self-efficacy and influencing factors of community diabetes patients and provide a strong basis for the follow-up self-management intervention. Methods From September to November 2015, a multistage cluster random sampling method was adopted to collect 1 community health service in each of the 5 districts (counties) in Shanghai Pudong, Minhang, Songjiang, Changning and Baoshan. Center, which included 25 general-purpose diabetes patients and 100 randomly selected patients in the T2DM pool managed by each team. After informed consent, a questionnaire survey was conducted to collect 2 249 valid questionnaires. The self-efficacy of patients was assessed by the Diabetes Self-Efficacy Scale. The self-management skills of patients were assessed using the “Self-Management Behavior of Michigan Diabetes Mellitus (SDSCA)” and the HLS-EU-Q6 Indicators and collect general information. SPSS 20.0 software for statistical analysis, multiple sets of measurement indicators of variance analysis, factors affecting the level of self-efficacy of patients using multiple linear regression analysis. Results The average score of overall self-efficacy of patients was (3.42 ± 0.82) points, of which the highest score was (3.84 ± 1.22), which was the highest among all the non-drug treatments (diet control, regular exercise, blood glucose monitoring, foot care, (3.57 ± 0.95), (3.30 ± 1.20), (3.07 ± 1.07), (3.24 ± 1.11) and (3.47 ± 1.03) points, respectively. Multiple linear regression analysis showed that among the demographic characteristics, gender and educational level were the influencing factors of self-efficacy, the difference was statistically significant (P <0.05, P <0.01). The scores of health literacy (β = 0.210), social support score (β = 0.201), self-management behavior score (β = 0.217) and glycemic control score (β = 0.088) were all positive effects of self-efficacy Factors and differences were statistically significant (P <0.05, P <0.01). Conclusions Self-efficacy of community-based diabetes patients is at the upper-middle level. When carrying out self-management health education programs, we should consider the comprehensive improvement of health literacy, social support, self-management behaviors and blood glucose control.