| Objective: Diabetes mellitus is one of the major chronic non-contagious diseases that threaten human health,and has become a major public health problem in the world due to its high incidence,high disability rate and high fatality rate.China has the largest elderly population in the world,and the prevalence of diabetes among the elderly has exceeded20%.The population of diabetes patients is obviously aging,so it is urgent to pay attention to the management of diabetes in the elderly.Based on the theoretical model of extended planning behavior,this study explores the self-health management model of elderly diabetes patients,providing scientific basis for the prevention and control of diabetes.The specific objectives include: 1.Taking theory of planned behavior as the core framework,adding two variables of diabetes knowledge and objective barriers to self-management,combining with the definition of behavior in the cross-theoretical model,forming an extended theory of planned behavior model,and discussing the path research of selfmanagement behavior in the elderly with type 2 diabetes based on this model.2.Can the combined use of extended planning behavior theory model help us better understand the common characteristics of patients with diabetes and explore the association between patients’ underlying categories and glycemic control? 3.Based on the extended theory of planned behavior model,the intervention strategies of self-management behavior in elderly type 2 diabetes mellitus were studied to form a health intervention program.4.Guided by the intervention program,an intervention study was conducted in Tianjin community health service center to evaluate the effectiveness of glucose control,comorbid control,self-management behavior and other aspects as well as the intervention process of elderly diabetes patients.Methods: Mixed research methodPart I: Self-management behavior of elderly type 2 diabetes patients based on extended theory of planned behaviorThrough literature search at home and abroad,semi-structured interviews and expert panel discussions,The self-administered Questionnaires for elderly type 2 diabetes were written strictly in accordance with The requirements and procedures Of The manual "Constructing Questionnaires Based On The Theory Of Planned Behaviour",and a small sample Of Questionnaires was tested.Revise the draft questionnaire.Based on the theory of planned behavior,construction of elderly patients with type 2 diabetes self-management behavior extension model,in October 2021,convenient to select 520 cases of elderly patients with type 2 diabetes questionnaire survey was conducted as the research object,USES the structural equation model to verify this extension model,using the latent profile analysis to explore self management behavior and the relationship between fasting blood glucose.Part II: Research on developing self-management intervention strategies for elderly type 2diabetes based on extended theory of planned behavior modelThrough the method of literature retrieval in type 2 diabetes intervention studies both at home and abroad,and the interventions and strategies are summarized,and the reference model,green through face-to-face communication for target audience to intervention needs assessment,in combination with expansion plans behavior theory to analyze the tendency of diabetes self-management crowd,promote and strengthen factor,Identify the individual behavior and lifestyle causing the patient’s health problems and develop initial intervention strategies.Experts and practitioners from the fields of clinical medicine,nursing,community health and health management are invited to conduct two rounds of Delphi expert consultations.According to the intervention strategy to make questionnaire,using likert 5 score method to evaluate the strategy of the importance of operability,use SPSS22.0 calculating the positive of experts,degree of authority and degree of coordination,such as correlation coefficient,combined with expert advice to adjust and modify the intervention strategy form "elderly type 2 diabetes self-management intervention plan".Intervention contents include intervention objectives,intervention implementation plan and intervention evaluation plan.Part III: Evaluation of the effect of self-management intervention in elderly patients with type 2 diabetesFinally,a randomized controlled experimental study was carried out,using the method of cluster sampling,256 elderly patients with diabetes were divided into the intervention group(124)and control group(132)in community health service centers.The control group received routine community care.On the basis of the control group,the intervention group received one-to-one health education courses and personalized guidance from family doctors according to the "Elderly type 2 diabetes self-management intervention program",and the intervention cycle was three months.T-test,χ2-test and other statistical methods were used to compare the differences in fasting blood glucose,blood pressure and self-management behavior between the intervention group and the control group before and after the intervention,to evaluate the effectiveness of the intervention program,and to evaluate the implementation process of the intervention program.Results:Part I: Self-management behavior of elderly type 2 diabetes patients based on extended theory of planned behavior1.Reliability and validity test of the elderly diabetes self-management Behavior scale developed based on theory of planned behavior: The overall Cronbach’s α of the questionnaire was 0.829,and the Cronbach’s α of each dimension was between 0.722 and0.795.Five factors were extracted from the questionnaire,and the cumulative variance contribution rate was 70.6%.Confirmatory factor analysis showed that AVE values and CR values of each observation index ranged from 0.501 to 0.889 and 0.844 to 0.960.2.The average score of self-management behavior and attitude in elderly patients with type2 diabetes was 4.39 ± 0.68;The average score of subjective norm was 4.37 ± 0.86.The average score of perceptual behavior control was 4.11 ± 0.86.The mean score of objective disorder was 0.82 ± 1.57.The mean score of diabetes knowledge was 61.98 ± 66.35.The mean score of behavioral intention was 4.32 ± 0.79;The average score of self-management was 4.21 ± 1.25.Behavioral attitude,subjective norms,perceived behavioral control,knowledge of diabetes and objective barriers affected the intention of self-management of type 2 diabetes patients,and the intention of self-management affected the behavior of selfmanagement of diabetes patients(P < 0.05).3.The extended theory of planned behavior model can explain 76.6% of variance variation of self-management behavior intention in elderly patients with type 2 diabetes.The latent variable that had the greatest influence on the intention of self-management behavior was subjective norms,with an effect of 0.625,followed by attitude towards behavior(0.292),perceived behavioral control(0.172),objective barriers(-0.217)and diabetes knowledge(0.006).These variables influence self-management behavior through behavioral intention(0.508)as a mediator.4.Latent profile analysis results: The patients were divided into four categories: good lifestyle/medication compliance(77.7%),bad lifestyle/medication compliance(4.6%),bad lifestyle/medication compliance(11.2%),good lifestyle/medication compliance(6.5%).The good lifestyle/non-compliance group had higher education level and higher income level;Most of the patients with bad lifestyle/non-compliance with medicine had a short period of illness(≤5 years),and the rates of excessive drinking and dangerous drinking were the highest.The patients in the good lifestyle/medication group had a longer time of disease,most of them had a family history of diabetes and had complications of varying degrees.In terms of glycemic control,fasting glucose was significantly lower in the other three groups of patients than in the poor lifestyle/non-compliance group(good lifestyle/non-compliance group: β=-4.438,P < 0.001;Adverse lifestyle/medication group:β=-2.467,P=0.011;Good lifestyle/non-medication group: β=-3.625,P < 0.001).Part II: Research on developing self-management intervention strategies for elderly type 2diabetes based on extended theory of planned behavior model1.Family doctors play an important role in diabetes management.Through the cooperative mode of scientific research institutions and grassroots health service centers,the shortage of high-quality medical resources at grassroots level can be alleviated,so that patients with diabetes can get better health education effects.2.Comprehensive health intervention is mainly carried out by combining the perceived behavioral control,subjective norms,attitudes and healthy behavioral intentions of diabetes patients with reasonable diet,regular exercise,medication as prescribed by doctors,self-monitoring of blood sugar and other self-management behaviors.3.The positive coefficients of the two rounds of expert consultation were 83.3% and 100%respectively;The degree of authority(Cr)ranged from 0.75 to 0.90.In the first round of consultation,the importance of intervention strategies ranged from(3.93 ± 0.46)to(4.93±0.26),and in the second round,the importance of intervention strategies ranged from(3.87± 0.35)to(4.93± 0.26).The coordination coefficients of the two rounds of consultation were 0.303 and 0.371 respectively(P < 0.01).The coefficient of variation of the two rounds of correspondence consultation ranged from 0.052 to 0.168 and 0.052 to 0.110,respectively.Combined with expert advice and group discussion,the final "elderly type 2diabetes self-management intervention program" was determined.Part III: Evaluation of the effect of self-management intervention in elderly patients with type 2 diabetes1.Compared with the control group,the intervention significantly reduced the fasting blood glucose value of the intervention group,and increased the fasting blood glucose compliance rate(P < 0.01).2.Compared with the control group,the intervention group significantly reduced the systolic and diastolic blood pressure,and increased the systolic and diastolic blood pressure compliance rate(P < 0.01).3,intervention can improve the intervention group of elderly patients with diabetes selfmanagement of attitude,subjective norm,perceived behavioral control and selfmanagement intention scores and make the patient in a reasonable diet,regular exercise,prescribed medication,blood sugar monitoring and foot care forward with selfmanagement behavior change stages,in the action phase and maintaining phase patients increased.Conclusions: 1.The extended model constructed based on theory of planned behavior has good explanatory and predictive power for self-management behavior and intention of elderly type 2 diabetes patients.2.The intention of self-management behavior and subjective norms are the important influencing factors of self-management behavior and behavior intention respectively.3.Supported by the results of latent profile analysis,future intervention studies need to provide tailored guidance for different patient types and reveal the importance of health behavior change.4."Elderly type 2 diabetes Self-management intervention Program" summarized successful cases at home and abroad,carried out preliminary evaluation of intervention objectives,built on the basis of theory,demonstrated by expert consultation,and verified by experiment,the intervention program can achieve better intervention effects.4.The intervention program developed based on the extended theory of planned behavior model and relying on family doctors to conduct intensive intervention for elderly type 2 diabetes patients for a period of 3 months can significantly reduce fasting blood glucose and improve self-management ability,which is conducive to the disease control of elderly patients with diabetes in the community. |
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