Application Of The Transtheoretical Model Of Behavior On The Behavior Of Foot Self-care In Diabetic Patients

ObjectiveDiabetic foot is one of chronic complication of diabetes.Diabetic patients with in the course of more than five years or blood sugar of long-term poor control appeared foot complications such infection,ulcers,gangrene and etc.Once diabetic patients with diabetic foot occurrence,not only for expensive with treatment cost,but also amputation was numerous because of diabetic foot occurred in patients every year.It is higher rate of amputation in the special population and special areas.The patients and their relatives have cased tremendous physical and psychological harm by the higher rate of incidence in diabetic foot and the higher rate of amputation.The family and the community are carried a heavy financial burden by high medical costs. As a result how to prevent and delay the diabetic foot is the point of the treatment of diabetic foot.It was discovered by preliminary study of DCCT,Best behavior of foot care can prevent and reduce effectively the higher rate of incidence in diabetic foot and the higher rate of amputation.How to help the diabetic patients to establish a good foot self-care is a nursing focus in prevent and delay occurrence of diabetic foot.The transtheoretical model of behavior(TTM) was conceptualized by Prochaska and Diclemente in 1983 and 1984.It was base on social psychology,and focus on the process of behavior change and the needs of people.Change people's bad daily behavior by various guidance,accordingly promoted the health.At first,the TTM was application in behavioral change of smoking cessation,then being applied to the intervention of other bad lifestyle change,all of produced good results.In recently years,TTM was applied to the bad lifestyle change with chronic disease and enhance the ability of self-care of the patients in chronic disease by some researchers, and have acquired certain effect.But TTM was not applied to the self-care of diabetic foot in diabetic patients by the researchers in China.Therefore,this subject based on the foot self-care cross-sectional investigation with diabetic patients,TTM will apply to the self-care of diabetic foot in diabetic patients by our group.The prevention based on the TTM theory will apply to prevent the self-care of diabetic foot in diabetic patients.Through the matching intervention with the intervention methods of the TTM and the stage of behavior change intervention,To achieve to establish the good self-care behavior of diabetic foot,to achieve the improving the skin condition of the patients and prevent and delay the occurred of the complication in diabetic foot.Methods1.The cross-sectional investigation of foot self-care with the diabetic patients By convenient sampling,The 302 patients in several communities in Guangzhou who were diagnosed with diabetes,and according with the inclusive criteria and the exclusive criteria of the research.These patients were investigated the stage of self-care in diabetic foot with the questionnaire of general demography by self-designed and the evaluation of the stage of the foot self-care.The questionnaire of general demography included gender,age,height,weight,BMI,FBG,HbA_1c, educational background,payment mode,income and vocational.The evaluation of the stage of the foot self-care was designed according to the TTM theory,the questionnaire was individual choice with five difference options.The software SPSS for Windows,release 13.0 for personal computers was used for statistical activity.Statistical methods included descriptive statistics analysis, Shapiro-Wilk normality test,χ² test and Spearman correlation analysis.The standard test isα=0.05 level.2.Application the TTM theory on the behavior foot self-care with diabetic patientsBased on the investigation result,The 120 diabetic patients in precontemplation and contemplation in the first part were divided into TTM group(the transtheoretical model of behavior change group) and control group(diabetic knowledge education group),each group had 60 patients.Control group only received knowledge education of diabetic foot,TTM group received the matching intervention based on the stage of TTM and the intervention of TTM.The time of follow-up was 6 months after intervention in the two groups.Before and after the intervention of two time points,the knowledge,the efficacy, the ability of foot self-care and the skin condition of foot were evaluated to the evaluation tools.The evaluation tools included self socio-demographic information questionnaire(With the first part),the questionnaire of knowledge about diabetic foot the questionnaire of the skin condition of foot and the registration sheet of the foot self-care behavior,(According to 'Foot Care for People with Diabetes' by American Academy of Family Physicians in Sep 1999),the Self-Efficacy Scale of diabetic foot and the Self-care Scale of diabetic foot(Designed by J.S Wang in Taiwan,the scale included five items,The scaling method was 5-level of Liker, twenty-five was the highest.).The software SPSS for Windows,release 13.0 for personal computers was used for statistical activity.Statistical methods included descriptive statistics analysis,Shapiro-Wilk normality test,χ² test in enumeration data, One-Way ANOVA,repetitive measurement and analysis of variance and Wilcoxon Signed Ranks test in measurement data between the two group.The standard test isα=0.05 level.Results1.302 diabetic patients were investigated in the status of TTM,because some patients did not received the investigation,286 questionnaires were returned,recovery was 94.7%,and 271 were available,efficiency was 94.67%.114 cases were male,157 cases was female,age range from 31 to 78,and average age was(56.45±7.614) years. Among the 271 patients,65 patients in precontemplation,76 patients in contemplation,96 patients in preparation,27 patients in action and 7 patients in maintenace.2.Socio-dimographic factors for foot self-care of diabetic patients to a little extent,except between different educational background and different vocational were significant deviation.Other socio-dimographic factors did not correlate with the foot self-care.In addition,there were negative correlation between FBG,HbA_1C, Weight,BMI and the stage of foot self-care.3.After intervention,compare the knowledge,the ability of self-care,the efficacy of self-care between the TTM group and the control group.The ability of self-care,self-efficacy were significant deviation between the two group(P＜0.05). In condition of the foot skin between the two group,the chap of foot skin, paronychia and the foot skin destruction were significant deviation(P＜0.05), ringworm of feet was no statistical difference(P＞0.05).4.Compare the knowledge,the ability of self-care,the efficacy of self-care between before and after intervention in the TTM group,were significant deviation (P＜0.05).Compare the knowledge,the ability of self-care,the efficacy of self-care, between before and after intervention in the control group,the ability of self-care, were significant deviation(P＜0.05),the self-efficacy was no statistical difference(P＞0.05).5.After intervention,the performance of the foot self-care with follow-up of six months,statistical analysis the value on average.The results showed,the different time points were significant deviation(P＜0.05).It was significant deviation between(P＜0.05).The interaction effect was in the difference time and intervention factors.Compare the performance of the foot self-care in the two groups,the results showed,in addition to the first month of follow-up was no significant difference(P＞0.05).The TTM group was superior than the control group,it was significant deviation in other each time(P＜0.05).6.Compare the performance of the foot self-care before and after intervention in the two groups.The results showed,the difference month were significant deviation itself between before and after intervention(P＜0.05).The 4^th,5^th,6^th were superior to the 1^st,2^nd,3^rd in the TTM group,It was no significant difference between the 4^th,5^th and 6^th.it was significant deviation between the other month(P＜0.05).1^st,2^nd were superior to the 3^rd,4^th,5^th and 6^th in the control group,3^rd,4^th and 5^th were superior to the 6^th.It was no significant difference between the 3^rd,4^th and 5^th,it was significant deviation between the other month(P＜0.05).Conclusions1.Foot self-care has been seldom in the diabetic patients.The patients of the lower level of the educational were on the first two stages,and the higher level of the educational was on the latter three stages.Most of the non- incumbency were on the latter three stages,most of the incumbency were on the first two stages.The diabetic patients of different population were no difference.In addition,there were negative correlation between FBG,HbA_1c,Weight,BMI and the stage of foot self-care. Because the correlation coefficient were less than 0.4,the results showed that FBG, HbA_1c,weight and BMI were little effective with the stage of behavior in foot self-care of diabetic patients.2.The strategy of self-efficacy,the recognitive change,behavior change and decisional balance were matching intervention according to the psychological and behavioral characteristics of the diabetic patients in the various stage of behaviour change.The knowledge of foot-care and the efficacy were inproved,the favourable behavior of foot self-care was established.Through the favourable behavior of foot self-care,the condition of foot skin were improved,diabetic foot were prevented and delayed.