| Objectives:Patients with diabetic foot in Yunnan province and find out the present situation of the late diagnosis,analysis of the influencing factors,and to know KAP model as the theoretical framework,according to the results of investigation before intervention combined with diabetes teaching management APP make comprehensive diabetes foot nursing intervention program,to explore the intervention program in patients with diabetes foot late diagnosis application effect of self management.Methods:This study is divided into two stages:cross-sectional study and quasi-experimental study.Period:by cross-sectional study survey of current situation and influencing factors of diabetic foot delay,using random sampling,according to the included and exclusion criteria.selection in October 2018 to June 2019 in the second people’s hospital of yunnan province(the only company in yunnan province was established diabetic foot clinic hospital)endocrinology in hospital treatment of 74 cases of patients with diabetic foot delay as the research object,according to the delay of time is divided into three groups:Delay time to 7 days or less group(n=19),the delay time of 8-31 days group(n＝28),delay time>31 days group(n=27)using the general demographic information questionnaire,diabetes foot care knowledge,attitude and behavior evaluation questionnaire,blood glucose,blood lipids,diabetes foot self-management behavior scale questionnaire and foot situation questionnaire survey carried out on the patient.Stage 2:Will be the first stage of the investigation object using the random number table method for random grouping,due to lost to follow-up(3 cases),control group of 35 cases,intervention group for 36 cases,for control of confounding factors,the intervention of the two groups remain the same,on the content,the control group given endocrinology routine nursing intervention,intervention group based on the theory of knowledge KAP mode combined with diabetes teaching management APP personalized comprehensive nursing intervention,intervention in 1 month and 3 months respectively investigate two groups of patients with diabetic foot care knowledge,attitude and behavior,diabetic foot self-management behavior,blood sugar,blood fat and foot conditions,To evaluate the effectiveness of the intervention model in patient self-management.Results:Results of the first phase:1.The average delay time of 74 diabetic foot patients was 49.07 days,19 patients(25.9%)with the delay time<7 days,28 patients(37.8%)with the delay time of 8-31 days,and 27 patients(36.5%)with the delay time of>31 days.2.The influence factors of diabetic foot late diagnosis:three groups of patients with diabetic foot of ethnic,cultural degree,family per capita income,foot ulcer volume sum,Wagner stage,see a doctor before,whether to accept a diabetic foot before health education,see a doctor if they can identify dangers of diabetic foot,foot care knowledge,attitude and behavior,in patients with diabetic foot self-management behavior was statistically significant(P<0.05).3.Diabetic foot delay time of multiple linear regression analysis:the single factor analysis inspection level is set to P<0.1,the ethnic,cultural degree,family per capita income as the independent variables,such as delay time as a dependent variable,multiple linear regression analysis,according to national,family per capita income Wagner grading,self-management behavior score for patients with late diagnosis independent impact factors,the resulting model:Y=90.125+0.15X nation-0.926X family income per month+1.478Xwagner-1.636X Total score of self-management seal·Results of the second phase:1.The results of anova of repeated measures of knowledge and self-management before and after intervention of the two groups of patients showed that there were statistical differences in knowledge and self-management scores of the two groups of patients at all time points(P<0.05),and the pantwise comparison(LSD method)between the three time points had statistical significance(P<0.05).After controlling the time factor,the intervention measures in the two groups had different effects on the improvement of the score of knowledge,credit and banking and the score of self-management(P<0.05).There was an interaction between time and grouping(P<0.05),that is,the score of knowledge,communication and self-management before and after intervention was different between the two groups.At each time point,there was no significant difference in the scores of knowledge,communication and self-management between the two groups before intervention(P>0.05),but there was a difference in the score of knowledge,communication and self-management between the two groups one month after intervention and three months after intervention(P<0.05).With the change of time,the measures of the two groups improved the scores of knowledge trust and self-management,and the improvement trend of the intervention group was more obvious than that of the control group2.Anova results of repeated measurement of biochemical indexes before and after intervention of the two groups showed that BMI,FBG and P2BG of the two groups were significantly different at each time point(P<0.05),and there was an interaction between the groups and time(P<0.05).After controlling the time factor,there was no significant difference in the group main effect of BMI(P>0.05),while there was a significant difference in the group main effect of FBG and P2BG(P<0.05).Look from each point in time,two groups of patients with BMI in intervention before and after the intervention a month no statistical difference(P>0.05),there are differences between the three months after the intervention(P<0.05),FBG and P2BG have differences between three time points(P<0.05),with the change of time of two groups of measures for BMI,FBG and P2BG can both reduce the role,and the measures of intervention group is better than the control group3.The comparison of foot conditions and the risk signals of identifying diabetic foot before and after intervention between the two groups showed that there was no statistical difference in Wagner ulcer number,ulcer volume and the risk signals of identifying diabetic foot between the two groups before intervention,and there was a statistical difference in the first and third months after intervention.Intervention group of grade of Wagner,ulcer,ulcer combined volume and can identify the risk of diabetic foot there was a significant difference between the three time points(P<0.001)after comparing the two found that number of ulcers and ulcer volume sum of differences were statistically significant,Wagner intervention before and after the intervention a month no difference,but there are differences between the three months after the intervention,intervention can identify the risk of diabetic foot signal after a month no difference between three months and after the intervention,but there are differences before and intervention.In the control group,Wagner grading and the ability to recognize the danger signal of diabetic foot showed no statistical difference between the three time points(P>0.05).However,there was a statistical difference between the number of ulcers and the total volume of ulcers at the three time points(P<0.05)and the difference was statistically significant after pairwise comparison.Conclusions:1.The phenomenon of delayed treatment for diabetic foot patients is common.2.Diabetic foot late diagnosis and ethnic,cultural degree,family percapita income,foot ulcer volume sum,Wagner stage,see a doctor before,whether to accept a diabetic foot health education,to see a doctor if they can identify the risk of diabetic foot before signal,foot care knowledge,attitude and behavior,in patients with diabetic foot self-management behavior.It is of referential significance for promoting the health of patients to clarify the influencing factors of delayed treatment of diabetic foot.3.To known KAP theory model as the theoretical framework combining the results of a survey before intervention and diabetes management APP individualized nursing intervention can improve the ability of self management of diabetic foot patients delay and improve diabetes foot care knowledge,attitude and behavior to form the correct health behavior and promote the healing of foot ulcers and blood sugar control,application effect is relatively good. |
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