The Effects Of A Commom Sense Model-based Programe On Illness Perceptions In Insulin-treated Tpye 2 Diabetics With Impaird Awareness Of Hypoglycemia In China

Objectives1.To investigate and analysis the current situation of illness perceptions in patients with insulin-treated type 2 diabetes mellitus(T2DM)and impaired awareness of hypoglycemia(IAH).To understand the patients’ specific experience of illness perceptions in different coping styles.2.To explore the effects of an intervention program based on the Common Sense Model on illness perceptions,coping styles,hypoglycemia fear and hypoglycemia awareness in the patients with insulin-treated T2DM and IAH.MethodsThe study was divided into two parts.1.The first part was used a mixed-method sequential explanatory design to retrieve data regarding the illness perceptions in patients with insulin-treated T2DM and IAH.The first stage is quantitative study.133 patients with insulin-treated T2DM and IAH who met inclusion and exclusion criteria were recruited from the clinics of Endocrinology and Metabolism of an academic,medical and teaching hospital in Zhenjiang,a city in eastern China were investigated.Measures included the brief illness perception questionnaire(BIPQ),simplified coping style questionnaire(SCSQ)were used.And analysing the situation and differences of illness perceptions in patients with IAH who had different coping styles.The second stage is qualitative study.14 patients from the quantitative study who had different characteristic features and different coping styles from quantitative study were chosen to have interviews to understand the specific experience of illness perceptions.2.The second part was a quasi-randomized controlled trial.The program was grounded on the Common Sense Model,and it involved two main circuit(improving cognitive and emotional representations),four branches(promoting illness knowledge,improving motivation to manage illness,optimizing strategies to manage psychological pressure,and establishing positive coping procedures).78 patients with insulin-treated T2DM and IAH were recruited from the clinics of Endocrinology and Metabolism of an academic,medical and teaching hospital in Zhenjiang,Jiangsu province between April and November 2020.A total of 39 participants were recruited for each group.Both intervention and control groups attended usual care.Intervention group received the program based on the Common Sense Model.The illness perceptions,coping styles,hypoglycemia fear and hypoglycemia awareness were measured at the baseline,1month and 3-month after intervention.Results1.Of the 133 patients with insulin-treated T2DM and IAH,49(36.8%)patients were positive coping style,and 84(63.2%)patients were negative coping style.The results showed that summary of illness perceptions,consequences,personal control,identity,concern,coherence and emotional response were differed across coping styles(P<0.05).From the qualitative study,patients in different coping styles have different experience of illness perceptions.Patients who had positive coping style are deficient in self-management behavior,sensitive to hypoglycemia symptoms,reducing the social interaction,increasing the illness stress and having high demands of illness knowledge.From the view of patients in negative coping style,they always identify hypoglycemia based on personal experience,rationalize the prevalence of illness,deny suffering from the negative impact of illness,lack of psychological fluctuation experience caused by illness and emphasize the dangers of hyperglycemia.2.Overall,75 patients with insulin-treated T2DM and IAH were identified completed the data collection at 3-month follow up.The results showed that the intervention group exhibited significant improvements in consequences(P=0.032),personal control(P=0.006),treatment control(P=0.046),positive coping style(P=0.002)at the 3-month,timeline(P=0.004)at the 1-month follow ups.Compared with the control group,hypoglycemia fear and hypoglycemia awareness data in the intervention group were not improved significant.No intervention related adverse events were observed.Conclusion1.The suitation of illness perceptions in patients with insulin-treated T2DM and IAH have some space to improve.Coping style was an important factor affecting illness perceptions.Therefore,nurses can provide personalized health education and positive emotional support to cater to patients’ illness perceptions and coping styles.2.This study confirmed that a Common Sense Model-based intervention program could modify illness perceptions and improve positive coping style in IAH patients.Future researches in improving the hypoglycemia fear and awareness of hypoglycemia are necessary to evaluate the effect of this intervention program.