The Research Of The Health Education Maps On Patients With Type 2 Diabetes

BACKGROUNDAt present,there is nearly 40 million diabetes patient in China,while type 2 diabetes accounts for about 95%.Our country has become the second country of diabetes,following India.Diabetes and its complications pose a serious threat to life, and even lead to disability and death,so it has placed a heavy burden to patients and society.According to a survey of 11 cities in 2002,it is estimated that the direct medical costs of diabetes and its complications in our country is about 18.8 billion yuan,accounting for 4 percent of the total number.Diabetes Education,also known as the Diabetes Self-Management Education,is a method of providing knowledge and skills to the diabetic patients including self-care,control of acute and chronic complications,as well as how to change the way of life.There are more and more evidences that diabetes education plays an important role in diabetes management.It helps to improve patient's knowledge of self-management skills and metabolism,to delay complications,to reduce the direct costs of treatment,and to improve quality of life,so that diabetes education has become an essential control measures.At present,diabetes health education is only to provide information in our country,focusing on the medical knowledge of diabetes.So that the educators is health care provider.However,the diabetes education of international has changed into an active learning mode which based on patient's individual experience.One of the representative samples is the Conversation Map tools which were created by Healthy Interactions.The Conversation Map tools was first used in Canada in 2006 and they have became the standard procedure of the diabetes education.They were carried out by ADA in june 2007.This tools showed that they can improve the self-care ability and glycemic control of patients with diabetes.The Conversation Map tools is composed by 5 color pictures,which size is 3-foot(1 meter) by 5-foot (1.5 meters),Conversation cards and educator guideline.The time spent on each picture was 60～90mins.The Conversation Map tools are composed by several images and metaphors,and can be spreaded out on the table,so that the participants can see and find the information.The Conversation cards includes many flase topic of diabetes,and they were used to provide information to help the patients to engage into the study.The concept of Conversation Map is to illuminate group discussion. The educator and 3～10 patients sat around the table which a Conversation Map tools was spreaded on.They discussed and exchanged opinion.For example,reasonable diet.So that the patient can discriminate and change the bad behavior.The role of the educator is to create an environment without any stress,so that participants can study more relevant knowledge from the pictures,from the educator and from other participants.The effect of the traditional education modes,including health education lecture and deliver knowledge pamphlet,is not satisfied.Because they lacked interactive and interest.The Conversation Map tools are interactive and can make up the defects of the traditional education modes.So the patients can take action and change behavior spontaneously.Owing to the copyright,the Conversation Map tools have not be introduced into China in October,2007,when we began to design the Health Education Maps.Therefore,it is necessary to develop an Diabetes Health Education Maps tools which is suitable for China,refering to the concept of the Conversation Map.It can meet the purpose of setting up foundation for effective health education of diabetes.OBJECTIVETo develop the Health Education Maps referring to the concept of the US. Conversation Map tools,and to evaluate the effectiveness of the Diabetes Health Education Maps on patients with diabetes mellitus.METHODSThis study is divided into three parts.PartⅠ(The survey of acceptability of the Diabetes Health Education Maps on patient with type 2 diabetes).151 patients with diabetes were enrolled into the investigation.Five Diabetes Health Education Maps were hanging on the walls of the aisle in Endocrine Division. We obtained imformation from patients through "one-on-one" form of visits with their consent before they discharged from hospital.The interviews include:(1) Whether they paid attention to these the Diabetes Health Education Maps and red them;(2) How about the feasibility of this means of health education;(3) Which Map they like most.All quantitative data of questionnaire survey was analyzed by SPSS13.0.χ~2 test were used to evaluate the general opinion of patients and.patients with different cultural levels and different age.PartⅡ(Effects of the Dibetes Health Education Maps).220 patients with type 2 diabetes were engaged in the study and 195 of them were utility.93 cases(110 cases into the group,lost 12 cases) were divided into health education Diabetes Education Unit and 102 cases(110 cases into the group, lost 8 cases) were divided into General Education Unit by the means of randomized single-blind control method.They came into the study when dosage of the medication was relatively stable.The control group patients attended hospital diabetes lectures regularly,while the experimental group patients received Diabetic Education Maps education,using the pictures to conduct diabetes knowledge,with group discussion. Compared the scores of the SDSCA Scale and blood test results,including FPG (Fasting plasma glucose),2hPG(2 hours postprandial blood glucose),HbAlc (Hemoglobin A1C) before,after 3 months and 6 months.All quantitative data of questionnaire survey was analyzed by SPSS13.0.χ~2 test were used to evaluate the baseline conditions,two-sample t test were used to evaluate the separate effects of group,single-factor repeated measure were used to evaluate the variance effect of the time.two-factor repeated measure were used to evaluate the main effects and interactive effects.PartⅢ(The introduction and evaluation of the Revised Diabetes Self-care Behavior Scale(SDSCA)130 patients with type 2 diabetes were enrolled in the investigation,and 110 of them were utility.All quantitative data of questionnaire survey was analyzed by SPSS13.0.Analysis the Reliability and validity of SDSCA.Test-retest reliability coefficient and inter-item corelation coefficient were used to evaluate the reliability. Factor analysis were used to test the Validity.RESULTSPartⅠ1.All 151(100%) patients had noticed and red the Maps.140(92.7%) patients thought that the Diabetes Health Education Maps is a good way for health education. 136(90.0%) patients had a strong impression on Diabetic diet,while 108cases(71.5%) on Diabetes Introduction Maps,84 cases(55.6%)on Diabetes exercise Maps,99 cases(65.6%) on Diabetes Self-care Maps,99 cases(65.6%) on Diabetes Drug Maps.2.The evaluation of health education Maps was not significantly different among patients with different cultural levels(P＞0.05).3.The evaluation of health education Maps was not significantly different among patients with different ages(P＞0.05).PartⅡ1.The scores of general diet,specific diet,exercise,blood glucose monitoring,foot care and smoking between the two groups was significant different,p＜0.001.2.The scores of general diet,specific diet,exercise,blood glucose monitoring,foot care and smoking before and after Education was significant different,P＜0.001.3.The scores of general diet,specific diet,exercise,blood glucose monitoring,foot care and smoking was no significant different(P＞0.05)at the baseline;The scores of general diet,specific diet was significant different(P＜0.05)at 3 and 6 month,and remained at a high level at 6 month.The scores of exercise,blood glucose monitoring and foot care between the tow group was no significant different(P＞0.05),but significant different at 6 month(P＜0.05).4.There was an interaction effect before and after education between the tow group in general diet,specific diet,exercise,blood glucose monitoring,foot care and smoking(P＜0.000).5.The level of the fasting blood glucose,2 hours postprandial blood glucose and hemoglobin A1c was significantly different between the tow groups(P＜0.001).6.The level of the fasting blood glucose,2 hours postprandial blood glucose and hemoglobin A1c was significantly different before and after 3 months and after 6 months health education(P＜0.001).7.The level of the fasting blood glucose,2 hours postprandial blood glucose and hemoglobin A1c were not significantly different(P＞0.05)at the baseline(P＞0.05); The fasting blood glucose,2 hours postprandial blood glucose was significant different at 3 and 6 month,remained at a lower level at 6 month;The hemoglobin A1c was significant different at 6 month(P＜0.001).8.There was a interaction effect before and after education between the tow groups in fasting blood glucose,2 hours postprandial blood glucose and hemoglobin A1c(P＜0.001).9.93 patients in the experimental group was investgated.32(34.4%) patients considered that the Diabetes Health Education Maps Modes was helpful to improve self-management skills.50(53.7%) thought there was considerable help.60(64.5%) patients gave their advices,of whom 35(58.3%) considered Diabetes Health Education Maps should be promoted,20(33.3%) thought they should be promoted after improvement,5(8.3%) thought the Maps was not good to be promoted.PartⅢ1.Test-retest reliability coefficient of the dimension in the Chinese version SDSCA Scale was from 0.763 to 1.000.2.Inter-item corelation coefficient of items in the dimension of the scale was moderate to high correlation(0.555～0.933),the specific diet lowest(0.104).3.Exploratory principal component analysis of the scals's items identified a four first-order factors model that accounted for 67.483%of the total variance.The factor loading of items in Chinese version SDSCA Scale were satisfactory(≥40%).CONCLUSIONS1.The Diabetes Health Education Maps is acceptability,and can be used to diabetes health education.2.Diabetes health education Maps educational model can significantly improve patient's self-care behavior and improve the level of metabolic control.3.The reliability and validity of chinese version SDSCA Scale is good and suitable for evaluating the effectiveness of diabetes health education.