Effect And Need Assessment Of Community-based Self-management Program Among Diabetes Patients

ObjectiveTo evaluate the effect and needs of community-based self-management program among diabetes patients enrolled in a health promotion pilot study in Beijing, and to provide scientific evidence for promoting diabetes self-management program at the community level in China.Subjects and MethodsWith the principle and procedures of informed consent,121(44 males,77 females, with average age of 59.9±±6.0) diabetes patients from 6 communities in Tianzhu Town, Shunyi District in Beijing were recruited in the study. Based on international (Chronic Disease Self-management Program)CDSMP theory and past experiences, we developed "Community Diabetes Self-management Guide" and "Leadship Manual for Diabetes Self-management Workshop" after the expert's evaluation and pre-test, whichwere used as the teaching materials for a 6-week community-based self-management training courses among diabetes patients. A combination of qualitative and quantitative method was utilized for data collection.. Information about awareness, knowledge and behaviors related to diabetes before and after the 6-week intervention as well as self-management needs was analysed.. In-depth interviews were organized among community heath center directors, health workers, group leaders and patients'family membersto understand their attitude, acceptability and willingness to involve/support diabetes self-management program at their communities. Databases were established with Epidata3.1, and analysed with SPSS 16.0 statistic software. Ratio comparison was conducted by Chi-square test, changes in the values of indexs were compared with analysis of variance and nonparametric test. Content analysis methods was used to analyse interview presentations.Results1) Health Knowledge:After a 6-week intervention, knowledge coveage on diabetes defintion, diagnostic criteria, define conditons for high-risk groups, chronic complications, no radical cure for diabetes and correct treatment increased by 24.0%,29.6%,45.4%,48.7%,31.4% and 35.6% respectively (P<0.001)2) Behavior changes:healthy behaviors such as total diet amount control, less salt and fat intake or more fruit and vegetable intake, physical exercises frequency and attention to foot care increased by 17.4%,16.5%,25.6% and 27.3%(P<0.001). Meanwhile, risk behaviors like smoking and excessive drinking decreased by 5.8% and 6.6%(P>0.05). 3) Self-efficacy:The patient medication compliance score, diet control self-efficacy score, physical exercise self-efficacy score, confidence score to self-manage diabetes and to overcome disease impact markedly increased (P<0.001)4) Self-management behaviors:The proportion of meeting the required frequency of blood glucose and HbAlc monitoring increased by 45.5% and 51.9%, and the proportion of the exchange condition with the doctor increased by 32.2%(P<0.001).5) Fasting blood glucose control:The proportion of good blood glucose control increased by 13.2%(P<0.05), and the average level of fasting blood glucose decreased by 0.40mmol/L(P<0.05).6) Patients satisfaction:86.0% of respondents expressed their satisfaction to the training leaders.7) Needs assessment:After intervention,79.3% of patients believe there was a need to continue raising their awareness and building self-management skills, and 81.8% of them prefer to parcipate in self-management programme. In terms of training content, "behavior change guidance" was considered as the most helpful part (41.2%).90.1% of study subjects believed that self-management program does great help in promoting health behivours.While,86.0% of participants wish that diabetes self-management activities could be continued on after 6 week workshop. Nevertheless,50% of the respondents showed their precondition for their participation was that there would be some health professionals be on the site of trainging.Conclusions1) This study results indicated that community-based diabetes self-management program could be of help for changing patients' risk behaviors, improving their self-management effectiveness, and and enhancing physician-patient communication.2) There were still some requirements for diabetic patients to increase their awareness/knowledge and build skills to maintain health behavior and self efficacy through sustainable CDSMP activities in the future.3) Challenges need to be confronted in order to expand a sustainable community-based diabetes self-management program. It is necessary to set up and stablize funding mechanism and mobilize local recourses by enhancing multisectoral collaboration.