Application Of Coping Skills Intervention In Type2Diabetic Self-management

Background:Diabetes (Diabetes Mellitus,DM) is a metabolic disease characterized by chronichyperglycemia due to genetic factors, environmental factors and other factors.Thelong-cause of DM and the sever complications caused by hyperglycemia pose a threatto patients’ health, quality of life even life,and increased the medical burden ofpatients and society. At present, the comprehensive treatments for diabetes all arefollowing the "five carriages" principles: dietary treatment, exercise therapy, drugtreatment, regular examination, health education at home and abroad,and healtheducation is its core, behavior change is considered to be the success of the sign ofthe comprehensive treatment measure.Coping skills intervention was initially used in the settlement of psychologicalstress, stress, depression and other psychological problems, and then was applied to a variety of diseases in many foreign articles. A large number of studies showed thatcoping skills intervention has significantly improved drug and alcohol abuse anddiabetes metabolic control.A systematic review about education and psychosocialintervention for diabetic youth found that training in diabetes relevant knowledgeand skills development, social skills, problem solving, and communication skills, aswell as self-management interventions, can lead to self-management and behaviorchange, and ultimately improve the metabolic control. American Association ofhealth education on diabetes mellitus (AADE) raised that improving problem solvingand coping skills are as the self-management goals of patients with diabetes in2008.This research is to investigate the situation of health belief, coping style, andself-management behaviors, and analyze their correlations. And apply coping skillsintervention to self-management, then observe its effects on health belief, copingstyle, and self-management behaviors and blood glucose control in patients with type2diabetes.Objectives:1. To investigate the situation of health belief, coping style, and self-managementbehaviors in patients with type2diabetes, and analyze their correlations.2. To explore the influence of coping skills intervention on the health belief, copingstyle, self-management behavior and blood glucose control among patients withtype2diabetes.Methods:1. The investigation of the situation of health belief, coping style, andself-management behaviors in patients with type2diabetes: Totally252patientswith type2diabetes were surveyed using the self-made general condition questionnaire contained demographic characteristics (such as age, educationallevel, etc), clinical features (such as the course, HbAlc etc.); the diabetes healthquestionnaire, medical deal with faith questionnaire (medical coping modesquestionnaire, MCMQ), and type2diabetes self-management actionsquestionnaire (diabetes self-care scale,2-DSCS),and analyzes their relevance.2. Application of Coping skills intervention in type2diabetic self-management:Divided96patients into the experiment group and the control group, there were48cases in each group. Routine health education was used in the control group,while the coping skills intervention was used in the experiment group. Bothgroups were followed up with telephone for6months. The Scores of diabetesself-management behavior and the HbAlc was collected before intervention, and3,6months after the interventions.Results:1. The total score of health belief was77.5±16.32.71.8percent patients’ healthbelief was in the secondary level, and only1.2percent in poor level. And benefitsof treatment had the highest score, followed by maintenance of the health motives,treatment of the harmful effects of scoring the lowest in patients with type2diabetes.2. Face of coping styles had the highest scores for16.48±5.36, but their score waslower than the norm, and yielding scores higher than the norm, with statisticallysignificant differences in patients with type2diabetes.3. The total score of self-management behavior was84.69±6.96.Prescribedmedication had the highest score, followed by rule diet control and exercise, footcare, prevention and management of high or low blood sugar,and blood glucosemonitoring had lowest score.78.6percent patients’ self-management behaviors were in the secondary level,12.4percent poor, and only9percent had better self–management in patients with type2diabetes.4. We found a positive correlation between Health beliefs and self-managementbehavio（rr=0.476，P<0.01）,and the patient’s health belief and coping styles havedifferent effects on the self-management behavior（β=0.062～0.482，P<0.05）.5. Before the intervention, the difference of the score of health belief, coping styleand self-management behavior was not statistically significant, P>0.05. After theintervention, the score of health belief and self-management behavior inexperimental group was higher than that in control group, The score of face stylewas higher yet yield and avoid scores were lower than that in control group, anddifference was statistically significant, P<0.05.6. Before the intervention, the difference of the score of HbA1c was not statisticallysignificant, P>0.05. After the intervention, the averages of the scores of HbA1cvaried similarly with the time of intervention in the control and experimentalgroup, namely reduce firstly and then increased. But experiment group was betterthan the control group, P<0.01. After the intervention, HbA1c in control groupwas higher than before the intervention group and that in experimental groupsignificantly decreased, P <0.05.Conclusions:Health beliefs and self-management were in the secondary level in patients withtype2diabetes mellitus. Patients mainly used face coping to deal with the disease.Health beliefs, coping styles affected self-management behavior in varying degrees.Coping skills intervention can not only improve patient health beliefs, but alsoimprove patient coping and self-management behaviors, and ultimately improveglycemic control in patients with type2diabetes mellitus. Maintaining ideal blood sugar needed various activities such as network platform, peer education, healthclubs to continue intervention in discharged patients.