| ObjectivesTo access empowerment score and its related factors among patients with type 2 diabetes mellitus(T2DM)in community;To investigate the effects of empowerment-based health education to the fasting plasma glucose,two-hours postprandial blood glucose,body mass index,empowerment score,self-care activities and medical coping styles in patients with T2 DM in community.Methods1 A cross-sectional study was conducted over a period of 18 months during May 2015 to October 2016.Patients with a diagnosis of T2 DM and living in the chosed communities of Tianjin WangDingDi Community Health Service Centre were recruited.Patients received a questionnaire survey including Sociodemographic and Disease Questionnaire,Diabetes Empowerment Scale-Short Form(DES-SF),Diabetes Self-Care Activities Scale(SDSCA),36-Item Short Form Health Survey(SF-36)and Medical Coping Modes Questionnaire(MCMQ).2 A quasi-experimental study was carried out.Two communities were selected randomly as trial sites,one for Intervention Group and the other one for Control Group.Then patients with T2 DM were recruited from the two communities.From June to October 2016,Intervention Group received health education based empowerment theory in the form of dialogue,while Control Group received tranditional health education in the form of lecture.The duration of health education was two months for each group.After the health education,we made follow-up at one month and three months,and FPG,2hPBG and BMI were checked when doing follow-up.Besides,DES-SF,SDSCA and MCMQ were filled out again by experiment objects.All collected data was analysed using SPSS software version 19.0.To analyze the data,T-test,Chi-square test,One-way ANOVA,Pearson/Spearman correlation analysis,Multiple Linear Regression analysis and Multiple-factor repetitive measurement ANOVA were used.Results1 Results of cross-sectional study1.1 We distributed 440 questionnaires and acquired 406 effective questionnaires,and effective return ratio was 92.3%.1.2 In the 406 patients with T2 DM in community,170 patients(41.87%)were male and 236 patients(58.13%)were female;the average age was 66.70±7.75 years old;the average duration of diabetes was 8.00(4.00,15.00)years;the average BMI was 25.44±3.56kg/m2;the average FPG was 8.03±2.37mmol/L;the average 2hPBG was 10.68±3.13mmol/L;100 patients(24.63%)received diabetes health education before.1.3 The average score of DES-SF of the 406 patients with T2 DM in community was 3.14±0.75.From the analysis of influencing factors,we found that patients with different monthly income and diabetes health education history showed different empowerment score(P<0.05).By the correlation analysis,we found that the empowerment score of patients with T2 DM in community was negatively correlated with age(r=-0.171,P=0.001),FPG(r=-0.122,P=0.014),2hPBG(r=-0.126,P=0.011)and triglyceride(r=-0.139,P=0.013).1.4 The average score of diabetes self-care activity of the 406 patients with T2 DM in community was 16.28±5.78.The average score of diet was 3.95±1.43,and the median score of exercise,blood glucose monitoring,foot care and drug using were 3.50(1.00,6.00),0.50(0.00,1.50),2.50(0.00,3.50)and 3.50(3.50,7.00),respectively.Correlation analysis showed that the empowerment score of patients with T2 DM in community was positively correlated with self-care activity(r=0.419,P<0.001),diet(r=0.461,P<0.001),exercise(r=0.210,P<0.001),blood glucose monitoring(r=0.200,P<0.001)and foot care(r=0.298,P<0.001).1.5 The average score of physical health and mental health of the 406 patients with T2 DM in community were 269.25±87.01 and 296.59±69.03 respectively.The average score of each dimension were 81.12±23.29(Physical Function,PF),60.59±44.95(Role Physical,RP),80.45±18.59(Bodily Pain,BP),46.82±17.88(General Health,GH),68.33±10.88(Vitality,VT),78.69±21.56(Social Function,SF),71.02±41.38(Role Emotional,RE)and 69.50±13.18(Mental Health,MH),respectively.Correlation analysis showed that the empowerment score of patients with T2 DM in community was positively correlated with physical health,mental health,PF,RP,BP,GH,VT,SF,RE and MH.1.6 The average score of confrontation,obviation and submission of the 406 patients with T2 DM in community were 17.51±3.41,16.34±2.80 and 10.15±2.74,respectively.153 patients(37.69%)tended to confront diabetes,while 189 patients(46.55%)tended to obviate diabetes and 64 patients(15.76%)tended to submit to diabetes.Correlation analysis showed that the empowerment score of patients with T2 DM in community was positively correlated with confrontation(r=0.600,P<0.001),while negatively correlated with obviation(r=-0.362,P<0.001)and submission(r=-0.457,P<0.001).1.7 Multiple Linear Regression analysis showed that age,triglyceride,self-care diet,self-care foot care,PF,confrontation and submission entered into the regression equation,and the standardized partial regression coefficient were-0.114,-0.086,0.278,0.100,0.134,0.298 and-0.189,respectively,and they explained 50.90% total variation.2 Results of quasi-experimental study2.1 There were no statistical significant differences between the two groups in sociodemographic and disease characteristics,empowerment scores,self-care activity,SF-36 scores and medical coping styles(P>0.05).2.2 There was better improve in patients of the Intervention Group in empowerment scores,self-care activity and medical coping styles than those in the Control Group(P<0.05),while there were no statistical significant differences between the two groups in FPG,2hPBG and BMI(P>0.05).Conclusions1 The empowerment ability of patients with T2 DM in community was poorer than inpatients with T2 DM,and was mainly affected by age,triglyceride,self-care diet,self-care foot care,PF,confrontation and submission.Nursing staff in Community Health Service Centres should take these relevant factors into account and take targeted and effective measures to enhance their empowerment ability and improve their glucose.2 Empwerment-based health education could effectively enhance the empowerment ability of patients with T2 DM in community,and improve their self-care activity.Besides,it played an active role in helping patients to cope with disease positively. |
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