Cross-sectional Study Of The Health Self-management Status On CKD Prevention Among Hypertensives And Diabetics In Community Level Of Kunming City

Research Objectives:To investigate the self-management status on CKD prevention among hypertensives and diabetics in Kumming urban communities,analyze the factors influencing the self-management on CKD prevention,and to pointedly propose countermeasures and suggestions for enhancing the self-management on CKD prevention.Research Methods:Two questionnaires were designed for hypertensives and diabetics,as well as for community medical staff,respectively.The questionnaire response mode was self-administered.Pre-survey was conducted to guarantee the feasibility.4 community health service centers were selected from Kunming City through stratified cluster sampling,and a total of 4 survey spots were set.519 patients were surveyed through random Sampling,while 49 community medical staff were surveyed through cluster sampling.The main contents of questionnaire survey included individual level(including basic conditions of hypertensives and diabetics;cognition,attitude,belief and behavior on CKD prevention;disease self-management;and community health service utilization),industry level(including basic conditions of community medical staff;cognition,attitude and belief on CKD prevention;and service delivery),and society level(including family care and media publicity).The PCAT-AE scale was employed to measure the degree of community health service utilization;in addition,other self-designed scales were also used.The data analysis methods were as follows,descriptive statistical analysis,single factor analysis(t test,analysis of variance or SPEARMAN correlation analysis),and multiple factor analysis(multiple stepwise regression analysis).Interview:Semi-structured individual interview was conducted among the principals of Chronic Disease Management Department in Kunming Center for Disease Control,as well as community chronic disease physicians.The interview contents mainly included carrying out chronic disease management,CKD management experience and problems existing during the carrying out process for the interviewees.Research Results:(1)Individual levelDisease cognition:The overall pass rate was 64.40%,among which,the pass rate of basic kidney knowledge was 84.20%,that of basic kidney disease knowledge was 24.90%,that of the clinical manifestation and risk factor knowledge of chronic kidney disease(CKD)was 48.90%,and that of treatment and prevention knowledge was 60.30%.Meanwhile,education background(p=0.19,t=4.19,P<0.05),income(P=0.14,t=2.92,P<0.05),community health service utilization(β=0.14,t=3.31,P<0.05)and sex(p=0.11,t=2.00,P<0.05)were the factors influencing the cognition level.Health belief:Only 14.50%hypertensives and diabetics chose that they would carry our self-management if they became the CKD patients.Meanwhile,the pass rate of health belief in hypertensives and diabetics in the community was 64.50%.Cognition level(β=0.70,t=22.47,P<0.05),community health service utilization(β=0.10,t=2.91,P<0.05)and age(β=0.08,t=2.44,P<0.05)were the factors influencing the health belief.Health behavior:The pass rate of healthy habits and behaviors was 92.30%.Sex(wald=19.10,OR=4.97,P<0.01)was the factor influencing of the healthy habits and behaviors.Disease management:With regard to drug compliance,88.70%hypertensives and 82.50%diabetics could take medicine on time.83.60%hypertensives and 85.00%diabetics knew the names of the antihypertensive agents or hypoglycemic agents that they were taking.93.20%hypertensives and 90.30%diabetics understood the methods of taking medicine.In terms of satisfaction with blood pressure and blood glucose control,72.30%hypertensives were relatively satisfied with their blood pressure control,whereas 50.50%diabetics were not satisfied with their blood glucose control.As for self-monitoring,80.80%hypertensives could perform regular monitoring according to follow-up suggestions,while only less than 50.00%diabetics could regularly monitor their blood glucose levels according to follow-up suggestions;moreover,over 20.00%diabetics could monitor their blood pressure or blood glucose monthly or every several months.Community health service utilization:74.40%patients were satisfied with community health service utilization.With regard to knowledge acquisition,60.70%patients had never obtained any CKD related knowledge from the community,and 58.80%patients had never consulted any CKD related information.In terms of medical visit,25.60%patients had paid medical visits in the community for over 5 years,and 14.60%patients did not have a fixed institution for medical visit.(2)Industry levelKnowledge and skills:The pass rate of community medical staff on CKD prevention related knowledge was 49.00%,and income(β=0.43,t=3.26,P<0.05)was the factor influencing knowledge and skill score.Attitude and belief:The pass rate of community medical staff on CKD prevention attitude and belief was 83.70%.Training opportunity(P=0.35,t=2.71,P<0.05),age(β=0.40,t=3.18,P<0.05)and turnover intention(β=-0.28,t=-2.24,P<0.05)were the factors influencing the attitude and belief of community medical staff.Service delivery:51.00%community medical staff occasionally participated in distributing or pasting CKD related brochures or posters,and 38.80%of them frequently or always participated in such work.73.40%communities occasionally or never carried out CKD prevention related lectures.89.80%community medical staff occasionally or never carried out CKD related knowledge popularization or guidance.(3)Society levelFamily care:98.70%patients lived with their families,74.80%patients believed that their family members cared for them,but 25.30%patients thought that their family members did not show enough care for them.Media publicity:The top three pathways for hypertensives and diabetics to obtain CKD related knowledge were TV(31.60%),medical staff(21.80%)and wardmate or family member(20.80%).Besides,TV(r=0.09,P<0.05),network(r=0.17,P<0.05),medical staff(r=0.10,P<0.05),newspapers and books(r=0.22,P<0.05),and wardmate or family member(r=0.11,P<0.05)pathways were positively correlated with the cognition levels in patients.In the meantime,newspapers and books(β=0.23,t=2.51,P<0.05),wardmate or family member(β=0.16,t=3.70,P<0.05),network(β=0.15,t=3.54,P<0.05),and medical staff(β=0.13,t＝3.13,P<0.05)were the factors influencing the cognitive pathways of patients on CKD related knowledge.ConclusionsIndividual level:(1)The community hypertensives and diabetics lack the knowledge on kidney disease.(2)The healthy belief of community hypertension and diabetes patients is better,but the self-management consciousness of preventing CKD is not strong,and the subjective responsibility is not clear.(3)Patients with hypertension and diabetes have better behavior habits,and women’s behaviors are better than men’s.(4)Poor management of patients with hypertension and diabetes in the community.(5)Lacking of knowledge in the use of health services for patients with hypertension and diabetes in the community,and the need for relevant life guidance.Industry level:(1)The gender and educational structure of community medical personnel are relatively unitary and need to be improved.(2)Community medical personnel have poor knowledge and skills in preventing CKD,and it is difficult to support their guidance for patients’ self-management.(3)The community medical staff have better attitude and belief in preventing CKD support.(4)The form of community support services is relatively monotonous,with little targeted prevention.Social aspects:(1)Some patients with hypertension and diabetes have a poor sense of whether their family cares about their illness.(2)Social propaganda of newspapers,books,Internet,medical personnel and TV channels has a positive effect on the cognitive level of patients.SuggestionsGovernment level:(1)improve the mechanism for managing chronic diseases.Integrate CKD into the community chronic disease management directory as soon as possible.(2)To improve the policy of attracting talents and expand the prospects of basic career development.Community level:(1)Strengthen the construction and cultivation of the talent team to prevent CKD.(2)Strengthen the publicity and education of patients on a regular basis.(3)Carry out targeted work for patients’ families and help patients to manage themselves.(4)To carry out healthy education which is diversified and easy to accept.Personal level:(1)Recognize the main responsibility and strengthen the consciousness of the subject.(2)Improve the trust of doctors and patients and actively cooperate with medical staff.