| Objective:To evaluate the intervention effect of self-management intervention in patients with hypertension and diabetes,and to explore the influencing factors of self-management efficiency and self-management behavior,and to provide scientific basis for the sustainable development of hypertension and diabetes self-management and the prevention and control of chronic diseases.Methods:According to the principle of stratified random sampling,38 communities were randomly selected from each of 16 towns in Wujin district.19 communities were randomly selected for self-management of hypertension patients and 19 communities for self-management of diabetes patients.30 patients with hypertension or diabetes were recruited in each community according to the principle of voluntary registration,and randomly divided into intervention group and control group.A total of 76 groups were set up in the region,including 19hypertension and diabetes intervention groups,19 hypertension and diabetes control groups,15 people in each group,and 1,140 people were planned to be investigated.For self-management intervention group,community doctors and self-management group leader were trained by relevant experts,Then,activities were organized in groups in accordance with“hypertension self-management”and“diabetes self-management”by combining teaching and group discussion.There were 6 courses every 2 months for 1 year.For the control group,routine community promotion of education and chronic disease follow-up management was carried out every 3 months.Questionnaire survey,physical examination and laboratory examination were conducted for all intervention groups and control groups before and after one year of intervention.Self-efficacy,self-management behavior and health services used questionnaires adapted from the chronic self-management study scale developed by the Stanford Patient Education Research Center.Results:1.A total of 1,168 patients with hypertension and diabetes were recruited,1,085completed the baseline questionnaire survey and physical examination,and the response rate was 92.89%.There were 502(46.27%)males and 583(53.73%)females.Age range was 36 to96 years,and the mean of age was 65.50±8.83 years;The mean of systolic blood pressure was136.12±15.47mm Hg,diastolic blood pressure was 81.77±9.08mm Hg,fasting blood glucose was 7.01±2.24mmol/L,BMI was 25.02±3.31kg/m2,waist circumference was 86.40±8.97cm,disease duration was 10.41±8.33.The mean score of symptom management self-efficacy was6.71±2.24,disease common management self-efficacy was 7.01±2.20,aerobic exercise was103.38±103.58 minutes/week,stretching and strength exercise was 4.80±23.30 minutes/week.,cognitive symptom management was 1.30±0.93,and communication with doctors was 2.22±1.15.2.The average scores of each item of self-management efficiency and self-management behavior were taken as the dependent variable,and age,gender,marital status,education level,income level,smoking,drinking,physical exercise and chronic disease years were taken as the independent variables,and multivariate linear stepwise regression was used to analyze the risk factors.The results showed that income level(?=0.487,95%CI:0.360~0.614,P<0.05),education level(?=0.222,95%CI:0.062~0.382,P<0.05)and physical exercise(?=0.175,95%CI:0.064~0.286,P<0.05)were the risk factors of self-management efficiency.gender(?=-0.206,95%CI:-0.352~-0.060,P<0.05),marital status(?=-0.244,95%CI:-0.421~-0.066,P<0.05),smoking(?=-0.108,95%CI:-0.202~-0.014,P<0.05),age of illness(?=0.009,95%CI:0.002~0.016,P<0.05)and income levels(?=0.184,95%CI:0.128~0.240,P<0.05)were the risk factors of cognitive symptoms management,while income levels(?=0.093,95%CI:0.025~0.161,P<0.05),physical exercise(?=0.129,95%CI:0.067~0.192,P<0.05)were the risk factors of communication with doctors.3.There was no significant difference in baseline characteristics between the intervention group and the control group of hypertension group and diabetes group(P>0.05).After one year of the self-management project,compared with the control group,BMI of the hypertension intervention group decreased by 0.31 kg/m~2 and the difference was statistically significant(P<0.05),WC statistically decreased by 0.46 cm(P<0.05),SBP statistically decreased by 3.91 mmHg(P<0.05),DBP statistically decreased by 1.66 mmHg(P<0.05),FPG statistically decreased by 0.03 mmol/L(P>0.05),and there was no statistically significant difference in serum lipid index(TC,TG,HDL_C and LDL_C)(all P>0.05).Compared with the control group,the symptom self-management efficacy score of the hypertension intervention group increased by 0.41 and the difference was statistically significant(P<0.05),the disease common self-management efficacy score statistically increased by 0.50(P<0.05).Aerobic exercise statistically increased by 32.17 minutes per week(P<0.05),stretching and strength exercise were no statistically significance(P>0.05),cognitive symptom management statistically increased by 0.23(P<0.05),and communication scores statistically increased by 0.26 per week(P<0.05).Compared with the control group,the times of visiting physician in the hypertension intervention group statistically decreased by 1.04 times in the last 6 months(P<0.05).The times of the emergency treatment,the times of hospitalization and the total nights in the hospital were no statistically significance compared with the control group(P>0.05).compared with the control group,BMI of the diabetes intervention group decreased by 0.23 kg/m~2 and the difference was statistically significant(P<0.05),WC statistically decreased by 0.33 cm(P<0.05),SBP statistically decreased by 4.29 mmHg(P<0.05),DBP statistically decreased by 2.38 mmHg(P<0.05),FPG statistically decreased by 0.45 mmol/L(P<0.05),and there was no statistically significant difference in serum lipid index(TC,TG,HDL_C and LDL_C)(all P>0.05).Compared with the control group,the symptom self-management efficacy score of the diabetes intervention group increased by 0.61 and the difference was statistically significant(P<0.05),the disease common self-management efficacy score statistically increased by 0.47(P<0.05).Aerobic exercise statistically increased by 25.41 minutes per week(P<0.05),stretching and strength exercise were no statistically significance(P>0.05),cognitive symptom management statistically increased by 0.27(P<0.05),and communication scores statistically increased by 0.32 per week(P<0.05).Compared with the control group,the times of visiting physician in the diabetes intervention group statistically decreased by 1.12 times in the last 6 months(P<0.05).The times of the emergency treatment,the times of hospitalization and the total nights in the hospital were no statistically significance compared with the control group(P>0.05)4.After one year of the self-management project,the difference between the blood pressure control rate and the regular drug rate of the intervention group in the hypertension group was statistically significant(P<0.05).Compared with the control group,the blood pressure control rate and the regular drug rate after the intervention were statistically significant(P<0.05),and the effect of the intervention group was better.The difference between fasting blood sugar control rate and regular drug rate of the intervention in diabetic group was statistically significant(P<0.05).Compared with the control group,the controlled rate of fasting blood sugar and the regular drug rate after intervention were statistically significant(P<0.05),and the effect of the intervention group was better.there was no statistical difference in other indicators(P>0.05).Conclusion:The risk factors of the self-management efficiency of chronic patients include gender,income levels,education levels and physical exercise,etc.Through the development of chronic self-management activities,systolic blood pressure,diastolic blood pressure,fasting blood sugar,BMI and waist circumference were reduced.The rate of blood pressure control in hypertension and the rate of fasting blood glucose control in diabetes were improved.The self-management efficiency scores of patients with chronic diseases were improved,cognitive symptom management,communication with doctors and aerobic exercise times were also improved,and the times of visiting physician in the last 6 months were reduced.Through the development of self-management activities of hypertension and diabetes patients in rural communities had the advantages of small investment,wide coverage and easy acceptance by patients,which can be regarded as a suitable extension technology for community prevention and treatment of chronic diseases in Wujin District. |
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