| OobjectiveTo evaluate the results of community self-management effects of type 2 diabetes patients after participating self-management intervention group activities,follow-up and investigate the change of self-management effect at different stages(1 year,2 years,and 3 years after intervention),and analyze the influencing factors on changes of patients' self-management effects.MethodsSelected six provinces/municipalities in Beijing,Shanghai,Jiangsu,Zhejiang,Guangdong,and Chongqing from 2012 to 2014 who have received self-management of the China Initiative for Diabetes Excellence(CIDE)patients with type 2 diabetes as a study group.Participating patients were recruited through community mobilization,screening from health files,telephone notifications,posting of recruitment posters,and sending of recruitment letters in accordance with the inclusion and exclusion criteria.After collating and matching patient information,patients who participated in the baseline survey before the intervention,post-activity survey,and final assessment 3 surveys were included in this study,with a total of 3542 study subjects.In study,we mainly used quantitative methods to evaluate the self-management effect of patients participating in community diabetes self-management group intervention activities,including evaluated the changes of patients' self-management knowledge and behavior,self-efficacy,and quality of life before,after,and at the end of the intervention.And analysis of influencing factors on changes of patients knowledge of self-management,self-efficacy and quality of lifeResults1.General conditionA total of 3542 subjects were included in this study,the proportion of men and women was 36.93%and 63.07%,the average patient age was(66.72 ± 9.15)years old,971 patients lost to follow-up,the proportion of loss patients was 21.52%.2.Self-management group activity satisfaction evaluationIn 2012,2013,and 2014,patients' were more than 90%satisfied with self-management group activities,and 90.33%,89.38%,and 82.36%of patients expressed their willingness to continue to participate in self-management group activities.The main reasons for attracting patients to participate in the activity are that the knowledge learned in the activity is good for their own health,it is helpful for diabetes,and it is convenient for consultation because of the participation of community doctors.3.Effect of intervention3.1 Self-management knowledgeAfter the intervention,the total score of self-management knowledge of the patients in the 2012 group was increased by 100%compared with that before the intervention[(25.69 ± 18.26)vs(51.39 ± 21.07)];the group of patients in 2013 increased by 107%[(26.43 ± 18.32)vs(54.82 ± 20.42)];in 2014,patients increased by 35.40%[(48.11± 19.57)vs(65.14 ± 16.33)],the difference was statistically significant(P<0.01).In the final assessment,compared with that after the intervention,the total knowledge score of diabetic patients in the first year after the activity decreased by 7.28%,and the self-management knowledge scores of the patients in the second year and the third year after the activity increased by 5.62%and 16.27%.The difference was statistically significant(P<0.01).With the extension of the time after the intervention,the patient's diabetes self-management knowledge score gradually improved.3.2 Self-efficacyAfter the intervention,the patients in the 2012 group was increased by 13.68%[(90.23 ± 20.93)vs(102.57± 17.05)];the 2013 group of patients increased by 15.24%[(100.21±19.22)vs(86.96 ± 23.42)];the patients in the 2014 group increased by 17.13%[(98.14±18.50)vs(83.78 ±20.94)],the difference was statistically significant(P<0.01).At the end of the assessment,compared with that after the intervention,the total self-efficacy scores of patients in second year after the activity and in third year after the activity decreased by 2.09%(1.82±24.87)points and 2.17%(2.23± 23.04)points and the differences were statistically significant(P<0.05).The longer after the intervention,the greater the decline in patient self-efficacy.The longer the time after intervention,the greater the decline in patient self-efficacy.3.3 Self-management behaviorAt the time of the final assessment,the proportion of diabetic patients who performed blood glucose monitoring and foot care behaviors 1 to 7 times a week in the past 30 days was 75%and 60%,which were lower than other self-management behaviors.The proportion of patients who followed a healthy diet of diabetes in the past 30 days after the activity was higher than that in the second and third years after the activity.And the proportion of patients who performed aerobic exercise and adhere to medication in the third years after the activity was higher than that of the patients in the first year after the activity(P<0.01)3.4Quality of LifeAt the time of the final evaluation,the comprehensive scores of the quality of life of patients in 2012,2013 and 2014 were:(599.41± 141.52)points,(593.41 ± 137.74)points,(612.75±134.87)points.The comprehensive quality of life score of the patient in the first year after the activity is higher than the patient score of second years and the third years after the activity,the difference was statistically significant(P<0.05).The quality of life scores of all dimensions have the highest scores in the social function dimension and the lowest scores in the overall health dimension.4.Influencing factors on changes of self-management effects4.1 Analysis of influencing factors on the change of self-management knowledge scoreThe single factor analysis:residence,education,family's average monthly income,and time after intervention were the influential factors that affected the change of self-management knowledge scores of diabetic patients(P<0.05).The multiple linear regression analysis:place of residence and time after intervention are the factors that affect patients' knowledge scores(?values are 0.06,0.24,P<0.01).Rural patients are more likely than urban patients,and in the third years,in the second years after intervention the patient's self-management knowledge score increased more than after intervention in the first year4.2 Analysis of influencing factors of changes in self-efficacyThe single factor analysis:residence,education,income,whether combined with complications,whether combined with other chronic diseases,and the time after intervention were factors that affected patients' self-efficacy(P<0.05).Multivariate linear regression analysis:the self-efficacy score of patients with high education and other chronic diseases was lower decline than that of patients with low education and no other chronic diseases(? values were 0.04,0.05,P<0.05);compared with patients without complications,patients with complications and the patients who were in the third years after intervention had a more significant decrease in self-efficacy scores than those of patients who were in the first year after intervention(? values were-0.04,-0.05,P<0.05).4.3Analysis of influencing factors on the quality of lifeThe single factor analysis:age,gender,residence,education,income,whether combined with complications,whether combined with other chronic diseases and the time after intervention were factors affecting the quality of life of patients.Multivariate linear regression analysis:older,female,rural,diabetic patients with complications and other chronic diseases have lower quality of life than younger,male,urban,and patients without complications and other chronic diseases(? values are-0.19,-0.05,-0.13,-0.15,respectively),-0.05,P<0.01);the higher the the family's average monthly income,the better the quality of life of patients(?=0.09,P<0.01).Conclusion1,Self-management intervention group activities can significantly improve the self-management knowledge level and self-efficacy of patients with diabetes,which is of great significance for improving patients' self-management behavior and quality of life.2.It is recommended that the self-management group activities of diabetes patients be included in the routine management in the community.3.It is recommended to formulate and carry out targeted and personalized self-management activities according to the patient's own conditions to improve the enthusiasm of patients to participate4.It is recommended to improve the self-management level of rural,low-education and low-income patients.Young and middle-aged patients with diabetes can be used as key research objects and populations in the future. |
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