Study On The Status Quo And Influencing Factors Of Disease-distress And Self-management In Elderly Patients With Type 2 Diabetes

ObjectiveTo understand the status of diabetes-distress and self-management in elderly patients with type 2diabetes mellitus and analyze the influencing factors.To explore the relationship between diabetes-distress and self-management,social support and health literacy in elderly patients with type 2diabetes.Qualitative research was used to further explore the past self-management experience and influencing factors of elderly patients with type 2 diabetes.MethodThis study adopts a combination of quantitative research and qualitative research.1.Cross-sectional surveyThe convenience sampling method was used to select 270 elderly patients with type 2 diabetes in Department of Endocrinology from 2 grade-3 level-A general hospitals in Kaifeng City from March 2021 to August 2021.The survey tools included general information questionnaire(demographic and sociological data and disease related information),Diabetes Distress Scale(DDS),diabetes self-management activity questionnaire(SDSCA),social support rating scale(SDSCA),chronic disease patients health literacy scale(He LMS).Epidata3.2.Establish database and input data by two persons;SPSS 25.0 software and AMOS 23.0 software were used to analyze the data;The collected data were statistically processed by t-test,one-way ANOVA,Pearson correlation analysis,multiple linear regression analysis and path analysis.(1)Test was conducted to analyze the differences in pain and self-management level among different gender,age and medical insurance reimbursement groups.(2)Using one-way ANOVA to analyze the differences in diabetes-distress and self-management variables among different educational background,marital status,occupation,family average monthly income,medication plan and complications.(3)Pearson(Correlation)analysis was used to analyze the correlation between diabetes-distress,social support,health literacy and self-management variables.(4)Taking diabetes-distress and self-management as the dependent variable,the indexes with statistical significance in one-way ANOVA and correlation analysis were used as independent variables to carry out multiple linear regression analysis.(5)Using path analysis to further explore the relationship between social support and health literacy in diabetes-distress and self-management variables.(1)Cross-sectional surveyThe score of summary of diabetes self-care activities was(42.50±12.56),and was low at average.Among them,the high level accounted for 6.30%,the middle level accounted for 35.60%,and the low level accounted for 58.10%.The score of diabetes distress scale was(44.99±12.83),the average level was at the middle level,the proportion of diabetes patients suffering from high pain was 31.50%,the middle level was 45.20%,and the low level was 23.30%.The score of social support was(39.62±6.171),and the level of social support was at the medium level;The score of health literacy of patients with chronic diseases was(84.37±16.98),which was in the state of insufficient health literacy.(2)The results of correlation analysis showed that diabetes pain was negatively correlated with social support(r=-0.195,P < 0.01),health literacy(r=-0.292,P<0.01)and self-management(r=-0.145,P<0.05).Self-management was positively correlated with social support(r=0.295,P<0.01)and health literacy(r=0.399,P<0.01).(3)Multiple linear regression analysis showed that age,occupation,number of complications,convenience of taking medicine and social support were significant factors affecting diabetes mellitus patients’ pain.(4)Multiple linear regression analysis showed that gender,course of disease,number of hospitalizations,social support and health literacy were significant influencing factors of self-management behavior.(5)Amos path analysis results show.There are some mediating effects between social support and health literacy on diabetes-distress and self-management,and the mediating effect of social support on diabetes-distress and self-management.β=-0.287,P<0.01)accounted for 9.51%,the mediating effect of health literacy on diabetes-distress and self-management.β=-0.334,P<0.01),accounting for 22.01%.2.Qualitative researchBased on the results of the questionnaire survey,the purpose of this study is to select semi-structured interviews with elderly patients with type 2 diabetes who have low self-management scores.The Colaizzi’s phenomenological 7 step analysis method is used to analyze the influencing factors of diabetes-distress and self-management in elderly patients with type 2 diabetes mellitus.The qualitative research results extracted 6 themes and 23 sub themes.(1)Perception of diabetes related pain(pain caused by the disease itself,the pain caused by the potential threat of complications,the pain caused by diet control,the pain caused by poor blood sugar control,the pain caused by insulin therapy,and the economic pressure).(2)Feel social care(family support,professional guidance provided by medical staff)(3)Lack of social support(lack of care and low trust in community service)(4)Inadequate health literacy(untimely disease discovery,non-compliance with medical treatment,unconscious disease severity,narrow access to information,wrong awareness of saving,non self-discipline in diet,irregular medication,poor blood glucose monitoring,excessive dependence on medical personnel,lack of disease knowledge)(5)Self management disorder(Sports compliance disorder,fatigue of self-management consciousness,limited access to information)(6)Absence of roleResearch conclusion1.The self-management behavior of elderly patients with type 2 diabetes is at a low level.The main influencing factors are gender,course of disease,number of hospitalizations,social support and health literacy;2.The disease-distress of elderly patients with type 2 diabetes mellitus is at the moderate pain level.The main influencing factors are age,occupation,monthly family income,place of residence,course of disease,number of complications and convenience of taking drugs;3.Disease-distress of elderly patients with type 2 diabetes self-management behavior in elderly patients with type 2 diabetes4.Disease-distress can directly affect self-management behavior,and can also affect self-management behavior through social support and health literacy;5.The qualitative research results show that the elderly patients with type 2 diabetes have widespread disease-distress,low self-management behavior ability,insufficient social support level,and low health literacy,which need high attention from the society.