| Objective: To investigate the current situation of quality of life,illness perception,and treatment adherence of elderly patients with type 2 diabetes.To analyze the correlation between illness perception,treatment adherence and quality of life.Analyzing influencing factors of quality of life of elderly patients with type 2 diabetes and investigating the mediating effect of treatment adherence between illness perception and quality of life.Evaluating the effectiveness of the Hospital-Community-Family tertiary intervention model which aims at improving illness perception and treatment adherence on the quality of life of elderly patients with type 2 diabetes.Methods: This study included a cross-sectional study and a quasi-experiment study.A total of 302 elderly patients with type 2 diabetes were selected through the convenient sampling method from January 2022 to October 2022 in the endocrinology department of a tertiary care hospital in Wuxi,Jiangsu Province.Using the general information questionnaire,the Brief Illness Perception Questionnaire,the diabetic treatment adherence scale,and Diabetes Specific Quality of Life Scale to investigate the current status of patients’ illness perception,treatment adherence,quality of life,and their differences in socio-demographic and disease-related characteristics.Analyzing the correlation between illness perception,treatment adherence,and quality of life by correlation analysis.Multiple linear regression analysis was used to explore the factors influencing quality of life.Mediated effects test was used to establish a mediating model of illness perception,treatment adherence,and quality of life to investigate the impact pathway.Based on the development of a mediator model,25 elderly patients with type 2 diabetes who met the inclusion criteria and exclusion criteria were selected by convenient sampling method from October 2022 to December 2022 for the Hospital-Community-Family tertiary intervention model in the pre-experimental study.Patients’ illness perception,treatment adherence,quality of life,and fasting blood glucose were assessed before and after the intervention.Results:(1)The total score of quality of life was 40.00(35.00 ～ 46.25)points,the total score of illness perception was(37.29 ± 9.32)points,and the total score of treatment adherence was 51.00(46.00 ～ 54.00)of elderly patients with type 2 diabetes.(2)The results of the univariate analysis showed significant differences in quality of life scores of patients with different body mass index,education level,monthly per capita household income,smoking status,status of receiving diabetic education,treatment modality,number of hospitalizations in the last six months,fasting blood glucose and glycosylated hemoglobin,and number of diabetic complications(P(27)0.05).Illness perception scores were statistically different among patients with different gender,education level,monthly per capita household income,smoking,the duration of diabetes,status of receiving diabetic education,treatment modality,fasting blood glucose and glycosylated hemoglobin,and number of diabetic complications(P(27)0.05).Treatment adherence scores were statistically different among patients with different age,body mass index,education level,monthly per capita household income,smoking,status of receiving diabetic education,number of hospitalizations in the last 6 months,fasting blood glucose and glycosylated hemoglobin,and number of diabetic comorbidities(P(27)0.05).(3)The results of correlation analysis showed that illness perception scores were positively correlated with quality of life scores(r = 0.784,P(27)0.001).Illness perception scores were negatively correlated with treatment adherence scores(r =-0.618,P(27)0.001).Treatment adherence scores were negatively correlated with quality of life scores(r =-0.678,P(27)0.001).(4)The results of multiple linear regression analysis revealed that illness perception,treatment adherence,and general informational(status of receiving diabetic education,treatment modality,number of hospitalizations in the last 6 months,number of diabetic complications)were predictors of quality of life in elderly patients with type 2 diabetes.These factors together explained 69.3% of the variance in the total score of quality of life.(5)The results of analysis of mediating effects showed that illness perception indirectly and positively predicted quality of life with treatment adherence as a mediating variable.The indirect effect was 0.168(95% CI: 0.102,0.242,P < 0.001)and a direct effect was 0.574(95% CI: 0.488,0.660,P < 0.001).(6)After the Hospital-Community-Family tertiary intervention model for elderly patients with type 2 diabetes,patients had significantly lower illness perception scores(P < 0.001),significantly higher treatment adherence scores(P < 0.001),significantly lower quality of life scores(P < 0.05),and significantly lower fasting blood glucose levels(P < 0.001)than before the intervention.Conclusion:(1)The quality of life of elderly patients with type 2 diabetes was at an intermediate level,illness perception was at an intermediate level,and treatment adherence was at a good level.(2)There was a significant correlation between illness perception,treatment adherence and quality of life in elderly patients with type 2 diabetes.The higher the negative illness perception,the worse the quality of life.The higher the negative illness perception,the worse the treatment adherence.The worse the treatment adherence,the worse the quality of life.(3)Illness perception,treatment adherence,status of receiving diabetic education,treatment modality,the number of hospitalizations in the last six months,and the number of diabetic complications were the factors influencing the quality of life of elderly patients with type 2 diabetes.(4)The treatment adherence played a partly mediating role between illness perception and quality of life.Illness perception not only affected quality of life directly,but also influenced quality of life through treatment adherence indirectly.The mediating effect of treatment adherence accounted for 22.62% of the total effect.(5)The Hospital-Community-Family tertiary intervention model based on improving illness perception and treatment adherence effectively help elderly patients with type 2diabetes improve their quality of life. |
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