| Objective:1.To comprehensively investigate the current situation and real experience of selfmanagement of patients with non-proliferative diabetic retinopathy by combining quantitative and qualitative methods,and analyze its influencing factors,so as to provide reference for the construction of early management programs.2.Based on the theory of planned behavior,delphi method was used to construct an early management programs for patients with non-proliferative diabetic retinopathy,and to explore the effect of this programs on the level of blood glucose control and self-manage me nt ability of patients.Methods:1.Survey and influence factors analysis : A total of 200 patients with non-prolifera t ive retinopathy were selected from October 2021 to June 2022 in the diabetic fundus department of a tertiary eye hospital.The general information questionnaire,General Self-Efficacy Scale,Social Support Rating Scale,Mishel Uncertainty in Il ness Scales for Adults,and Diabetic Retinopathy Self-Management Scale were used to investigate the status quo of selfmanagement and its influencing factors.2.Qualitative research: Objective sampling method was adopted to select 15 patients with diabetic retinopathy who were admitted to the vitreoretology department of a tertiary eye hospital from November to December 2021.Semi-structured interviews were conducted on them to deeply explore their real experience of self-management.3.Program construction: Through literature analysis,combined with the results of previous studies and based on the theory of planned behavior,the early management program of patients with non-proliferative diabetic retinopathy was preliminarily established.Then,the final early management program is formed through expert consultation and preexperiment.4.Empirical research: Preliminary application of the program through quasiexperimental study.A total of 112 patients with non-proliferative diabetic retinopathy were selected from the diabetic fundus department of a tertiary eye hospital from July 2022 to October 2022.Based on parity,they were divided into a control group and an intervent io n group.The control group used conventional intervention,and the intervention group used the early management program based on theory of planned behavior.The blood glucose control level,knowledge level of disease,self-efficacy,and self-management ability were compared between the two groups.Results:1.Survey and influence factors analysis: A total of 195 patients were finally included,and the self-management score of patients was(65.31±6.09),which was at a medium and low level.The multiple linear regression analysis showed that degree of education,duration of diabetes years,degree of retinopathy,self-efficacy,and ilness uncertainty were influencing factors of patients’ self-management behavior(P<0.05).2.Qualitative research: Based on the theory of planned behavior and through the analysis of interview data,three themes and seven sub-themes about the self-management experience of patients with diabetic retinopathy were extracted: Behavioral attitude(indifference,negative emotion);Subjective norms(medical staff support,family and social support,peer support);Perceived behavioral control(lack of self-management knowledge and skills,poor self-control,objective conditions).3.Program construction: The early management program was initially constructed based on the theory of planned behavior and literature research,and the final early management program was formed after two rounds of consultation with 15 experts.The positive degree of the two rounds of expert consultation was 88.24% and 100%,the expert authority coefficient was 0.83 and 0.86,and the coordination coefficient was 0.281 and 0.223(P<0.01),indicating that the early management program constructed in this study had certain scientific and reliability.4.Empirical research:(1)A total of 109 patients completed the study with 54 in the control group and 55 in the intervention group;(2)Repeated measurement analysis of variance showed that the FBG,2h PG,disease knowledge level,self-efficacy and selfmanagement ability were compared between the two groups,and the group effect,time effect and interaction effect were statistically significant(P<0.001);There were statistically significant differences in Hb A1 c between the two groups after 12 weeks of intervention(P<0.05).Conclusion:1.Self-management of patients with non-proliferative diabetic retinopathy is at a moderate and low level,which needs to be further improved.2.In the early stage of the diabetic retinopathy,patients lack disease knowledge,poor self-management ability,which are affected by many factors.It is urgent for clinical medical staff to strengthen the management of patients in the early stage.3.The early management program for patients with non-proliferative diabetic retinopathy constructed based on the theory of planned behavior and delphi method is beneficial to improve blood glucose control level,self-management ability,and clinical prognosis in patients with non-proliferative diabetic retinopathy. |
