基于个人与家庭自我管理理论的2型糖尿病患者足部自我管理行为的情境因素分析

摘要

Objective To explore the current situation of foot self-management behaviors in hospitalized patients with type 2 diabetes mellitus, and to analyze the influencing context factors on the basis of individual and family self-management theory (IFSMT) , in order to provide information for the targeted intervention study.Methods By convenience sampling method, a self-designed questionnaire was used to investigate 162 hospitalized patients with type 2 diabetes mellitus in the Department of Endocrinology, Xiangya Hospital of Central South University from April to October 2017.Results The average score of foot self-management knowledge was 14.67±4.43, and the standard score was 73.35, which was at the middle level.The average score of self-care behavior of patients' foot was 32.19±8.41 and the standard score was 59.61;thus the overall level of patients' foot self-care behavior was poor.There were significant differences in the scores of foot self-care behavior among patients with different educational level, the progress of disease, foot care education, and the degree of mastery of foot self-care knowledge (all P<0.05).Multivariate regression analysis showed that receiving foot care education, foot self-care knowledge and the education level were the main influencing factors of self-care behavior in patients with type 2 diabetes (P<0.05).Conclusions The status of foot self-management behaviors is not optimistic. Base on the IFSMT, medical staff should use the main context factors affecting the foot self-management behaviors to regulate individualized health education during hospitalization, and to strengthen the self-management of home-based diabetes patients by integrating community health institutions to prevent the occurrence of diabetic foot ulcer.%目的 了解新入院2型糖尿病患者足部自我管理行为现状, 并结合个人与家庭自我管理理论 (individual and family self-management theory, IFSMT) 进行情境影响因素分析, 为医护人员实施针对性干预措施提供有效依据.方法 2017年4-10月, 便利抽样法选择新入住中南大学湘雅医院内分泌科的162例2型糖尿病患者为调查对象, 采用自行设计的糖尿病患者足部自我管理行为调查表对其进行调查.结果 患者足部自我管理知识平均得分为 (14.67±4.43) 分, 标准分73.35分, 总体处于中等水平;患者足部自我护理行为平均得分为 (32.19±8.41) 分, 标准分为59.61分, 患者足部自我管理行为总体水平较差.不同文化程度、病程、是否接受足部护理教育及足部自我管理知识掌握程度的患者, 其足部自我管理行为得分差异均有统计学意义 (均P<0.05) .多元线性回归分析显示, 是否接受足部护理教育、足部自我管理知识和文化程度是2型糖尿病患者自我管理行为的主要情境因素 (P<0.05) .结论 2型糖尿病患者足部自我管理行为不容乐观.医护人员可运用IFSMT理论, 结合影响患者足部自我管理行为的主要情境因素规范住院期间个体化健康教育, 并联合社区卫生机构一体化加强居家糖尿病患者的自我管理, 以有效预防糖尿病足的发生.