糖尿病共同照護對病患之糖化血色素、健康信念與健康行為之影響

Abstract

目標：探討加入糖尿病共照網之病患與未加入者之糖化血色素控制、健康行為與健康信念改變是否有異，並檢視2組病患之糖尿病相關健康行為改變，分別與何種健康信念之改變有關及其影響之程度。 方法：採類實驗研究法，收案對象為第2型糖尿病病患，分成「共照組」與「非共照組」，依性別、年齡配對，以1:2比例分別收案208與421人，並於首次收案時及6個月後，進行糖化血色素與問卷資料收集。 結果：多變項線性自迴歸模式分析顯示，共照組之後測糖化血色素較低(β=-0.18)，後測健康行為得分亦較高(β=0.13)。共照組後測健康行為與自覺利益、行動線索之提升具顯著關聯，非共照組後測健康行為則與自覺罹患性、自覺利益之提升，以及自覺障礙、行動線索之下降具顯著關聯。 結論：共照組病患之糖化血色素控制與健康行為改變均較非共照組佳，但2組之健康行為改變係由不同健康信念所驅動，故未來糖尿病健康照護介入，可參考本研究之發現，於2組分別針對不同之健康信念設計合適之介入策略。

Objectives: To examine if diabetic patients in the diabetic shared care and regular care groups differed in their glycated hemoglobin (HbA1c) control and their changes in diabetes-related health behaviors and health beliefs, and to explore the degree to which different health belief changes contributed to health behavior changes in the two groups. Methods: A quasi-experiment, this study recruited 208 and 421 patients with type II diabetes in the shared care and regular care groups, respectively, at a 1:2 ratio, matched on gender and age. Their HbA1c levels were measured and survey data were collected on their diabetes-related health behaviors and health beliefs at pre-test and 6-month post-test. Results: Multivariate autoregressive analysis indicated that patients in the shared care group had significantly lower HbA1c levels (β=-0.18) than those in the regular care group at post-test. Similarly, patients in the shared care group had significantly higher health behavior scores (β=0.13) than their regular care counterparts at post-test. In the shared care group, increased health behavior scores at post-test were directly related to elevated levels of perceived benefits and cues to action. In the regular care group, increased health behavior scores at post-test were positively associated with increased levels of perceived susceptibility and perceived benefits, as well as decreased levels of perceived barriers and cues to action. Conclusions: Patients in the shared care group had better HbA1c control and health behavior changes, which were attributed to different health belief changes in the two groups. These findings could inform future diabetic care intervention efforts.