糖尿病病人足部自我監測行為及相關因素之探討

Abstract

糖尿病病人反覆發生足部潰瘍、截肢，是病人、醫護與社會皆輸的悲劇。足部自我監測為足部照護的重要措施之一，醫護人員了解病人足部自我監測行為及相關因素，有助於引導病人提升對疾病的警覺性。 本研究探討糖尿病人足部自我監測行為及相關因素。採描述性相關性研究設計，以自行設計的糖尿病人足部自我監測知識、態度及行為量表為研究工具，採立意取樣以自填及訪談方式共收案100人。 統計採獨立樣本t檢定、單因子變異數分析、皮爾森相關分析和多變項階層迴歸分析。結果發現100位住院糖尿病病人的基本資料：男女比例為1：0.8、平均年齡61.56歲、教育程度以「國小」畢業者最多、罹患糖尿病的年數平均為16.75年、疾病診斷類型以「第2型」為主、曾接受足部自我監測相關指導少於半數、診斷糖尿病後曾發生足部潰瘍超過半數、三分之一的人有現存足部潰瘍。 足部自我監測知識平均得分為12.97分 (標準差4.90分)，總分為19分，答對率為68.26%，在足部問題篩檢與記錄、警覺足部神經病變的知識較不足； 足部自我監測態度平均得分為49.63分 (標準差7.72分)，總分為76分，得分範圍30~76分，呈現足部自我監測態度趨正向，但在「我覺得請他人幫忙檢查足底皮膚，是很難為情的事，我很難啟齒」，大於半數表示同意(61%)。 足部自我監測行為平均得分為12.64分 (標準差9.68分)，總分為44分，只達滿分的28.7%，得分範圍0~37分，病人執行足部自我監測行為得分偏低、執行頻率偏少，且以「記錄自我監測結果」、「脫鞋後立即檢查足底皮膚是否發紅」和「檢查足部血管跳動」的行為表現較差。 簡言之，糖尿病病人足部自我監測知識有不錯的水準、態度的展現上也偏正向，但行為得分偏低、執行次數偏少。 足部自我監測知識、態度、行為均呈顯著正相關，自我監測知識與自我監測行為相關係數為0.20，自我監測態度與自我監測行為相關係數為0.44。階層迴歸分析顯示「整體足部自我監測知識」、「整體足部自我監測態度」、「教育程度(大專以上)」、「曾接受足部自我監測相關指導」、「曾執行足部照護」五個預測變項共可解釋「整體足部自我監測行為」32.8%的變異量。另外，「整體足部自我監測知識」和「整體足部自我監測態度」共可解釋「整體足部自我監測行為」19.2%的變異量，但排除「整體足部自我監測態度」後，「整體足部自我監測知識」對「整體足部自我監測行為」的解釋力只有0.1% (F改變量＝.153，p =.696>.05)。換句話說，多變項分析發現「整體足部自我監測知識」不是「整體足部自我監測行為」重要的解釋變項，「整體足部自我監測態度」才是最顯著的解釋變項。 本研究結論是病人較少執行足部自我監測行為，建議衛教者應先評估病人自我監測能力，有無肥胖而困難彎腰或視力不佳，並確認可協助執行的人，以及病人教育中仍需強調自我監測的知識和行為，如：感受足部神經血管病變症狀、監測脈動的方法和創新的足部自我監測儀器，以早期發現新潰瘍或潰瘍復發。然而，要維護健康行為，確實執行是最重要的，針對糖尿病足高危險族群，強化自我監測的態度以增進其行為，是當務之急。

The recurrence of foot ulcer in patients with diabetes that leads to amputation is a tragedy for patients, health professionals, and the society. Thus, self-monitoring is a crucial measure of diabetic foot care. Understanding patients’ self-monitoring of foot health and relating factors of foot ulcer helps health professionals to enhance patients’ awareness of the disease. This study investigated the behaviours of foot self-monitoring in patients with Diabetes Mellitus and its relating factors. A descriptive correlational research design was adopted, and a self-designed scale was used to investigate the patients’ self-monitoring knowledge of foot health as well as their attitude toward this topic and actual behaviours. Purposive sampling was performed to recruit 100 patients, who were either interviewed or asked to fill in the questionnaire. The collected data were analysed using independent t tests, one-way analysis of variance, Pearson’s correlation analysis, and multivariate hierarchical regression. The demographic data of the 100 hospitalized diabetic patients are as follows: the sex ratio was 1:0.8 (male: female), and the average age was 61.56 years old. Most of the patients had an educational level of elementary school, had developed diabetes for an average of 16.75 years, and were mostly diagnosed with Type 2 diabetes. Less than half of the patients had received instructions regarding diabetic foot self-monitoring; more than half of the patients had experienced foot ulcer after being diagnosed with diabetes, and one third of the patients had foot ulcer when participating in this research. The average score for the knowledge of foot self-monitoring was 12.97 (standard deviation [SD] = 4.90), with a total score of 19; thus, the correct rate was 68.26%. Specifically, the patients had relatively insufficient knowledge of foot problem screening and recording and were less alerted to neuropathy in feet. The average score of self-monitoring attitude was 49.63 (SD = 7.72), with a total score of 76. The range of the obtained scores was 30–76, indicating a positive attitude toward foot self-monitoring. However, 61% of the participants agreed with the statement that “I feel embarrassed and difficult to ask other people to help me check my foot skin.” The average score of foot self-monitoring behaviour was 12.64 (SD = 9.68), which only reached 28.7% of the total score (44). The obtained scores ranged from 0 to 37, indicating that the patients seldom performed self-monitoring of their foot health. In particular, they had relatively poor performance in “recording the self-monitoring results,” “checking whether the foot skin turned red immediately after taking off the shoes,” and “checking their pedal pulse.” In sum, patients with diabetes had a satisfactory level of foot self-monitoring knowledge and held relatively positive attitude toward foot self-monitoring, but obtained low scores for the self-monitoring behaviour, which indicated their low frequency of performing foot self-monitoring. Significantly positive correlations were observed among the knowledge, attitude, and behaviour of foot self-monitoring. The correlation coefficient for self-monitoring knowledge and behaviour was 0.20, and that for self-monitoring attitude and behaviour was 0.44. The hierarchical regression analysis indicated that the five predictor variables, namely overall foot self-monitoring knowledge, overall foot self-monitoring attitude, educational level (bachelor degree and higher), having received instructions regarding foot self-monitoring, and having performed foot care, together explained 32.8% of the variance of the overall foot self-monitoring behaviour. Moreover, the overall foot self-monitoring knowledge and attitude explained 19.2% of the variance of the overall foot self-monitoring behaviour. However, if the attitude variable was excluded, the explanatory power of the overall foot self-monitoring knowledge for the behaviour was only 0.1% (F = .153, p = .696 > .05). In other words, the multivariate analysis revealed that the overall foot self-monitoring attitude, instead of the overall foot self-monitoring knowledge, was the most significant explanatory variable for the overall foot self-monitoring behaviour. This study concluded that the patients seldom implement foot self-monitoring behaviours. Thus, health education practitioners are suggested to evaluate patients’ self-monitoring ability in advance, examine whether they have difficulty in bending over due to obesity or have poor eyesight, and confirm whether any person can assist the patients in the self-monitoring tasks. In addition, the self-monitoring knowledge and methods should still be emphasised in patient education, such as how to perceive symptoms of neurovascular foot lesions, method of monitoring pulsation, and innovative foot self-monitoring devices, to help the patients identify new ulcer or ulcer recurrence as early as possible. Actual implementation is most critical to maintain a good health condition. Thus, enhancing the attitude of patients at high risk of diabetic foot toward self-monitoring and encouraging them to conduct self-monitoring actions are imperative.