對話地圖對糖尿病共同照護病患健康行為之影響

Abstract

目標：研究估計，至2035年全球將會有五億九千一百多萬的糖尿病患，2013年臺灣衛生福利部統計亦顯示，糖尿病於臺灣死因之排名由第五名上升至第四名。為提升糖尿病控制成效，許多糖尿病衛教工具相繼而生。故本研究欲探討，運用對話地圖衛教工具 (conversation maps) 之介入，是否可有效提升糖尿病病患之飲食運動健康行為。 方法：採隨機分派實驗 (randomized controlled trial) 研究法，收案對象為第二型糖尿病共同照護病患，將其隨機分成「對話地圖組」與「控制組」，以1:1比例分別收案308與307人，並於介入前與介入3個月後，分別進行前測與後測問卷資料收集。 結果：多變項線性自迴歸模式 (multivariate linear autoregressive models)，於校正前測之健康行為及其他相關因子後，發現對話地圖組相較於控制組，其後測時之飲食 (β=0.265) 及運動 (β=0.273) 健康行為均顯著較佳。進一步納入健康信念改變後，發現後測時對話地圖組之飲食 (β=0.178) 及運動 (β=0.179) 健康行為，仍顯著較控制組佳。不論組別，若自覺飲食利益及障礙、行動線索有正向改變者，其後測時飲食健康行為較佳；若自覺罹患性、自覺運動利益及障礙、行動線索有正向改變者，其後測時運動健康行為較佳。 結論：對話地圖組之飲食及運動健康行為改變，均較控制組佳，此外，對話地圖介入對後測飲食及運動健康行為改變，具直接與間接影響。間接影響係透過健康信念正向改變之中介作用，故未來針對共同照護網之糖尿病病患，可考慮增加對話地圖之介入，以促進飲食與運動健康行為之正向改變。至於對話地圖組對飲食運動健康行為之直接影響，其機轉值得未來研究進一步探討。

Introduction: Research has estimated that the global population of diabetic patients will exceed 591 million by 2035. Statistics released by the Taiwanese Ministry of Health and Welfare in 2013 showed that diabetes rose from the fifth- to the fourth-leading cause of death in Taiwan. Many health education tools have been developed to enhance the efficacy of diabetes control. This study investigated whether intervention using conversation maps can effectively adjust the diet- and exercise-related health behaviors of diabetic patients. Methods: A randomized controlled trial was conducted among patients with type 2 diabetes mellitus who participated in a diabetes shared-care program. The participants were randomly assigned to the conversation map group and the control group. Participants in the two groups comprised 308 and 307 people, respectively. For data collection, a pretest and a posttest survey was conducted before and three months after the intervention, respectively. Results: Multivariate linear autoregressive models were estimated for data analysis. After controlling for their diet- and exercise-related health behaviors along with other relevant factors at pretest, we found that compared with participants in the control group, those in the conversation map group exhibited significantly improved diet- (β=0.265) and exercise-related (β=0.273) health behaviors at 3-month posttest. After including changes in health beliefs, we observed that participants in the conversation map group exhibited significantly improved diet- (β=0.178) and exercise-related (β=0.179) health behaviors at 3-month posttest, compared with those in the control group. In both groups, participants that showed positive changes in perceived benefits of diet, perceived barriers of diet, and cues to action exhibited significantly improved diet-related health behaviors at 3-month posttest; and participants that showed positive changes in perceived susceptibility, perceived benefits of exercise, perceived barriers of exercise, and cues to action exhibited significantly improved exercise-related health behaviors at 3-month posttest. Conclusions: Compared with participants in the control group, participants in the conversation map group exhibited significantly better changes in their diet- and exercise-related health behaviors. Furthermore, conversation map intervention had direct and indirect effects on diet- and exercise-related health behaviors at 3-month posttest. Specifically, the indirect effect was mediated through positive changes in health beliefs. Therefore, conversation map intervention can be implemented in the future care of diabetic patients in shared-care programs to induce positive changes in diet- and exercise-related health behaviors. Additionally, further research is warranted to explore the mechanism underlying the direct effect of conversation maps on diet- and exercise-related health behaviors.