Howells L, Wilson A C, Skinner T C, Newton R, Morris A D, Greene S A
Tayside Institute of Child Health, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK.
Diabet Med. 2002 Aug;19(8):643-8. doi: 10.1046/j.1464-5491.2002.00791.x.
To evaluate changes in self-efficacy for self-management in young people with Type 1 diabetes participating in a "Negotiated Telephone Support" (NTS) intervention developed using the principles of problem solving and social learning theory.
One-year RCT with 79 young people (male 39; mean age +/- sd 16.5 +/- 3.2 years, duration 6.7 +/- 4.4 years, HbA(1c) 8.6 +/- 1.5%) randomized into: Group 1 (control group), continued routine management, n = 28; Group 2, continued routine management with NTS, n = 25; Group 3, annual clinic with NTS, n = 26.
HbA(1c), self-efficacy, barriers to adherence, problem solving, and diabetes knowledge.
There were no differences between the groups at baseline. Participants in Groups 2 and 3 received an average of 16 telephone calls/year (range 5-19), median duration 9 min (2-30), with a median interval of 3 weeks (1-24) between calls. Significant correlations were found between age and average length of call (r = 0.44, P < 0.01) and frequency of contact (r = 0.36, P < 0.05). Social and school topics were discussed frequently. After 1 year, while the participants in the two intervention groups showed significant improvements in self-efficacy (P = 0.035), there was no difference in glycaemic control in the three groups. Barriers to insulin use adherence were a significant predictor of HbA(1c) (P < 0.001) after controlling for baseline.
NTS is an effective medium to deliver a simple theory-based psychological intervention to enhance self-efficacy for diabetes self-management. Reduced clinic attendance, combined with NTS, did not result in a deterioration of HbA(1c). Intensive personal support needs to be combined with intensive diabetes therapy to improve glycaemic control in this age group.
评估参与一项基于问题解决和社会学习理论原则开发的“协商电话支持”（NTS）干预的1型糖尿病青少年自我管理自我效能的变化。
对79名青少年（男性39名；平均年龄±标准差16.5±3.2岁，病程6.7±4.4年，糖化血红蛋白8.6±1.5%）进行为期一年的随机对照试验，随机分为：第1组（对照组），继续常规管理，n = 28；第2组，继续常规管理并接受NTS，n = 25；第3组，每年接受一次门诊并接受NTS，n = 26。
糖化血红蛋白、自我效能、依从性障碍、问题解决能力和糖尿病知识。
各组在基线时无差异。第2组和第3组的参与者平均每年接到16个电话（范围5 - 19个），通话时长中位数为9分钟（2 - 30分钟），通话间隔中位数为3周（1 - 24周）。发现年龄与平均通话时长（r = 0.44，P < 0.01）和联系频率（r = 0.36，P < 0.05）之间存在显著相关性。社会和学校话题经常被讨论。1年后，虽然两个干预组的参与者自我效能有显著改善（P = 0.035），但三组的血糖控制无差异。在控制基线后，胰岛素使用依从性障碍是糖化血红蛋白的显著预测因素（P < 0.001）。
NTS是一种有效的媒介，可提供基于简单理论的心理干预，以增强糖尿病自我管理的自我效能。减少门诊就诊次数并结合NTS，并未导致糖化血红蛋白恶化。在这个年龄组中，强化个人支持需要与强化糖尿病治疗相结合以改善血糖控制。
