School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada.
Patient Educ Couns. 2012 Apr;87(1):93-100. doi: 10.1016/j.pec.2011.09.007. Epub 2011 Oct 10.
To investigate the impact of generic and diabetes-specific self-management programs offered in a real world context.
A quasi-experimental design with 12-week follow-up compared Living with a Chronic Condition and Living with Diabetes. Self-report data collected included: Self-management Knowledge and Skills; Health Related Quality of Life (HRQOL); Depression; Social Isolation; Loneliness; Self-efficacy; and Health Behaviours.
Participants (N=458) in the two programs differed on almost all baseline measures. Both demonstrated statistically significant improvements in Self-management Knowledge and Skills, as well as reductions in depression. In addition to younger age, low HRQOL, high self-efficacy and Positive and Active Engagement in Life, were the clinical factors most likely to lead to improvements in HRQOL and self-efficacy. Changes in different characteristics predicted different outcomes.
Both generic and disease-specific programs led to improved outcomes, despite the two programs attracting significantly different participants. Referral patterns also differed but GP referral rates were low for both.
Positive participant outcomes can be achieved in real life clinical settings. While younger people with a positive attitude may appear to gain more, it is important to encourage people from low socio-economic status to enter these programs so that social inequalities in health are not worsened.
研究在真实环境中提供通用和糖尿病特定自我管理计划对患者的影响。
采用为期 12 周的随访的准实验设计，比较《慢性病患者生活》和《糖尿病患者生活》这两个项目。收集的自我报告数据包括：自我管理知识和技能；健康相关生活质量（HRQOL）；抑郁；社会隔离；孤独感；自我效能；健康行为。
两个项目的参与者（N=458）在几乎所有基线指标上存在差异。两个项目都在自我管理知识和技能方面取得了统计学上的显著改善，同时抑郁程度也有所降低。除了年龄较小、HRQOL 较低、自我效能较高以及积极参与生活外，HRQOL 和自我效能改善的最可能的临床因素还包括积极的态度和生活方式。不同特征的变化预示着不同的结果。
尽管两个项目吸引了显著不同的参与者，但通用和疾病特定的项目都导致了改善的结果。转诊模式也有所不同，但两个项目的全科医生转诊率都较低。
在现实临床环境中，可以实现积极的参与者结果。虽然年轻、态度积极的人可能会获得更多的收益，但重要的是要鼓励社会经济地位较低的人参与这些项目，以避免健康方面的社会不平等加剧。
