糖尿病宿命论对成年糖尿病患者药物依从性和自我护理行为的影响。
Effect of diabetes fatalism on medication adherence and self-care behaviors in adults with diabetes.
机构信息
Center for Health Disparities Research, Medical University of South Carolina, P.O. Box 250593 Charleston, SC, USA.
出版信息
Gen Hosp Psychiatry. 2012 Nov-Dec;34(6):598-603. doi: 10.1016/j.genhosppsych.2012.07.005. Epub 2012 Aug 13.
OBJECTIVE
Diabetes fatalism is defined as "a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness" and associated with poor glycemic control. This study examined the association between diabetes fatalism and medication adherence and self-care behaviors in adults with diabetes.
METHODS
Data on 378 subjects with type 2 diabetes recruited from two primary care clinics in the Southeastern United States were examined. Previously validated scales were used to measure diabetes fatalism, medication adherence, diabetes knowledge and diabetes self-care behaviors (diet, physical activity, blood sugar testing and foot care). Multiple linear regression was used to assess the independent effect of diabetes fatalism on medication adherence and self-care behaviors controlling for relevant covariates.
RESULTS
Fatalism correlated significantly with medication adherence (r=0.24, P<.001), diet (r=-0.26, P<.001), exercise (r=-0.20, P<.001) and blood sugar testing (r=-0.19, P<.001). In the linear regression model, diabetes fatalism was significantly associated with medication adherence [β=0.029, 95% confidence interval (CI) 0.016, 0.043], diabetes knowledge (β=-0.042, 95% CI -0.001, -0.084), diet (β=-0.063, 95% CI -0.039, -0.087), exercise (β=-0.055, 95% CI -0.028, -0.083) and blood sugar testing (β=-0.055, 95% CI -0.023, -0.087). There was no significant association between diabetes fatalism and foot care (β=-0.018, 95% CI -0.047, 0.011). The association between diabetes fatalism and medication adherence, diabetes knowledge and diabetes self-care behaviors did not change significantly when depression was added to the models, suggesting that the associations are independent of depression.
CONCLUSION
Diabetes fatalism is associated with poor medication adherence and self-care and may be an important target for education and skills interventions in diabetes care. In addition, the effect of diabetes fatalism is independent of depression, suggesting that interventions that target depression may not be sufficient to deal with diabetes fatalism.
目的
糖尿病宿命论被定义为“一种以绝望、无助和无力感为特征的复杂心理循环”，与血糖控制不佳有关。本研究探讨了糖尿病宿命论与成年人糖尿病患者的药物依从性和自我护理行为之间的关系。
方法
从美国东南部的两家初级保健诊所招募了 378 名 2 型糖尿病患者的数据。使用先前经过验证的量表来衡量糖尿病宿命论、药物依从性、糖尿病知识和糖尿病自我护理行为（饮食、体育活动、血糖检测和足部护理）。使用多元线性回归来评估糖尿病宿命论对药物依从性和自我护理行为的独立影响，同时控制相关协变量。
结果
宿命论与药物依从性（r=0.24，P<.001）、饮食（r=-0.26，P<.001）、运动（r=-0.20，P<.001）和血糖检测（r=-0.19，P<.001）显著相关。在线性回归模型中，糖尿病宿命论与药物依从性显著相关[β=0.029，95%置信区间（CI）0.016，0.043]、糖尿病知识（β=-0.042，95%CI-0.001，-0.084）、饮食（β=-0.063，95%CI-0.039，-0.087）、运动（β=-0.055，95%CI-0.028，-0.083）和血糖检测（β=-0.055，95%CI-0.023，-0.087）。糖尿病宿命论与足部护理之间没有显著关联（β=-0.018，95%CI-0.047，0.011）。当将抑郁加入模型中时，糖尿病宿命论与药物依从性、糖尿病知识和糖尿病自我护理行为之间的关联没有显著变化，这表明这些关联独立于抑郁。
结论
糖尿病宿命论与药物依从性差和自我护理行为有关，可能是糖尿病护理中教育和技能干预的重要目标。此外，糖尿病宿命论的影响独立于抑郁，这表明针对抑郁的干预措施可能不足以解决糖尿病宿命论。
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