提高糖尿病教育参与度的策略。一项定性研究。
Strategies for improving participation in diabetes education. A qualitative study.
作者信息
Schäfer Ingmar, Pawels Marc, Küver Claudia, Pohontsch Nadine Janis, Scherer Martin, van den Bussche Hendrik, Kaduszkiewicz Hanna
机构信息
Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany.
出版信息
PLoS One. 2014 Apr 14;9(4):e95035. doi: 10.1371/journal.pone.0095035. eCollection 2014.
OBJECTIVE
Diabetes mellitus is highly prevalent and can lead to serious complications and mortality. Patient education can help to avoid negative outcomes, but up to half of the patients do not participate. The aim of this study was to analyze patients' attitudes towards diabetes education in order to identify barriers to participation and develop strategies for better patient education.
METHODS
We conducted a qualitative study. Seven GP practices were purposively selected based on socio-demographic data of city districts in Hamburg, Germany. Study participants were selected by their GPs in order to increase participation. Semi-structured face-to-face interviews were conducted with 14 patients. Interviews were audiotaped and transcribed verbatim. The sample size was determined by data saturation. Data were analysed by qualitative content analysis. Categories were determined deductively and inductively.
RESULTS
The interviews yielded four types of barriers: 1) Statements and behaviour of the attending physician influence the patients' decisions about diabetes education. 2) Both, a good state of health related to diabetes and physical/psychosocial comorbidity can be reasons for non-participation. 3) Manifold motivational factors were discussed. They ranged from giving low priority to diabetes to avoidance of implications of diabetes education as being confronted with illness narratives of others. 4) Barriers also include aspects of the patients' knowledge and activity.
CONCLUSIONS
First, physicians should encourage patients to participate in diabetes education and argue that they can profit even if actual treatment and examination results are promising. Second, patients with other priorities, psychic comorbidity or functional limitations might profit more from continuous individualized education adapted to their specific situation instead of group education. Third, it might be justified that patients do not participate in diabetes education if they have slightly increased blood sugar values only and no risk for harmful consequences or if they already have sufficient knowledge on diabetes.
目的
糖尿病极为常见，可导致严重并发症及死亡。患者教育有助于避免不良后果，但多达半数患者并未参与。本研究旨在分析患者对糖尿病教育的态度，以确定参与障碍并制定改善患者教育的策略。
方法
我们开展了一项定性研究。根据德国汉堡市城区的社会人口统计学数据，有目的地选取了7家全科医疗诊所。研究参与者由其全科医生挑选，以提高参与度。对14名患者进行了半结构化面对面访谈。访谈进行了录音并逐字转录。样本量由数据饱和确定。通过定性内容分析对数据进行分析。类别通过演绎和归纳确定。
结果
访谈产生了四种类型的障碍：1）主治医生的陈述和行为会影响患者对糖尿病教育的决策。2）与糖尿病相关的良好健康状况以及身体/心理社会合并症均可成为不参与的原因。3）讨论了多种动机因素。从对糖尿病重视程度低到因接触他人的疾病经历而避免糖尿病教育的影响。4）障碍还包括患者的知识和活动方面。
结论
首先，医生应鼓励患者参与糖尿病教育，并指出即使实际治疗和检查结果良好，他们也能从中受益。其次，有其他优先事项、存在心理合并症或功能受限的患者可能从适应其特定情况的持续个体化教育中获益更多，而非团体教育。第三，如果患者仅血糖值略有升高且无有害后果风险，或者他们已经对糖尿病有足够了解，那么他们不参与糖尿病教育可能是合理的。
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