Ouyang Chung-Mei, Dwyer Johanna T, Jacques Paul F, Chuang Lee-Ming, Haas Catherine F, Weinger Katie
Department of Dietetics, National Taiwan University Hospital, Taipei, Taiwan, ROC.
The Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
Asia Pac J Clin Nutr. 2015;24(3):430-7. doi: 10.6133/apjcn.2015.24.3.02.
The effects of patient characteristics on reported adherence to dietary self-care behaviours in 184 Taiwanese outpatients 40 years or older with type 2 diabetes was assessed. Patient characteristics included the presence of predisposing factors affecting diabetes adherence (knowledge and attitudes about the disease, self-efficacy, and the absence of psychological problems), enabling factors (understanding of diabetes and environmental factors affecting it), and reinforcing factors (presence of medical and social support) which were evaluated using a 72 item self-administered questionnaire with 8 subscales. Adherence was assessed by patients' reports of carrying out 7 self-care behaviours (following a diabetic meal plan, following the diabetes exchange system, eating meals providing the same amount of carbohydrate every day, counting carbohydrates, reducing dietary fat, consuming high fiber foods, and keeping a daily food record). Reported adherence ranged from 17% to 74%. No single predisposing, enabling, or reinforcing factor predicted adherence to all of the dietary self-care behaviours. However, more self-efficacy, better understanding, and a better attitude toward diabetes were associated with performing five or more of the dietary self-care behaviours examined. With respect to specific self-care behaviours, women were more likely than men to count carbohydrates (OR=5.75) and reduce fat in their diets (OR=2.57). Patients who attended more nutrition education sessions were more likely to follow diabetes meal plans (OR=2.11) and the diabetes exchange system (OR=3.07). Efforts are needed to encourage providers to teach diabetes self-care behaviours to patients and to capitalize upon demographic and psychosocial characteristics that can enhance patient adherence.
评估了184名40岁及以上的台湾2型糖尿病门诊患者的个体特征对报告的饮食自我护理行为依从性的影响。个体特征包括影响糖尿病依从性的易感因素（对疾病的知识和态度、自我效能感以及无心理问题）、促成因素（对糖尿病的了解以及影响糖尿病的环境因素）和强化因素（医疗和社会支持的存在），这些因素通过一份包含72个项目、8个分量表的自填问卷进行评估。依从性通过患者对7种自我护理行为（遵循糖尿病饮食计划、遵循糖尿病食物交换系统、每天进食提供相同碳水化合物量的餐食、计算碳水化合物摄入量、减少饮食脂肪、食用高纤维食物以及记录每日饮食）的执行情况报告来评估。报告的依从性范围为17%至74%。没有单一的易感、促成或强化因素能预测对所有饮食自我护理行为的依从性。然而，更高的自我效能感、更好的理解以及对糖尿病更好的态度与执行所检查的五种或更多饮食自我护理行为相关。就特定的自我护理行为而言，女性比男性更有可能计算碳水化合物摄入量（比值比=5.75）并减少饮食中的脂肪（比值比=2.57）。参加更多营养教育课程的患者更有可能遵循糖尿病饮食计划（比值比=2.11）和糖尿病食物交换系统（比值比=3.07）。需要努力鼓励医疗服务提供者向患者传授糖尿病自我护理行为，并利用可提高患者依从性的人口统计学和社会心理特征。
