Bhandari Pratibha, Kim Miyoung
Pratibha Bhandari, PhD, RN, is Assistant Professor, Department of Nursing, Woosong University, Daejeon, South Korea. Miyoung Kim, PhD, RN, is Associate Professor, Department of Nursing, Ewha Womans University, Seoul, South Korea.
Nurs Res. 2016 May-Jun;65(3):202-14. doi: 10.1097/NNR.0000000000000153.
Most previously reported literature on diabetes self-care is either solely quantitative or qualitative research conducted in developed countries; findings may not be generalizable to developing countries with different sociodemographic and cultural factors.
The study aims to develop an explanatory mediation model for self-care and enhance model interpretation through qualitative input.
A quantitatively driven, sequential, mixed method design was used. Structured questionnaires were used to collect data for the quantitative component from 230 participants. Participants for the qualitative interview were selected using maximum variation sampling (n = 13), and interviewing was guided by semistructured questions.
Diabetes management self-efficacy had the strongest influence on diabetes self-care (standardized path coefficient = .42, p < .001), followed by perceived social support (standardized path coefficient = .26, p < .001), and educational status (standardized path coefficient = -.22, p < .001). Diabetes management self-efficacy significantly and partially mediated the relationship between diabetes duration and diabetes self-care (Sobel's z = 2.65, p < .001) and between expectation regarding aging and diabetes self-care (Sobel's z = 3.03, p < .001). Perceived social support significantly and partially mediated the relation between educational status and diabetes self-care (Sobel's z = -2.81, p < .001). The qualitative component elucidated nine themes interwoven in Nepalese culture, social structure, and religious belief. Responsibilities toward family and belief in God acted as boosters for self-care in the case of Nepalese adults, which differed by age, gender, and literacy status.
The results from this study suggest that tailored psychosocial interventions to promote diabetes management self-efficacy may be beneficial in promoting self-care among Nepalese adults with diabetes mellitus.
先前报道的大多数关于糖尿病自我管理的文献，要么是在发达国家进行的单纯定量研究，要么是定性研究；研究结果可能不适用于具有不同社会人口统计学和文化因素的发展中国家。
本研究旨在建立一个关于自我管理的解释性中介模型，并通过定性数据增强模型的解释力。
采用定量驱动的、序列混合方法设计。使用结构化问卷从230名参与者中收集定量部分的数据。采用最大差异抽样法选取定性访谈的参与者（n = 13），并以半结构化问题为指导进行访谈。
糖尿病管理自我效能感对糖尿病自我管理的影响最大（标准化路径系数 = 0.42，p < 0.001），其次是感知到的社会支持（标准化路径系数 = 0.26，p < 0.001）和教育程度（标准化路径系数 = -0.22，p < 0.001）。糖尿病管理自我效能感显著且部分中介了糖尿病病程与糖尿病自我管理之间的关系（索贝尔z值 = 2.65，p < 0.001）以及对衰老的预期与糖尿病自我管理之间的关系（索贝尔z值 = 3.03，p < 0.001）。感知到的社会支持显著且部分中介了教育程度与糖尿病自我管理之间的关系（索贝尔z值 = -2.81，p < 0.001）。定性部分阐明了九个与尼泊尔文化、社会结构和宗教信仰交织在一起的主题。对家庭的责任和对上帝的信仰在尼泊尔成年人中起到了自我管理促进因素的作用，且因年龄、性别和识字状况而异。
本研究结果表明，针对提高糖尿病管理自我效能感的个性化心理社会干预措施，可能有助于促进尼泊尔成年糖尿病患者的自我管理。
