Fløde Mari, Iversen Marjolein M, Aarflot Morten, Haltbakk Johannes
Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
Department of Medicine, Section of Endocrinology, Stavanger University, Stavanger, Norway.
Scand J Caring Sci. 2017 Dec;31(4):789-795. doi: 10.1111/scs.12398. Epub 2017 Jan 31.
Research interventions in uniform clinical settings and in patients fulfilling well-defined inclusion criteria might show a more pronounced effect than implementing the same intervention in existing practice. Diabetes Self-Management Education (DSME) is complex, and should be assessed in existing practice as it is an intervention widely implemented.
To examine the impact of an established group-based DSME in unselected people with type 2 diabetes referred from primary care.
A one-group, before-after design was used for assessments before, immediately after, and 3 months after participation in a group-based DSME programme conducted at two Learning and Mastering Centres in Norway between November 2013 and June 2014. Participants completed a questionnaire before (n = 115), immediately after (n = 95) and 3 months after (n = 42) the DSME programme. Primary outcome measure was diabetes knowledge (Michigan Diabetes Knowledge Test). Also patient activation (Patient Activation Measure [PAM]) and self-efficacy (General Self-Efficacy scale [GSE]) were measured. Changes in outcome measures were analysed using paired t-tests for normally distributed data and Wilcoxon signed-rank test for skewed data.
Mean knowledge improved significantly from baseline (p < 0.001). Changes persisted at the 3-month assessment. Mean PAM scores improved significantly from baseline (p < 0.001), and changes persisted for 3 months. Mean GSE scores improved from baseline (p = 0.022) and persisted for 3 months. However, when results were stratified for participants who responded at all three time points, GSE showed no change during the study period.
The complexity self-management in the individual is challenging to reflect in DSME. This implemented DSME programme for people with type 2 diabetes improved levels of diabetes knowledge and patient activation, persisting for at least 3 months. Hence, the DSME programme appears to be robust beyond standardised research settings, in educating unselected diabetes patients referred from primary care.
在统一的临床环境中，针对符合明确纳入标准的患者进行研究干预，可能比在现有实践中实施相同干预显示出更显著的效果。糖尿病自我管理教育（DSME）较为复杂，鉴于其是一项广泛实施的干预措施，应在现有实践中进行评估。
探讨在未经过筛选、从初级保健机构转诊而来的2型糖尿病患者中，既定的基于小组的DSME所产生的影响。
采用单组前后设计，于2013年11月至2014年6月在挪威的两个学习与掌握中心开展基于小组的DSME项目期间，分别在参与前、参与后即刻以及参与后3个月进行评估。参与者在DSME项目前（n = 115）、后即刻（n = 95）以及后3个月（n = 42）完成一份问卷。主要结局指标为糖尿病知识（密歇根糖尿病知识测试）。同时还测量了患者激活度（患者激活度量表[PAM]）和自我效能感（一般自我效能量表[GSE]）。对于正态分布数据，使用配对t检验分析结局指标的变化；对于偏态数据，使用Wilcoxon符号秩检验进行分析。
平均知识水平较基线有显著提高（p < 0.001）。在3个月评估时，这种变化依然存在。平均PAM得分较基线有显著提高（p < 0.001），且这种变化持续了3个月。平均GSE得分较基线有所提高（p = 0.022），并持续了3个月。然而，当对在所有三个时间点均有回应的参与者的结果进行分层分析时，GSE在研究期间未显示出变化。
个体的复杂自我管理在DSME中难以体现。此次为2型糖尿病患者实施的DSME项目提高了糖尿病知识水平和患者激活度，且至少持续了3个月。因此，在教育从初级保健机构转诊而来的未经筛选的糖尿病患者方面，DSME项目似乎在标准化研究环境之外也具有良好效果。
