Vissenberg Charlotte, Nierkens Vera, van Valkengoed Irene, Nijpels Giel, Uitewaal Paul, Middelkoop Barend, Stronks Karien
1 Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
4 VU University Medical Centre, Amsterdam, The Netherlands.
Scand J Public Health. 2017 Aug;45(6):569-583. doi: 10.1177/1403494817701565. Epub 2017 Jul 14.
This paper aims to explore the effect of the social network based intervention Powerful Together with Diabetes on diabetes self-management among socioeconomically deprived patients. This 10-month group intervention targeting patients and significant others aimed to improve self-management by stimulating social support and diminishing social influences that hinder self-management.
This intervention was evaluated in a quasi-experimental study using a mixed methods approach. Of 131 socioeconomically deprived patients with suboptimal glycaemic control, 69 were assigned to the intervention group and 62 to the control group (standard diabetes education). 27 qualitative in-depth interviews with the participants and 24 with their group leaders were held to study the subjective impact of the intervention. Further, self-management behaviours (medication adherence, diet and physical activity) were assessed at baseline, 10 and 16 months. Data were analysed using framework analyses and a linear mixture model.
Qualitative data showed that the intervention group had a better understanding of the way self-management influences diabetes. The intervention group showed more complex self-management behaviours, such as planning ahead, seeking adequate food and physical activity alternatives, and consistently taking their diabetes into consideration when making choices. In participants with complete follow-up data, we found a significant increase in physical activity in the intervention group (3.78 vs. 4.83 days) and no changes in medication adherence and diet.
This study indicates that an intensive support group and simultaneously involving significant others might improve diabetes self-management behaviours among socioeconomically deprived patients. More studies are needed to justify further implementation of the intervention. This study is registered in the Dutch Trial Register NTR1886. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1886.
本文旨在探讨基于社交网络的干预措施“与糖尿病携手共进”对社会经济条件较差的糖尿病患者自我管理的影响。这项为期10个月的团体干预针对患者及其重要他人，旨在通过激发社会支持和减少阻碍自我管理的社会影响来改善自我管理。
采用混合方法在一项准实验研究中对该干预措施进行评估。在131名社会经济条件较差、血糖控制不佳的患者中，69名被分配到干预组，62名被分配到对照组（标准糖尿病教育）。对参与者进行了27次定性深入访谈，对其组长进行了24次访谈，以研究干预措施的主观影响。此外，在基线、10个月和16个月时评估自我管理行为（药物依从性、饮食和体育活动）。使用框架分析和线性混合模型对数据进行分析。
定性数据显示，干预组对自我管理影响糖尿病的方式有更好的理解。干预组表现出更复杂的自我管理行为，如提前规划、寻找合适的食物和体育活动替代方案，以及在做出选择时始终考虑自己的糖尿病情况。在有完整随访数据的参与者中，我们发现干预组的体育活动显著增加（3.78天对4.83天），药物依从性和饮食没有变化。
本研究表明，一个强化支持小组并同时让重要他人参与，可能会改善社会经济条件较差的糖尿病患者的自我管理行为。需要更多研究来证明该干预措施的进一步实施的合理性。本研究已在荷兰试验注册库NTR1886注册。http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1886 。
