Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Escola Universitària d'Infermeria i Teràpia Ocupacional (EUIT), Carrer de la Riba, 90, 08221 Terrassa, Barcelona, Spain.
Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
Int J Nurs Stud. 2018 Oct;86:139-150. doi: 10.1016/j.ijnurstu.2018.06.016. Epub 2018 Jun 30.
Diabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes.
To evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia.
The methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia.
Out of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia.
Although there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease.
糖尿病、高血压和高胆固醇血症是全球日益普遍的重要慢性健康问题。教育干预是卫生团队面临的挑战。护士通过提供教育干预措施，在整体健康中发挥着重要作用，以帮助改善自我管理结果。
评估护士在初级卫生保健中进行的教育干预措施，以改善 2 型糖尿病、高血压和高胆固醇血症患者的代谢控制和/或慢性病管理。
该方法借鉴了无荟萃分析的系统评价，方法由 Cochrane 协作组织制定。根据 PRISMA 声明选择与内容相关的要素。检索了 Pubmed、Web of Science、CINAHL、PsycInfo、Cuiden、Enfispo 和 Cochrane 图书馆的数据库。还检查了相关文章的参考文献列表以获取其他参考文献。三位作者独立评估研究纳入的资格。对 2000 年至 2015 年期间发表的随机对照试验进行了综述。此外，还对选定的研究进行了分析，这些研究中护士积极参与初级卫生保健中心的教育干预措施的实施，以改善 2 型糖尿病、高血压和高胆固醇血症的控制和慢性病管理。
在系统评价中纳入的 20 项研究中，有 1 项研究的偏倚风险较低，14 项研究的偏倚风险不确定，5 项研究的偏倚风险较高。尽管几项研究显示测量变量有显著变化，但很少有研究能长时间保持差异，仅在代谢指标和临床变量上观察到，而在生活方式行为上则没有。此外，尽管大多数研究涉及营养、身体活动、烟草和酒精使用等与生活方式行为相关的问题，但很少有研究在干预后测量到变化。最后，综述中纳入的研究之间的比较困难在于教育策略、使用的评估方法和评估工具的差异，这使得难以确定在治疗糖尿病、高血压和高胆固醇血症期间最有效的干预措施的特征。
尽管有许多旨在控制糖尿病、高血压和高胆固醇血症的干预措施，但观察结果表明，获得的结果难以长时间维持。因此，有必要继续创建高质量的干预措施，这些措施具有低偏倚风险，并基于坚实的理论框架，不仅要治疗疾病的当前症状，还要帮助预防心血管疾病。
