南非高登省两家公立医院的糖尿病患者自我护理行为的遵医情况及其相关不平等和因素。
Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa.
机构信息
Research Use and Impact Assessment, Human Sciences Research Council, HSRC Building, 134 Pretorius Street, Pretoria, 0002, South Africa.
Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht University Medical Centre, Maastricht, The Netherlands.
出版信息
BMC Endocr Disord. 2020 Jan 28;20(1):15. doi: 10.1186/s12902-020-0492-y.
BACKGROUND
Self- management is vital to the control of diabetes. This study aims to assess the diabetes self-care behaviours of patients attending two tertiary hospitals in Gauteng, South Africa. The study also seeks to estimate the inequalities in adherence to diabetes self-care practices and associated factors.
METHODS
A unique health-facilities based cross-sectional survey was conducted amongst diabetes patients in 2017. Our study sample included 396 people living with diabetes. Face-to-face interviews were conducted using a structured questionnaire. Diabetes self-management practices considered in this study are dietary diversity, medication adherence, physical activity, self-monitoring of blood-glucose, avoiding smoking and limited alcohol consumption. Concentration indices (CIs) were used to estimate inequalities in adherence to diabetes self-care practices. Multiple logistic regressions were fitted to determine factors associated with diabetes self-care practices.
RESULTS
Approximately 99% of the sample did not consume alcohol or consumed alcohol moderately, 92% adhered to self-monitoring of blood-glucose, 85% did not smoke tobacco, 67% adhered to their medication, 62% had a diverse diet and 9% adhered to physical activity. Self-care practices of dietary diversity (CI = 0.1512) and exercise (CI = 0.1067) were all concentrated amongst patients with higher socio-economic status as indicated by the positive CIs, whilst not smoking (CI = - 0.0994) was concentrated amongst those of lower socio-economic status as indicated by the negative CI. Dietary diversity was associated with being female, being retired and higher wealth index. Medication adherence was found to be associated with older age groups. Physical activity was found to be associated with tertiary education, being a student and those within higher wealth index. Self-monitoring of blood glucose was associated with being married. Not smoking was associated with being female and being retired.
CONCLUSION
Adherence to exercising, dietary diversity and medication was found to be sub-optimal. Dietary diversity and exercise were more prevalent among patients with higher socio-economic status. Our findings suggest that efforts to improve self- management should focus on addressing socio-economic inequalities. It is critical to develop strategies that help those within low-socio-economic groups to adopt healthier diabetes self-care practices.
背景
自我管理对于糖尿病的控制至关重要。本研究旨在评估在南非豪登省的两家三级医院就诊的糖尿病患者的自我护理行为。本研究还旨在估计坚持糖尿病自我护理实践的不平等情况及其相关因素。
方法
2017 年，我们在独特的基于医疗设施的横断面调查中对糖尿病患者进行了调查。我们的研究样本包括 396 名患有糖尿病的人。使用结构化问卷进行面对面访谈。本研究考虑的糖尿病自我管理实践包括饮食多样性、药物依从性、体育活动、自我监测血糖、避免吸烟和限制饮酒。集中指数（CI）用于估计坚持糖尿病自我护理实践的不平等情况。拟合多元逻辑回归模型以确定与糖尿病自我护理实践相关的因素。
结果
大约 99%的样本不饮酒或适度饮酒，92%的人坚持自我监测血糖，85%的人不吸烟，67%的人坚持用药，62%的人饮食多样化，9%的人坚持体育活动。饮食多样性（CI=0.1512）和运动（CI=0.1067）自我护理实践均集中在社会经济地位较高的患者中，这表明 CIs 为正，而不吸烟（CI=-0.0994）集中在社会经济地位较低的患者中，这表明 CI 为负。饮食多样性与女性、退休和较高的财富指数有关。药物依从性与年龄较大的年龄组有关。体育活动与高等教育、学生和较高财富指数的人有关。自我监测血糖与已婚有关。不吸烟与女性和退休有关。
结论
锻炼、饮食多样性和药物的依从性被发现是不理想的。饮食多样性和运动在社会经济地位较高的患者中更为普遍。我们的研究结果表明，改善自我管理的努力应重点解决社会经济不平等问题。制定帮助那些处于低社会经济群体的人采用更健康的糖尿病自我护理实践的策略至关重要。
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