Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
Yonsei Med J. 2020 Feb;61(2):169-178. doi: 10.3349/ymj.2020.61.2.169.
This study investigated the sociodemographic factors associated with participation in diabetes self-management education (DSME) among community-dwelling adults with diabetes.
Data from 23400 people aged ≥30 years who were diagnosed with diabetes from the nationwide 2016 Korea Community Health Survey were analyzed. The relationship between sociodemographic factors and participation in DSME was examined by logistic regression analysis. The study sample was classified according to the type of institution providing DSME: hospitals/medical clinics (HMCs) and/or public health institutions (PHIs).
Of the total sample population with diabetes, 27.2% had attended DSME programs, including 21.9% at HMCs, 4.0% at PHIs, and 1.3% at both types of institutions. As age increased and educational level and monthly household income decreased, the odds ratios (ORs) of participation in DSME decreased in a fully adjusted model. Respondents living in rural areas had lower ORs for attending DSME compared to those living in urban areas [OR, 0.85; 95% confidence interval (CI), 0.80-0.91]. Service/sales workers and mechanical/manual workers had lower ORs for attending DSME (OR, 0.84; 95% CI, 0.71-0.99; and OR, 0.81; 95% CI, 0.69-0.94, respectively) compared to professional/managerial workers. However, in the subgroup of participants receiving education at PHIs, the likelihood of participation in DSME increased as age increased, and respondents living in rural areas had higher ORs compared to those living in urban areas (OR, 1.73; 95% CI, 1.51-1.98).
Customized DSME programs targeting socioeconomically vulnerable groups, including residential region and reimbursement of DSME by public insurance, are needed to resolve the inequalities in participation in DSME.
本研究旨在探讨与社区居住的成年糖尿病患者参与糖尿病自我管理教育（DSME）相关的社会人口学因素。
对全国 2016 年韩国社区健康调查中年龄≥30 岁、被诊断患有糖尿病的 23400 人的数据进行分析。采用 logistic 回归分析方法，检验社会人口学因素与参与 DSME 的关系。根据提供 DSME 的机构类型，将研究样本分为医院/诊所（HMCs）和/或公共卫生机构（PHIs）。
在糖尿病总样本人群中，27.2%的人参加了 DSME 项目，其中 21.9%在 HMCs，4.0%在 PHIs，1.3%在两种机构都参加了。在完全调整模型中，随着年龄的增加以及教育水平和月家庭收入的降低，参与 DSME 的可能性呈下降趋势。与居住在城市地区的人相比，居住在农村地区的人参加 DSME 的可能性更低[比值比（OR），0.85；95%置信区间（CI），0.80-0.91]。与专业/管理类工人相比，服务/销售工人和机械/手动工人参加 DSME 的可能性更低（OR，0.84；95%CI，0.71-0.99；和 OR，0.81；95%CI，0.69-0.94）。然而，在接受 PHIs 教育的参与者亚组中，随着年龄的增加，参与 DSME 的可能性增加，与居住在城市地区的人相比，居住在农村地区的人有更高的 OR[比值比（OR），1.73；95%置信区间（CI），1.51-1.98]。
需要针对社会经济弱势群体制定定制的 DSME 计划，包括居住地区和公共保险对 DSME 的报销，以解决参与 DSME 的不平等问题。
