Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States.
College of Nursing, The Pennsylvania State University, University Park, PA, United States.
JMIR Mhealth Uhealth. 2020 Mar 2;8(3):e16665. doi: 10.2196/16665.
Type 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital.
This study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes.
This randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change.
We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI -0.15,0.53; P<.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; P=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months).
We demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change.
ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176.
2 型糖尿病是一个日益严重的公共卫生问题，可以通过预防和健康促进来解决。由于健康行为对疾病结果有影响，因此支持和维持糖尿病自我管理的方法至关重要。
本研究旨在评估使用动机访谈结合移动健康（mHealth）技术对 2 型糖尿病患者进行护士辅导计划对糖尿病自我效能和自我管理的效果。
这项随机对照试验将常规护理与干预进行了比较，干预措施包括护士健康辅导和 mHealth 技术来跟踪患者生成的健康数据，并将这些数据整合到电子健康记录中。纳入标准如下：（1）在 3 家初级保健诊所之一注册，（2）年龄在 18 岁或以上，（3）患有 2 型糖尿病，（4）会说英语。我们在基线、3 个月和 9 个月时收集了结果测量值。主要结果是糖尿病自我效能；次要结果是抑郁症状、感知压力、身体机能和情绪困扰和焦虑。线性回归混合模型估计了人群趋势和变化的个体差异。
我们共招募了 319 名参与者；287 名参与者完成了研究（155 名对照组和 132 名干预组）。与常规护理相比，干预组在 3 个月时糖尿病自我效能（糖尿病赋能量表，0.34；95%置信区间-0.15，0.53；P<.01）和抑郁症状（患者健康问卷-9，0.89；95%置信区间 0.01-1.77；P=.05）显著改善，而其他结果则没有差异。在 9 个月时，两组之间的自我效能和抑郁评分差异没有持续。干预组的参与者在 3 个月时的体力活动显著增加（从每周 23770 步增加到每周 39167 步，9 个月时每周 32601 步）。
我们证明了这种干预的短期效果；然而，到 9 个月时，尽管体力活动仍高于基线，但自我效能的改善并未持续。进一步的研究应该评估继续进行行为改变所需的最低教练剂量，并评估技术为行为改变提供有效持续自动化强化的潜力。
ClinicalTrials.gov NCT02672176；https://clinicaltrials.gov/ct2/show/NCT02672176。
