Kazawa Kana, Osaki Kanae, Rahman Md Moshiur, Moriyama Michiko
Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553 Japan.
BMC Nurs. 2020 Mar 12;19:16. doi: 10.1186/s12912-020-0409-0. eCollection 2020.
We examined whether telecommunication-device-based distance interviews are inferior to face-to-face interviews in terms of facilitating behavioral changes and disease management in patients with diabetic nephropathy. We also examined the feasibility of a newly designed six-month telenursing program.
This study represents a post-hoc analysis of data from a randomized controlled trial, in which we compared the efficacy of remote self-management education with that of direct education for patients with diabetic nephropathy. The participants were 40 company employees, who were randomly divided into two groups. Over 6 months, the intervention group ( = 21) received three distance interviews using a tablet computer. Meanwhile, the control group ( = 19) received three face-to-face interviews. In addition, both groups received biweekly nine telephone calls. A triangulation approach was used. We first compared the two groups in inferiority tests. Then, we analyzed data from semi-structured interviews with all participants and nurses, examining whether trusting relationships and motivation were developed, and the accuracy of the information exchanges. Further, for the intervention group, we also enquired about the overall operability of the telenursing device.
The completion rates for the program were 81.0 and 78.9% for the participants in the intervention and control groups, respectively. Both groups showed similar behavioral changes, and the participants verified the feasibility of the distance interviews. The participants in the intervention group felt that they understood the severity of their diseases and the necessity of self-management, and felt confidence in the nurses. On the other hand, their degree of behavioral change regarding self-monitoring was lower than that shown by the control group.
Our findings show that both interview methods are effective for encouraging the adoption of self-management; further, in terms of taking medication and improving the main clinical indicators, we found that the distance method is not inferior to the direct face-to-face method. However, when considering long-term effects, based on the respective degrees of improvement in behavioral change, the direct method seems to be more effective.
The trial was registered with the University Hospital Medical Information Network clinical trial registry (No. UMIN000026568) on March 15, 2017, retrospectively.
我们研究了基于电信设备的远程访谈在促进糖尿病肾病患者行为改变和疾病管理方面是否不如面对面访谈。我们还研究了新设计的为期六个月的远程护理项目的可行性。
本研究是对一项随机对照试验数据的事后分析，我们比较了远程自我管理教育与直接教育对糖尿病肾病患者的疗效。参与者为40名公司员工，他们被随机分为两组。在6个月的时间里，干预组（n = 21）使用平板电脑接受了三次远程访谈。与此同时，对照组（n = 19）接受了三次面对面访谈。此外，两组均每两周接受九次电话随访。采用了三角测量法。我们首先在非劣效性试验中比较了两组。然后，我们分析了所有参与者和护士的半结构化访谈数据，考察是否建立了信任关系和动机，以及信息交流的准确性。此外，对于干预组，我们还询问了远程护理设备的整体可操作性。
干预组和对照组参与者的项目完成率分别为81.0%和78.9%。两组表现出相似的行为改变，且参与者证实了远程访谈的可行性。干预组的参与者认为他们了解了自身疾病的严重程度和自我管理的必要性，并对护士充满信心。另一方面，他们在自我监测方面的行为改变程度低于对照组。
我们的研究结果表明，两种访谈方法在鼓励采用自我管理方面都是有效的；此外，在服药和改善主要临床指标方面，我们发现远程方法并不逊色于直接面对面的方法。然而，考虑到长期效果，基于行为改变的各自改善程度，直接方法似乎更有效。
该试验于2017年3月15日在大学医院医学信息网络临床试验注册中心进行了回顾性注册（编号UMIN000026568）。
