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魁北克糖尿病赋权小组计划:计划描述以及关于在初级卫生保健环境中实施的可行性和可接受性的考量

The Quebec Diabetes Empowerment Group Program: Program Description and Considerations Regarding Feasibility and Acceptability of Implementation in Primary Health Care Settings.

作者信息

Hersson-Edery Fanny, Reoch Jennifer, Gagnon Justin

机构信息

Department of Family Medicine, McGill University, Montreal, QC, Canada.

Santé Kildare, Côte Saint-Luc, QC, Canada.

出版信息

Front Nutr. 2021 Mar 12;8:621238. doi: 10.3389/fnut.2021.621238. eCollection 2021.

Abstract

Diabetes is a highly prevalent chronic disease that frequently coexists with other medical conditions and implies a high burden for patients and the healthcare system. Clinicians currently are challenged to provide effective interventions that are both multidisciplinary and empower patient self-care. The Diabetes Empowerment Group Program (DEGP) was developed with the aims of fostering patient engagement in diabetes self-care through the lens of empowerment and to support the empowerment of patients with diabetes by providing multidisciplinary group-based care. This research's objectives were to: (1) develop a comprehensive description of the DEGP for potential adopters, and (2) explore the factors influencing the feasibility and acceptability of implementing it in other healthcare settings in Montreal. A qualitative descriptive study was conducted, following a participatory approach. Data were obtained from: (1) semi-structured interviews with 14 patients who participated in the pilot program; (2) from semi-structured group interviews with patient partners, healthcare professionals, and other stakeholders from 4 Montreal family medicine groups, and (3) discussions among the participatory research team during various knowledge translation activities. Inductive content analysis of the data was performed. The DEGP identified seven key elements: medical visit, continuity of care, group-based dynamics, multi-disciplinarity, clinician facilitation, patient-centered agenda, and a theoretical framework of empowerment. The content and organization of the group visits were conceived to address each of these four domains. The empowerment framework comprises four domains of self-care: emotional (attitude), cognitive (knowledge), behavioral (skills), and relational (relatedness). Factors impacting the feasibility and acceptability of implementing the DEGP in other primary care settings were identified. The DEGP fits within the discourse around the need for more patient-centered programs for people living with diabetes, following a more comprehensive empowerment model. This research could facilitate the development or adaptation of similar programs in other settings.

摘要

糖尿病是一种高度流行的慢性病,常与其他疾病并存,给患者和医疗系统带来沉重负担。目前,临床医生面临着提供多学科且能增强患者自我护理能力的有效干预措施的挑战。糖尿病赋权小组项目(DEGP)的开发旨在通过赋权的视角促进患者参与糖尿病自我护理,并通过提供多学科的小组护理来支持糖尿病患者的赋权。本研究的目的是:(1)为潜在采用者全面描述DEGP,(2)探索影响在蒙特利尔其他医疗环境中实施该项目的可行性和可接受性的因素。采用参与式方法进行了一项定性描述性研究。数据来自:(1)对14名参与试点项目的患者进行的半结构化访谈;(2)对来自4个蒙特利尔家庭医学小组的患者伙伴、医疗专业人员和其他利益相关者进行的半结构化小组访谈,以及(3)参与式研究团队在各种知识转化活动中的讨论。对数据进行了归纳性内容分析。DEGP确定了七个关键要素:医疗就诊、护理连续性、小组动态、多学科性、临床医生促进、以患者为中心的议程以及赋权的理论框架。小组就诊的内容和组织旨在解决这四个领域中的每一个。赋权框架包括自我护理的四个领域:情感(态度)、认知(知识)、行为(技能)和关系(关联性)。确定了影响在其他初级保健环境中实施DEGP的可行性和可接受性的因素。DEGP符合围绕为糖尿病患者提供更以患者为中心的项目的讨论,遵循更全面的赋权模式。这项研究可以促进其他环境中类似项目的开发或调整。

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本文引用的文献

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Toward relational empowerment.迈向关系赋权。
Am J Community Psychol. 2012 Sep;50(1-2):114-28. doi: 10.1007/s10464-011-9483-5.
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The value and challenges of participatory research: strengthening its practice.参与式研究的价值与挑战:加强其实践
Annu Rev Public Health. 2008;29:325-50. doi: 10.1146/annurev.publhealth.29.091307.083824.
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Transforming healthcare organizations.变革医疗保健机构。
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