Madit Wimol, Harnirattisai Teeranut, Hain Debra, Gaudio Paul Anton
Faculty of Nursing, Thammasat University, Pathum Thani, Thailand.
Christine E. Lynn College of Nursing, Florida Atlantic University, United States.
Belitung Nurs J. 2024 Jun 28;10(3):272-284. doi: 10.33546/bnj.3360. eCollection 2024.
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, leading to visual impairment and eventual blindness. Promoting self-care behaviors is crucial in controlling DR progression and preventing blindness.
This study aimed to investigate the effects of a Self-Care Promoting Program (SCPP) on engagement in self-care behaviors, HbA1c levels, visual acuity (VA), severity of DR, and vision-related quality of life (VRQoL) among individuals with type 2 diabetes and DR.
This study employed a single-blind randomized controlled trial design to compare SCPP with conventional diabetic care interventions (standard care). The SCPP was based on the Self-Care of Chronic Illness Theory, Self-efficacy theory, and the Association of Diabetic Care and Education Specialist (ADCES) guidelines incorporating health education, self-care maintenance, monitoring, and management skills training over 12 weeks. Ninety-eight participants were randomly allocated to the experimental or control group ( = 49 per group). While the experimental group received SCPP alongside standard care, the control group received standard care alone. Data collection occurred between May 2022 and March 2023 and included demographic information, the Self-Care of Diabetes Index questionnaire (SCODI), the self-care for diabetes eye care questionnaire (SCFDE), the impact of visual impairment questionnaire (IVI-Thai version), and retinal images for DR severity grading. Data analysis utilized descriptive statistics, Chi-Square tests, -tests, and MANOVA.
Following 8 and 16 weeks of SCPP, the experimental group had significantly higher mean scores in engagement with self-care and eye-care behaviors compared to the control group ( <0.001). The highest scores were observed in self-care and eye-care confidence behaviors, followed by maintenance, monitoring, and management. Furthermore, HbA1c levels and VRQoL significantly decreased and were lower than those of the control group at week 16 ( <0.001 and <0.05, respectively). However, there were no significant differences in VA, and DR severity increased in both groups by week 16.
SCPP benefits individuals with DR, enhancing their confidence and ability to perform, monitor, and manage self-care behaviors. These strategies contribute to improved diabetes management, enhanced quality of life, and reduced DR-related blindness. Integrating SCPP into routine DR management is recommended, with nurses playing a pivotal role in overseeing and driving this integration, highlighting the critical role of nurses in managing this widespread global disease.
Thai Clinical Trials Registration (TCTR20230302002).
糖尿病视网膜病变（DR）是糖尿病最常见的微血管并发症，可导致视力损害并最终失明。促进自我护理行为对于控制DR进展和预防失明至关重要。
本研究旨在调查自我护理促进计划（SCPP）对2型糖尿病合并DR患者的自我护理行为参与度、糖化血红蛋白（HbA1c）水平、视力（VA）、DR严重程度以及视力相关生活质量（VRQoL）的影响。
本研究采用单盲随机对照试验设计，将SCPP与传统糖尿病护理干预措施（标准护理）进行比较。SCPP基于慢性病自我护理理论、自我效能理论以及糖尿病护理与教育专家协会（ADCES）指南，在12周内纳入健康教育、自我护理维持、监测和管理技能培训。98名参与者被随机分配到实验组或对照组（每组49人）。实验组在接受标准护理的同时接受SCPP，对照组仅接受标准护理。数据收集于2022年5月至2023年3月期间进行，包括人口统计学信息、糖尿病自我护理指数问卷（SCODI）、糖尿病眼部护理自我护理问卷（SCFDE）、视力损害影响问卷（泰语版）以及用于DR严重程度分级的视网膜图像。数据分析采用描述性统计、卡方检验、t检验和多变量方差分析。
在SCPP实施8周和16周后，实验组在自我护理和眼部护理行为参与度方面的平均得分显著高于对照组（P<0.001）。自我护理和眼部护理信心行为得分最高，其次是维持、监测和管理。此外，HbA1c水平和VRQoL在第16周时显著下降，且低于对照组（分别为P<0.001和P<0.05）。然而，VA没有显著差异，到第16周时两组的DR严重程度均有所增加。
SCPP对DR患者有益，可增强他们执行、监测和管理自我护理行为的信心和能力。这些策略有助于改善糖尿病管理、提高生活质量并减少与DR相关的失明。建议将SCPP纳入常规DR管理，护士在监督和推动这种整合方面发挥关键作用，凸显了护士在管理这种全球广泛疾病中的重要作用。
泰国临床试验注册（TCTR20230302002）。
