基于跨理论模型的在线干预改善中国成年 2 型糖尿病初诊患者药物依从性的混合方法研究。

A Transtheoretical Model-Based Online Intervention to Improve Medication Adherence for Chinese Adults Newly Diagnosed With Type 2 Diabetes: A Mixed-Method Study.

机构信息

Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand.

School of Nursing, Southwest Medical University, Luzhou, China.

出版信息

J Prim Care Community Health. 2024 Jan-Dec;15:21501319241263657. doi: 10.1177/21501319241263657.

DOI:10.1177/21501319241263657

PMID:39077970

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11289821/

Abstract

BACKGROUND

Type 2 diabetes mellitus (T2DM) is increasing in China, with medication non-adherence being a significant contributor to uncontrolled T2DM. The Transtheoretical Model (TTM) has shown effectiveness in chronic disease management, but few studies have applied it in online interventions for T2DM medication adherence.

AIM

The study aimed to develop and investigate the effects of a TTM-based online health education program on promoting positive stage of change (SOC) movement, improving self-efficacy and medication adherence, as well as reducing HbA1c levels in newly diagnosed patients with T2DM.

METHODS

This sequential mixed-method study was conducted from April 2023 to March 2024. Using the TTM framework, the study initially explored 32 participants' experiences with hypoglycemic medications, health information acquisition, and perspectives on online programs. Then, a quasi-experimental study design was conducted. Two communities were randomly assigned as the intervention (n = 91) and comparison (n = 98) groups, with 189 newly diagnosed middle-aged T2DM patients from various SOC. The intervention group received short videos health education and participated in WeChat group discussions, compared with usual care in the comparison group. Data were collected at baseline, 3-month, and 6-month follow-ups.

RESULTS

The intervention group was more likely to achieve positive SOC movement ( < .001, Adj OR = 13.69 95% CI = 6.76-27.71) compared to the comparison group. The intervention group also had significantly higher mean CDMSS-11 and MMAS-8 scores at 6 months ( = .03 and <.001, respectively) and more likely to achieve clinically significant glycated Hemoglobin (HbA1c) change at 3 months ( < .001, Adj OR = 3.91, 95% CI = 1.77-8.63) and at 6 months ( < .001, Adj OR = 5.62, 95% CI = 2.70-11.69) compared to the comparison group.

CONCLUSION

These findings support that applying the TTM to develop an online program could promote behavior change, improve self-efficacy and medication adherence, and could lead to better glycemic control in newly diagnosed T2DM patients.

摘要

背景

2 型糖尿病（T2DM）在中国呈上升趋势，药物依从性差是导致 T2DM 控制不佳的重要原因。跨理论模型（TTM）在慢性病管理中已显示出有效性，但很少有研究将其应用于 T2DM 药物依从性的在线干预中。

目的

本研究旨在开发并探讨基于 TTM 的在线健康教育计划对促进新诊断 T2DM 患者积极转变阶段（SOC）、提高自我效能和药物依从性以及降低糖化血红蛋白（HbA1c）水平的效果。

方法

这是一项从 2023 年 4 月至 2024 年 3 月进行的序贯混合方法研究。使用 TTM 框架，研究最初探讨了 32 名参与者对降糖药物、健康信息获取和在线项目的体验。然后，进行了准实验设计。将两个社区随机分配为干预组（n=91）和对照组（n=98），共有 189 名来自不同 SOC 的中年新诊断 T2DM 患者。干预组接受短视频健康教育并参加微信群讨论，而对照组则接受常规护理。在基线、3 个月和 6 个月的随访中收集数据。

结果

与对照组相比，干预组更有可能实现积极的 SOC 转变（ < .001，调整后的优势比（OR）=13.69，95%置信区间（CI）=6.76-27.71）。干预组在 6 个月时的 CDMSS-11 和 MMAS-8 评分均值也显著更高（ = .03 和 <.001），并且在 3 个月（ < .001，调整后的 OR=3.91，95%CI=1.77-8.63）和 6 个月（ < .001，调整后的 OR=5.62，95%CI=2.70-11.69）时更有可能实现临床显著的糖化血红蛋白（HbA1c）变化。