Miyashita Ayano, Nakamura Keiko, Kibusi Stephen M, Meshi Eugene Benjamin, Bendera Anderson, Sato Hideko, Al-Sobaihi Saber, Tashiro Yuri, Ramaiya Kaushik L, Sunguya Bruno F, Seino Kaoruko
Department of Global Health Entrepreneurship, Division of Public Health, Institute of Science Tokyo (formerly, Tokyo Medical and Dental University), Tokyo, Japan.
Department of Public Health, School of Nursing and Public Health, The University of Dodoma, Dodoma, United Republic of Tanzania.
Int Health. 2025 May 1;17(3):342-350. doi: 10.1093/inthealth/ihae070.
The rise of hypertension (HTN) and diabetes mellitus (DM) in Tanzania underscores the importance of self-care practices (SCP) for disease management. Despite the proven effectiveness of SCP, financial barriers in resource-limited rural areas hinder continuous care. Health insurance (HI) emerges as a critical solution to alleviate financial constraints and support SCP.
This study examined an association between HI and SCP by generalised linear and ordinal logistic regressions, adjusted for sociodemographic factors. Mediation analysis highlighted the role of disease management behaviours (hospital visits and medication adherence) in the association. Data were collected through individual interviews with 909 patients.
Better SCP for HTN and DM were associated with the National Health Insurance Fund (HTN: coefficient=0.571; DM: coefficient=0.567, p<0.001) and the improved Community Health Fund (iCHF) or CHF (HTN: coefficient=0.330; DM: coefficient=0.472, p<0.05), after adjustment for sociodemographic variables. Mediation analysis showed that disease management behaviours partially or fully mediated the relationship between HI and SCP.
Enrolment in HI by patients in rural Tanzania exhibited better disease management behaviours and SCP. Efforts should focus on leveraging the HI schemes to expand their coverage in rural areas, which could benefit patients with non-communicable diseases.
坦桑尼亚高血压（HTN）和糖尿病（DM）发病率的上升凸显了自我护理措施（SCP）在疾病管理中的重要性。尽管SCP已被证明有效，但资源有限的农村地区的经济障碍阻碍了持续护理。健康保险（HI）成为缓解经济限制和支持SCP的关键解决方案。
本研究通过广义线性回归和有序逻辑回归分析了HI与SCP之间的关联，并对社会人口学因素进行了调整。中介分析强调了疾病管理行为（就诊和药物依从性）在这种关联中的作用。通过对909名患者进行个人访谈收集数据。
在对社会人口学变量进行调整后，加入国家健康保险基金（HTN：系数=0.571；DM：系数=0.567，p<0.001）以及加入改良社区健康基金（iCHF）或社区健康基金（CHF）（HTN：系数=0.330；DM：系数=0.472，p<0.05）与更好的HTN和DM的SCP相关。中介分析表明，疾病管理行为部分或完全介导了HI与SCP之间的关系。
坦桑尼亚农村地区的患者加入HI表现出更好的疾病管理行为和SCP。应努力利用HI计划扩大其在农村地区的覆盖范围，这可能使非传染性疾病患者受益。
