糖尿病患者自我導向學習衛生教育策略之效果研究

Abstract

本研究旨在瞭解糖尿病患者的糖尿病知識、糖尿病控制自覺利益、糖尿病控制自覺障礙、糖尿病自我照顧行為、及糖尿病控制自我效能之現況，並探討「糖尿病自我導向學習衛生教育策略」對糖尿病患者的糖尿病知識、糖尿病控制自覺利益、糖尿病控制自覺障礙、糖尿病自我照顧行為、及糖尿病控制自我效能之影響，並進一步暸解糖尿病患者對該介入課程之評價。

本研究採準實驗研究，以台北縣市、基隆市、桃園縣所屬糖尿病友團體之糖尿病患者為研究對象，招募自願參加者為實驗組和對照組，實驗組接受三天共十五小時之「糖尿病自我導向學習衛生教育策略」介入，對照組不介入。在教學介入前一週，以問卷收集研究對象的基本資料、糖尿病知識、糖尿病控制自覺利益、糖尿病控制自覺障礙、糖尿病自我照顧行為、及糖尿病控制自我效能之現況，並於介入後一週內進行後測，以瞭解教學介入的成效和過程評價。

研究資料以卡方檢定、獨立t檢定、配對t檢定、多元迴歸分析等方法進行資料分析，所得結果如下： 一、糖尿病患者的糖尿病知識偏高，對糖尿病控制的利益性持正向意見，自覺控制糖尿病的障礙為中等程度，執行糖尿病自我照顧行為情形為中低程度，對糖尿病控制的自我效能屬於中等程度。 二、「糖尿病自我導向學習衛生教育策略」對於提升糖尿病患者之糖尿病知識、糖尿病控制自覺利益、糖尿病自我照顧行為及糖尿病控制自我效能等方面達顯著效果，但對於改善糖尿病控制自覺障礙的效果不顯著。 三、「年齡」、「職業狀況」、「罹病年數」是影響糖尿病患者教學前糖尿病知識成績之顯著因素；「性別」和「教育年數」是影響糖尿病患者教學前糖尿病控制自覺利益成績之顯著因素；教學前的「糖尿病控制自我效能」是影響糖尿病患者教學前糖尿病控制自覺障礙成績之顯著因素；「年齡」和教學前的「糖尿病控制自我效能」是影響糖尿病患者教學前糖尿病自我照顧行為成績之顯著因素；「性別」和教學前的「糖尿病控制自覺障礙」、「糖尿病自我照顧行為」是影響糖尿病患者教學前糖尿病控制自我效能成績之顯著因素。 四、「教學策略」是影響糖尿病患者教學後糖尿病知識、糖尿病控制自覺利益、糖尿病自我照顧行為、及糖尿病控制自我效能之顯著因素。 五、教學前的「糖尿病知識」為影響糖尿病患者教學後糖尿病知識成績的顯著因素；「性別」和教學前的「糖尿病自我照顧行為」為影響糖尿病患者教學後糖尿病自我照顧行為成績的顯著因素；教學前的「糖尿病控制自覺利益」和「糖尿病控制自我效能」為影響糖尿病患者教學後糖尿病控制自我效能成績的顯著因素。 六、有九成以上的學員表示喜歡「糖尿病自我導向學習衛生教育課程」，認為這個課程有幫助、能符合需求，而且學習氣氛和時間掌握都良好。

整體而言，透用「糖尿病自我導向學習衛生教育策略」的介入方式，可以有效提升糖尿病患者自我照顧的相關知能，建議未來能進行相關研究深入探討，並將此策略推廣運用於各糖尿病病友團體中。The purposes of this study are: (1) to investigate diabetics’ knowledge of diabetes mellitus (DM), perceived benefits and barriers of DM control, DM self-care behavior and also self-efficacy of DM control among diabetics; (2) to evaluate the effects of knowledge change, perceived benefits and barriers of DM control, self-care behavior, and self-efficacy over DM control after implementing the self-directed learning strategy on the target population; finally, (3) to survey the diabetics’ perception of the intervention.

A quasi-experimentation design is conducted in the study. The study units are diabetics who volunteered to be survey form diabetes support groups in Taipei City, Taipei County, Keelung City and Taoyuan County. To evaluate self-directed learning strategy of diabetes control, the experimental group received a five-hour lecture daily for 3 days, whereas the intervention was not done on the control group. Two surveys are conducted one week before and after the intervention to collect information for evaluating the intervention.

Chi-square test, student-t test, Pair-t test, and multiple regression analysis are all conducted. The main findings of the study are as follows:

1. Generally, the higher the knowledge of DM, the higher perceived benefits of DM control. The medium level of perceived barriers of diabetes control shows lower medium self-care behavior of diabetics, and medium self-efficacy of diabetes control.

2. The intervention shows significantly improvement in the knowledge of DM, perceived benefits of DM control, self-care behavior of DM, and self-efficacy of DM control, whereas not in perceived barriers of DM control

3. Age, work, and duration of diabetes are the impact factors on the diabetic knowledge score before the intervention. Sex and education are the influential factors of perceived benefits of DM before the intervention as well. The self-efficacy of DM control before the intervention is the influential factor of perceived barriers of DM control. Age and self-efficacy of DM control before the intervention are influential factors of self-care behavior. Sex, perceived barriers of DM control, and self-care behavior of diabetics before the intervention are influential factors of self-efficacy of DM control.

4. The intervention, teaching strategy, significantly improves the knowledge of diabetics, perceived benefits of DM control, self-care behavior of diabetics, and self-efficacy of DM control.

5. The knowledge scores of diabetics of the pretests significantly influence the post-knowledge scores. Sex, and the pretest scores of self-care behavior of DM significantly influence the post-scores of self-care behavior of DM. The pretest scores of perceived benefits of diabetes, and of self-efficacy of DM control are both impact factors on thepost-score level of self-efficacy of DM control.

6. Ninety percent of the surveyed patients expressed that they like the lectures, and believe that the intervention is helpful in general. The course contents are meet participants’ need.

In conclusion, the self-directed learning strategy is an effective educational intervention to educate DM patients with adequate information of diabetes. The developed intervention can be a template to be used in other settings of diabetes support groups.