【作者】 靳英辉；

【导师】 孙玫；

【作者基本信息】 天津医科大学 ， 护理学， 2011， 硕士

【摘要】 目的1引进美国密歇根大学糖尿病赋能教育量表(Diabetes Empowerment Scale, DES),进行必要的修订与文化调试,并且验证其信度和效度,为引进赋能教育理论提供有效的测评工具。2应用赋能理论进行糖尿病教育,确定其应用价值。3对赋能教育组的部分患者进行质性研究,以了解患者经历赋能教育的主观体验,为赋能教育在国内的推广应用进一步提供理论依据。方法1以美国密歇根大学糖尿病教育和训练中心的DES为对象,并取得DES的原设计者Anderson RM的授权。经前译、回译、专家评审和文化调试、患者试填等阶段,确定中文版糖尿病赋能教育量表CM-DES (China Mainland Diabetes Empowerment Scale)。采取便利抽样研究方法,于2009年6月-2009年9月在天津医科大学总医院代谢病科进行治疗的糖尿病患者,随机抽取63名糖尿病患者进行量表的预试验以确定CM-DES的信度和效度。并对影响CM-DES的得分的某些可能的相关因素进行分析。2采用随机数字表,将135例糖尿病患者随机分为干预组(赋能教育组)和对照组(传统依从式教育组)。两组在经过了充分的糖尿病知识宣教后,赋能教育组：应用赋能教育的五步法对患者进行五次一对一的赋能教育,传统的依从式教育组只在日常护理过程中采用督促、命令式的教育方式,并不进行一对一的教育。两组均在患者出院后一个月、三个月、六个月进行三次随访。3以质性研究中的现象学方法为指导,以半结构的深入式访谈对干预组的15例糖尿病患者进行深度访谈以了解患者经历赋能教育的主观体验。结果1最终确定的CM-DES含20条目,三个维度：自我认知(对疾病控制现状的认知、自身控制能力的认知)；自我决策(设立目标和达到目标)；自我调整(寻求支持并应对压力)。CM-DES经检验具有良好的信度和效度,CM-DES的Cronbach’s a系数是0.90,各维度的系数在0.88～0.96之间。设定的重测时间间隔为两周,三个维度的重测系数在0.82-0.96之间,总量表的重测系数为0.94。对60例有效样本数据进行因子分析,经方差最大正交旋转后,取3个特征根大于1的公因子,可解释总变异的79.65%。CM-DES相关影响因素研究结果：病人糖化血红蛋白水平与CM-DES得分呈负相关(r=-0.51,P=0.00)；控制疾病的态度越积极(r=0.68,P=0.00)、文化程度越高(r=0.28,P=0.03),CM-DES得分越高。CM-DES得分与病史(r=0.18,p=0.17)、年龄(r=0.28,P=0.09)、家庭经济收入(F=1.09,P=0.36)、家庭照顾情况(F=0.23,P=0.80)没有明显的相关性。2赋能教育相对于传统的依从式教育明显的降低了空腹血糖(F=15.20,P=0.00)和餐后两小时血糖(F=37.77,P=0.00),提高了CM-DES得分(F=24.47,P=0.00)、自我效能水平得分(F=13.85,P=0.00)、自测血糖率(F=48.64,P=0.00)。两组随访期均未发现生存质量的变化(F=0.01,P=0.94)。3行为改变的阻力是：没有认识到疾病的严重性或将行为改变的失败归咎于他人或环境。赋能教育中教育者和患者是“水平式”平等合作关系,促进患者成为积极的、被赋能的患者是糖尿病赋能教育成功与否的关键。结论CM-DES可以作为有效的测评工具应用于赋能教育中。赋能教育理论建立在和患者“水平式”的合作关系上,能够通过帮助患者识别自我管理中的问题、分析讨论、共同设立目标、做出糖尿病自我管理计划等步骤来逐步提高患者自我管理能力和帮助患者进行良好的血糖控制。更多还原

【Abstract】 Objectives1 To develop the Chinese Mainland version of 28-item DES aiming providing effective assessment tools for introducing Empowerment Education and to assess the reliability and validity of the Chinese Mainland Version。2 To determine if an empowerment-based education programme (EBE) is more effective than tranditional compliance-based education (TBE) in blood glucose, diabetes-related quality of life and self-efficacy.3 To explore 15 patients’experiences of participating in an empowerment group education.Methods1 Firstly, we translated the 28-DES into Chinese according to the principal of forward translation, back translation and review and culture adaptation. The test-retest reliability and constrcut validity of CM-DES was assessed by means of correlation anlysis and factor analysis. Internal consistency was tested by use of the Cronbach’s a coefficient. Factors that could influence CM-DES were discussed using Pearson or Spearman correlations,t-tests and ANOVA.2 135 patients with type 2 diabetes were randomized to the EBE group or TBE group. All patients received routinely diabetes education classes. Besides, patients in EBE group received five times one-to-one empowerment education in which educator used the empowerment approach to help patients indentify self-management problems, consider options, set goals and make adjustments. Glycemic control, CM-DES, self-efficacy, the quality of life scores and rate of behavior change were followed up and analyzed.3 In-depth interviews were used to explore 15 patients’s experiences of participating in an empowerment group education. All interviews were audio-taped and the transcripts were analysed by editing and immersion.Results1 CM-DES ascertained included 20 items and three subscales (self-understanding, self-determination and self-regulation). The Cronbach’s a coefficient for CM-DES was 0.90, and for the three subscales:(self-understanding, a=0.96), (Self-determination, a= 0.88) and (self-regulation, a=0.96). Pearson’s correlation coefficients of subscales for test-retest reliability ranged from 0.82 to 0.96. Almost all items were strongly correlated with hypothesized scale. The factor analysis resulted in three factors with eigenvalues> 1.0, explaining of the 79.65% variance. Patients with good metabolic control scored significantly highly on all CM-DES subscales (r=-0.51, P=0.00). People with more positive coping attitude(r=-0.68, P=0.00) and higher education level (r=0.28, P=0.03) scored higher in CM-DES. Associations were not found among the CM-DES and diabetes duration(r=0.18, P=0.17), age(r=0.28, P=0.09), family income(F=1.09, P=0.36),family care(F=0.23, P=0.80). 2 59 patients in EBE group and 60 patients in TBE group completed the six months follow-up. Using empowerment-based strategies can improve CM-DES scores (F=24.47,P=0.00), self-efficacy scores(F=13.85,P=0.00) and rate of self-monitor blood glucose (F=48.64, P=0.00), and decrease level of FPG(F=15.20, P=0.00) and 2hPG (F=37.77, P=0.00)obviously compared with that in TBE group. No significant differences (F=0.01, P=0.94) were found in life quality between EBE group and TBE group.3 (1)15 patients were interviewed. Three main categories crystallized form the interviews:two resistances for behaviour change:people are not completely aware of the diabetes severity and always blame failure of behaviour change on others or environment. (2) Horizontal relationships was built in empowerment course. (3) The Key to success of empowerment education is to make patients active and empowered.Conclusions CM-DES has good validity and reliability and, thus, could be a suitable tool in evaluating empowerment-based education programmes. Patient empowerment is an effective approach to helping blood glucose management, behavioral outcomes and impoving CM-DES and self-efficacy.更多还原