研究背景：過去研究顯示糖尿病與輕度認知功能障礙或失智症有關，且糖尿病合併認知障礙的患者通常比起單純糖尿病患者會有較低醫療遵從性、較低的自我照顧能力和決策能力下降的情形，導致病患血糖控制不良以及產生合併症。為了提高糖尿病照護品質並減輕家庭照顧者的負荷，需要更多專業支持和照護資源的協助。
目的：本研究旨在從糖尿病衛教師、病患和家庭照顧者的三方觀點探討糖尿病合併認知功能障礙之病患的照護挑戰和需求，並發展糖尿病衛教資源，建立其專家效度與測試臨床適用性。
方法：本研究採用探索性設計，透過半結構式訪談收集數據，並以主題分析法分析質性資料。接著，整合文獻回顧和訪談結果發展糖尿病衛教資源，並以修正型德爾菲法建立專家驗證。研究的最後階段則檢驗此糖尿病衛教資源的臨床適用性。
結果：研究第一階段在台灣南部的一家醫學中心招募了8名糖尿病衛教師、7名患有認知功能障礙的糖尿病患者和6名家庭照顧者接受訪談。研究發現照護挑戰包括較低的病患的醫療遵從性與家庭照顧者的參與度，以及家庭照顧者之壓力。而照護需求包括糖尿病衛教師與家庭照顧者的認知功能障礙照護培訓和標準照護程序的建立，此外也發現臨床現實面顯示出醫療專業人員對於長期照護相關資源轉介缺乏共識。在第二階段所開發的糖尿病衛教資源擁有極佳的專家效度，包含重要性和清晰度的內容效度分別為1.0和0.99。在第三階段的衛教資源適用性評值中，14位健康衛教師中超過九成認為所有衛教資源的項目都是重要且清晰的。
結論：本研究所發展的糖尿病衛教資源應能協助衛教師面對當前糖尿病合併認知功能障礙之護理挑戰。此糖尿病衛教資源具良好的專家內容效度與適用性測試，顯示其具有提升糖尿病護理品質的潛力，應在臨床糖尿病衛教師之繼續教育中廣泛推廣，並因應不同機構的需求和特點修正。未來研究應探討不同地區或專業人員在管理合併認知障礙的糖尿病方面的護理經驗，以更全面地解決當前的照護挑戰和需求。

Background: Research has reported that diabetes is related to mild cognitive impairment or dementia. People with diabetes and cognitive impairment typically have lower medical adherence, reduced self-care ability, and diminished decision-making ability, which potentially leads to poor glycemic control and increased complications. In order to provide quality care for patients and reduce the burdens on their family caregivers, more support and care resources from professionals are needed.
Aims: The purpose of this study is to explore the care challenges and needs of people with diabetes and cognitive impairment from a tripartite perspective of diabetes educators, patients, and family caregivers. The aims also include developing diabetes educational material, establishing its expert validity, and testing its clinical usability.
Methods: The study utilized an exploratory design with semi-structured interviews and thematic analysis to collect and analyze qualitative data. After that, diabetes educational material was developed through the integration of literature review and the results of the interviews, and expert validation through the modified Delphi method was established. The clinical usability of the diabetes educational material was examined at the final stage of this research.
Results: Stage 1 recruited 8 qualified diabetes educators, 7 patients with diabetes and cognitive impairment, and 6 caregivers for interviews at a medical center in southern Taiwan. Findings revealed care challenges in adherence, limited family involvement, and distress of family caregivers. Care needs included training for educators on cognitive impairment management, caregiver education, and standard care procedures also identified. Clinical realities showed inconsistent awareness and a lack of consensus on resource referrals among healthcare professionals. The diabetes educational material developed in stage 2 showed excellent expert validity, which its average Scale-level Content Validity Index (S-CVI/Ave) was 1.0 for importance and 1.0 for clarity. The usability evaluation in stage 3 also reported that over 90% of the 14 health educators agreed that all items in the educational material are important and clear, which means it is suitable for diabetes educators to use in diabetes education.
Conclusions: The developed diabetes educational material should assist diabetes educators in addressing the care challenges of patients with diabetes and cognitive impairment. It demonstrates high content validity and has strong potential to enhance diabetes care quality. This material should be widely promoted in clinical diabetes education and adapted to the needs and characteristics of different institutions. Future research should explore the care experiences of various regions or professionals in managing diabetes and cognitive impairment, aiming to more comprehensively address current medical challenges and needs.

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