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研究生: 蘇海托
Sugiharto,
論文名稱: 糖尿病自我照顧月曆對第二型糖尿病病人自我照顧活動遵從性與血糖控制之成效
Effects of Diabetes Self-Care Calendar on Self-Care Activities Adherence and Glycemic Control among Patients with Type 2 Diabetes Mellitus
指導教授: 許玉雲
Hsu, Yu-Yun
學位類別: 博士
Doctor
系所名稱: 醫學院 - 護理學系
Department of Nursing
論文出版年: 2018
畢業學年度: 107
語文別: 英文
論文頁數: 109
外文關鍵詞: diabetes self-care activities adherence, diabetes self-care calendar, glycemic control, type 2 diabetes mellitus
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  • Background - Diabetes self-care is a complex regimen that requires self-management to accomplish with it. An appropriate reminder tool is demanded to satisfy the self-care activities. The appropriate self-care reminder tool should be customized based on those patients’ culture, conditions, and needs.

    Purposes - The study aimed to examine the effects of diabetes self-care calendar (DSCC), a self-care reminder tool, on diabetes self-care activities adherence, diabetes knowledge levels, social support, and glycemic control among patients with type 2 diabetes mellitus in Indonesia.

    Method - A randomized controlled trial design was used in this study. A total of 124 subjects who met the inclusion criteria participated in this study. Three community health centers were randomly assigned to either intervention or control groups. Moreover, proportionate stratified sampling was used to select potential subjects. The DSCC provided as an intervention, which is held over four months. The control group was treated with usual care without using any reminder tool. The Summary of Diabetes Self-Care Activities (SDSCA), the Diabetes Knowledge Questionnaire (DKQ), the Multidimensional Scale Perceived Social Support (MSPSS), and HbA1c were used as measurements. For the short-term and long-term effects were analyzed using descriptive analysis, independent t-test, the Mann-Whitney U-test, and repeated measurement ANOVA.
    Results - Overall, the average age of the subjects was 55 (SD = 7.3) ranging from 32 to 78 years old. The average duration of diabetes from diagnosis was 4.9 years (SD = 5.2) ranging from 0.6 to 40 years. Of the subjects, 68% were females and 32% had no formal education level and 30% had a primary school. The results show that diabetes self-care calendar could enhance self-care activities including general diet, specific diet, exercise, self-monitoring blood glucose, foot care, and taking medication, all p-value < .05. The diabetes knowledge levels in the intervention group were significantly greater than that in control group p-value < .001. In term of social support, the results show that only on friends subscale was affected by using diabetes self-care calendar p-value < .01. There is no changed (p-value > .05) neither subscales of family nor healthcare providers. The HbA1c level in the intervention group was significantly lower than that in the control group (p-value < .01).
    Conclusions - The Diabetes Self-Care Calendar could significantly improve self-care activities adherence, diabetes knowledge, social support, especially in friendship support, and improve blood sugar control.
    Implications and Recommendations – An accessible self-care reminder is needed to those who with diabetes. As the implications, the diabetes educators can apply the self-care calendar into their educational program to improve patient’s self-care adherence. The DSCC can be as a diabetes self-care reminder tool. Future studies should examine the effects of the self-care calendar on patients with type 1 diabetes mellitus and measure include other metabolic and psychosocial outcomes.

    COVER I ENDORSEMENT SHEET II ABSTRACT III ACKNOWLEDGEMENTS V TABLE OF CONTENTS VI LIST OF TABLES X LIST OF FIGURES XI CHAPTER I INTRODUCTION 1 1.1 Research Background. 1 1.2 Significant of the Study 3 1.3 Purposes 4 1.4 Hypotheses 4 1.5 The Theory Guiding the Study 5 1.6 Study Framework 7 1.7 Operational Definition 7 1.7.1 Diabetes self-care calendar 7 1.7.2 Glycemic control (HbA1c) 7 1.7.3 Diabetes self-care activities 8 1.7.4 Diabetes Knowledge 8 1.7.5 Social support 9 CHAPTER II LITERATURE REVIEW 11 2.1 Diabetes Self-Management 11 2.1.1 Definition of Diabetes Self-Management 11 2.1.2 Diabetes Self-Management Activities 12 2.1.3 Summary 19 2.2 Diabetes Self-Management Strategies 20 2.2.1 Types of Diabetes Self-Management Strategy 20 2.2.2 The Evidence in Relation to Diabetes Self-Management Strategies 20 2.2.3 Summary 22 2.3 Adherence to Diabetes Self-Management 23 2.3.1 Definition of adherence 23 2.3.2 Factors influencing adherence to diabetes self-management 23 2.3.3 Adherence to Diabetes Self-Management 25 2.3.4 Summary 25 2.4 Diabetes Self-Management Outcomes 26 2.4.1 Glycosylated Hemoglobin (HbA1c) 26 2.4.2 Diabetes Self-Management and HbA1c 26 2.4.3 Summary 27 CHAPTER III METHOD 28 3.1 Pilot Study 28 3.1.1 Feasibility Test of the Diabetes Self-Management Calendar 28 3.1.2 Procedures of Pilot Study 29 3.1.3 Results of Pilot Study 29 3.1.4 Conclusion 32 3.2 Study Design 32 3.3 Sample and Setting 33 3.3.1 Subjects 33 3.3.2 Setting 33 3.3.3 Sampling Procedures 34 3.4 Instruments 37 3.5 Cross-cultural translation process of the instruments 39 3.6 Intervention 41 3.7 Study Procedures 43 3.8 Ethical Considerations 45 3.9 Data Analysis 45 3.9.1 Univariate analyses 45 3.9.2 Bivariate analyses 46 CHAPTER IV RESULTS 47 4.1 Demographic Characteristics of Subjects 47 4.2 Diabetes Self-Care Activities Before, During and After the Intervention 51 4.3 Diabetes Knowledge Levels 55 4.4 Social Support 56 4.5 HbA1c 57 CHAPTER V DISCUSSION 60 5.1 The Diabetes Self-Care Calendar and the Diabetes Self-Care Adherence 60 5.2 The Diabetes Self-Care Calendar and the Diabetes Knowledge Levels 62 5.3 The Diabetes Self-Care Calendar and the Social Support 64 5.4 The Diabetes Self-Care Calendar and the Glycosylated Hemoglobin 65 CHAPTER VI CONCLUSIONS 68 6.1 Conclusions 68 6.1.1 From the perspective of intervention effect 68 6.1.2 From the perspective of trend 68 6.2 Limitations of the study 69 6.3 Implications and Recommendations of the Study 70 6.3.1 Clinical nursing practice 70 6.3.2 Future study 71 REFERENCES 72 APPENDIXES 84

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