賦權教育介入方案對第2型糖尿病個案之成效探討

本研究目的在探討賦權教育介入方案對第2型糖尿病個案之成效。研究採立意取樣，以台灣南部2家設置糖尿病共同照護網之診所與區域醫院的新陳代謝科門診為收案場所。其收案條件包括：（1）診斷為第2型糖尿病個案；（2）意識清楚，可與他人溝通者；（3）年齡為40至70歲；（4）識字，有書寫能力者；（5）能自行執行自我照顧者；（6）最近一次糖化血色素≧8％以上。採實驗性設計，以隨機化區組抽樣法分派個案為實驗組與對照組，研究對象共72位。對照組接受一般照護。實驗組接受每週1次，每次時間平均1小時，共12週的賦權教育介入方案。資料收集採質量性研究法，於介入前、介入完成後一週與介入完成後三個月以「糖尿病自我照顧行為量表」、「糖尿病賦權量表」、「生活品質量表」及「個案基本資料表」等量表與測量血中「糖化血色素」收集資料，並於介入完成後一週，以質性訪談大綱收集個案生活經驗的改變情形。量性資料以EXCEL 2003與SPSS 17.0套裝軟體進行建檔及統計分析，統計方法包括次數分配、百分比、平均值、標準差、卡方檢定、獨立樣本t檢定、配對樣本t檢定、效力計算與廣義估計方程式。質性資料則採內容分析法進行分析。結果顯示（一）實驗組之自我照顧行為、自我效能、生活品質於介入完成後一週即顯著升高，在介入完成後三個月可維持其效益，但無持續顯著上升；實驗組之糖化血色素於介入完成後一週即顯著下降，在介入完成後三個月有持續顯著下降；(二）於介入完成後一週與三個月，實驗組之自我照顧行為、自我效能、生活品質顯著高於對照組，實驗組之糖化血色素顯著低於對照組；（三）在介入完成後三個月與介入前改變量相對於介入完成後一週與介入前改變量，實驗組在自我照顧行為、自我效能、生活品質與糖化血色素之改變量差異雖高於對照組，但皆未達統計上顯著差異；（四）糖尿病個案生活經驗的改變情形包括（1）促進個人的成長，包括正視自己、個別性知識的澄清與增進、由身體跨越心靈層面的成長及自主調節自我照顧行為等四個次主題；（2）融合於外在環境，包括與重要他人共同面對、與專業人員成為伙伴關係及妥善運用身邊的資源等三個次主題；（3）超越糖尿病、掌控人生，包括把握當下、珍惜僅有及擺脫負擔、享受生活等兩個次主題。本研究結果可供實務、教育與研究參考，期藉賦權教育介入方案提升第2型糖尿病個案之健康與生活品質。

關鍵字

糖尿病；賦權；教育

並列摘要

The purpose of this study was to examine the effects of an empowerment-based education program for patients living with type 2 diabetes. Purposive sampling obtained from outpatient department of clinic and hospital with diabetes shared care in southern Taiwan. Sampling criteria included: (1) diagnose of type 2 diabetes, (2) clear mental status and able to communicate, (3) age between 40 and 70 years olds, (4) literacy and able to write, (5) ability to perform self-care, (6) HbA1C 8 % or higher. The study was an experimental design. Using permuted block randomization, 72 patients were randomly assigned into experiment or control group. Subjects in control group received the routine clinical care. The subjects of the experimental group received an empowerment-based education program. The program was held one time a week, with 12 times, average 1 hour per time. Using quantitative and qualitative methods,quantitative data were collected by Diabetes Self-Care scale, Diabetes Empowerment Scale, Diabetes Quality of Life scale and blood HbA1C before the education program and 1 week and 3 months thereafter; qualitative data were collected by interview at 1 week after the intervention program. Quantitative data were analyzed with EXCEL 2003 and SPSS for Windows 17.0 software. Statistical analyses included frequency, percentage, mean, standard deviation, independent-samples t test, paired-samples t test, effect size calculation, and generalized estimated equation. qualitative data were analyzed by content analysis. The results of this study indicated that patients in the experiment group significantly improved their levels of self-care behaviors, self efficacy, quality of life and HbA1C at 1 week and at 3 months post-intervention; however, only their HbA1C levels significantly differed between 1 week post-intervention and 3 months post-intervention. Also, patients in the experiment group significantly improved their levels of self-care behaviors, self efficacy, quality of life and HbA1C than those in the control group at 1 week and 3month post-intervention. Additionally, comparison of self-care behaviors, self-efficacy, quality of life and blood HbA1C between pre-intervention and 3months post-intervention and between pre-intervention and 1-week post-intervention showed not significantly improvements in the experimental group than in controls. Furthermore, in the experimental group, other changes revealed by content analysis included (1)increasing personal growth: self-awareness, clarify and increasing individual knowledge, physical and psychosocial growth and self-regulation of self care behavior; (2) well interacted with environments: faced diabetes with important person, partnership with healthcare provider and coordinated with resources; (3) beyond diabetes and control lives: seize the day, value only and get rid of burden and enjoy life. In conclusion, the results of this study provide a reference for health education, practice, and research for diabetes patients. To promote the health and quality of life of patients living with type 2 diabetes, an empowerment-based education program could be used.