同儕領導自我管理方案對老年糖尿病患者自我效能、自我管理與生理指標之成效探討：前驅隨機控制試驗

背景：現行糖尿病同儕自我管理方案大多以社區工作人員或一般65歲以下糖尿病為主導的介入模式，然因其難以感同老年患者在疾病照護的需要與障礙，致使老年人的自我管理成效有限。若能透過有相同文化背景與疾病照護生活經驗，且具成功自我管理經驗的同儕領導者，引導老年糖尿病患者學習自我管理技能，可能更事半功倍。目的：發展老年糖尿病患者同儕領導自我管理方案，並測試其在自我效能、自我管理及生理指標之效應。方法：採雙組前後測、區段隨機控制試驗設計，招募65歲以上社區老年糖尿病患者進入研究。實驗組個案(n=14)接受為期4週的同儕領導自我管理方案；對照組個案(n=14)僅發放自我管理手冊及接受原有的門診常規照護，並分別於方案介入前(T0)、介入方案結束當天(T1)及介入結束後滿12週(T2)測量其自我效能、自我管理與生理指標之成效，採用Chi-square Test、Fisher’s exact test、Mann-Whitney U test、Friedman test、Wilcoxon signed rank test、Generalized estimating equation等統計方法，進行結果分析。結果：同儕領導自我管理方案介入後，兩組組間比較顯示，實驗組在後測1(T1)與後測2(T2)於自我效能及自我管理改變量，均顯著高於對照組(p <.001)，實驗組在後測2的糖化血色素(HbA1c)、體重及身體質量指數，亦顯著優於對照組(p = .004; p < .001; p < .001 )。結論與實務應用:老年糖尿病患者同儕領導自我管理方案之研究結果已顯示初步成效，未來若能進一步透過縱貫性研究印證其長期效益，其實證研究結果將有助於社區中推廣，並培養更多的同儕領導者成為病友專家，引導老年糖尿病患者學習自我管理，不僅能受惠於更多的老年糖尿病族群，也可適度減緩健康照護人員的工作負荷。

關鍵字

老年；糖尿病；自我管理；同儕領導

並列摘要

Background: Diabetes PLSM (Peer Led Self Management) programs are typically led by community workers or peer patients under 65 years old. Older peer patients with a history of successful self-management, may improve the effectiveness of PLSM program for other older adults with diabetes. Aim: This pilot study aims to develop and explore the effectiveness of PLSM program on self-efficacy, self-management, and physiological measures in older adults with diabetes. Method: We recruited older adults with diabetes age > 65 in a double-blind, two group (pretest-posttest design) block randomized controlled trial. The experimental group (n=14) enrolled in a 4-week PLSM program; the control group (n=14) received instruction manuals on self-management and continued their usual clinical care. Indicators of effectiveness (self-efficacy, self-management, and physiological measures) were measured at three time points: before the intervention of the program (T0), the day it ended (T1), and 12 weeks after (T2). Chi-square test, Fisher's exact test, Mann-Whitney U test, Friedman test, Wilcoxon signed-rank test, Generalized estimating equation and other statistical methods were used to analyze the results. Results: After PLSM program, self-efficacy, self-management measures of the experimental group at post-test 1 (T1) and post-test 2 (T2) were significantly higher (p < .001). HbA1c, body weight and body mass index at post-test 2 (T2) also presented significantly better results than in the control group (p < .001; p < .001; p < .001). Conclusion and Implications for practice: If future longitudinal research can further substantiate the program’s long-term benefits, the promotion and training of older peer patients to lead PLSM program can alleviate the workload of healthcare professionals.

並列關鍵字

older adults ； diabetes ； self-management ； peer-led

參考文獻

Bandura, A. (1986). The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology, 4(3), 359-373. https://doi.org/10.1521/jscp.1986.4.3.359

宋藝君、陳淑芬、林秋菊(2008)‧慢性病自我管理的概念分析‧新台北護理期刊, 10(2), 49-56。https://doi.org/10.6540/NTJN.2008.2.005