在II型糖尿病患者進行自我管理教育，在布基納法索和海地的生活成果質量的國際比較

International Comparisons of Quality of Life Outcomes in Type II Diabetes Mellitus Patients Undergoing a Self-Management Education in Burkina Faso and Haiti

康斯坦(Constant Dahourou)

指導教授 ： 黃國哲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00188

摘要

背景：糖尿病（DM）是終身的內分泌紊亂，引起胰島素絕對缺乏或相對缺乏的病人的身體。它與長期損害的人體器官和增加年齡調整後的死亡率全球，特別是在發展中國家。使用的臨床措施，如控制血糖，糖化血紅蛋白（HbA1c）和合併症發生的水平是不夠的糖尿病綜合管理，以評估健康結果。糖尿病相關的生活質量，病人的福祉和自我估計的一部分需要進行探索，特別是在資源貧乏的設置。目前的研究中，我們選擇了一個非洲國家（布基納法索）和加勒比（海地）在台灣學到的經驗為基礎的糖尿病患者的生活質量評估和了解。這兩個國家有幾乎相同的社會經濟和人口特徵。根據世界衛生組織（訪問於2011年9月10日），從2000年到2030年，糖尿病患病率將提高至161，000在海地和124000在布基納法索388,000 401,000。糖尿病自我管理教育（DSME）已經認識到發展中國家作為一個最好的糖尿病患者健康相關生活質量（HRQOL）的預測。目前的研究提供一些見解，旨在探討這兩個概念（大宇造船和糖尿病的HRQoL），不僅為撒哈拉以南非洲和加勒比國家，也為所有發展中國家制定一些有用的命題。
目標：評估和比較糖尿病（DM）患者接受六個月的自我管理方案，在布基納法索和海地的生活成果的質量。
方法：本研究遵循實驗設計之前和之後1。我們在太子港王子（海地）和大道（布基納法索）設計和實施糖尿病自我管理教育（DSME）計劃，並在基線評估的參與者和使用糖尿病的具體問卷的D-39的研究。我們用SPSS統計軟件包版本18進行描述和推理測試。
結果：從招募和隨訪的195例患者中，有45名來自布基納法索（對照組為22和23研究組），從海地對照組（75和75研究組）和150。 72.3％的參加者年齡從31歲到60歲。 19.5％0F參與者為男性（N = 38與25日在布基納法索和海地13）和80.5％，女性20日在布基納法索和海地137（N = 157）。 26.2％的患者有合併症或馬克相關的並發症，只有26.7％可以由自己支付的糖尿病護理。在D-39問卷的可靠性為0.97和0.96 Cronbach的阿爾法後干預。
結果表明，所有與會者考慮組一起在糖尿病AP值小於0.05（糖尿病控制，能源和流動性，P = 0.004，P = 0.009，焦慮與生活質量的域顯著改善和擔心，P = 0.02，社會負擔P = 0.026）。不過，最後的域名（性功能）沒有表現出任何顯著的結果（P = 0.22）。有關國家的比較，所有的生活質量的改善，在布基納法索，比他們為海地。經過調整，包括從單因素干預前的階段，所有的變量，生活質量的預測因素包括運動（P = 0.002），對生活質量的總體看法（P = 0.003）和疾病的嚴重程度的總體看法（P <0.001）。干預後的多因素分析顯示，生活質量的預測因素包括年齡（p <0.001），與疾病的嚴重程度（P = 0.029）的總體看法。
結論：無論是國家，一個精心設計和實施的個人基於大宇造船可以改善貧乏的病人的生活品質，並幫助減少糖尿病的整體成本。護理人員的領導作用，與醫師合作是必要的，必須注意，我在了解糖尿病患者的性功能，以幫助他們實現一個正常的福祉和自我估計。

關鍵字

糖尿病 ； 生活質量 ； 海地 ； 布基納法索 ； 自我管理 ； 問卷的D-39

並列摘要

Background: Diabetes mellitus (DM) is a life long endocrine disorder caused by an absolute lack of insulin or a relative lack of it in the patient’s body. It is associated with a long-term damage of human organs and an increased age adjusted mortality rate worldwide, particularly in developing countries. The use of clinical measures like glycemic control, the level of hemoglobin A1c (HbA1c) and co-morbidities occurrence are not sufficient to assess the health outcomes of a comprehensive diabetes management. Diabetes related quality of life as part of patient well-being and self-estimation need to be explored particularly in poor resources settings. In the current study, we chose an African country (Burkina Faso) and a Caribbean one (Haiti) to evaluate and understand more about the quality of life of DM patients based on experiences learned in Taiwan. These two countries have almost the same socioeconomic and demographic profiles. According to the WHO (accessed on September 10th 2011), from year 2000 to 2030, DM prevalence will raise from 161, 000 to 401,000 in Haiti and from 124,000 to 388,000 in Burkina Faso. Diabetes self-management education (DSME) has been recognized in developing countries as a predictor of best health-related Quality of Life (HRQoL) in DM patients. The current study is designed to explore these two concepts (DSME and Diabetes HRQoL) by giving some insights and formulate some propositions useful not only for the sub-Saharan and the Caribbean countries but also for all developing countries.
Objectives: Evaluate and compare the quality of life outcomes of Diabetes Mellitus (DM) patients undergoing a six-month self-management program in Burkina Faso and Haiti.
Methods: This study followed a before and after experiment design. We designed and implemented a diabetes self-management education (DSME) program in Port-au-Prince (Haiti) and Dori (Burkina Faso) and evaluated the participants at the baseline and the end of the study using the diabetes specific questionnaire D-39. We used SPSS Statistical Package version 18 to perform descriptive and inferential tests.
Results: From the 195 patients recruited and followed up, 45 were from Burkina Faso (22 for the control group and 23 for the study group), and 150 were from Haiti (75 in control group and 75 in the study group). 72.3% of the participants were aged from 31 to 60 years. The 19.5% 0f the participants were male (n=38 with 25 in Burkina Faso and 13 in Haiti) and 80.5% were female (n=157 with 20 in Burkina Faso and 137 in Haiti). 26.2% of the patients had co-morbidities or complications associated to DM and only 26.7% could pay by themselves their DM care. The reliability of the D-39 questionnaire was 0.97 before and 0.96 Cronbach’s alpha after the intervention.
The results showed for all the participants considered together by group a significant improvement in four domains of diabetes related QOL with a p value less than 0.05 (Diabetes control p=0.004, Energy and mobility p=0.009, Anxiety and worry p=0.02, Social burden p=0.026). However, the last domain (sexual functioning) did not show any significant result (p=0.22). Regarding countries’ comparisons all the quality of life improvements were higher in Burkina Faso than they were Haiti. After adjustment, including all variables from the univariate stage and before the intervention, the predictor factors of quality of life consisted of exercise (p=0.002), overall view about quality of life (p=0.003) and overall view on severity of the disease (p<0.001). The multivariate analysis after the intervention showed that the predictor factors of quality of life consisted of age (p<0.001), and overall view on severity of the disease (p=0.029).
Conclusion: No matter the country, a well-designed and implemented individual based DSME can improve the HRQOL of patients in poor settings and helpfully reduce the overall cost of DM. The leadership role of nursing staff together with the collaboration of physicians is needed and an attention must me put in the understanding of DM patients’ sexual functioning in order to help them to achievement a normal wellbeing and self-estimation.

並列關鍵字

Diabetes Mellitus ； Quality of Life ； Haiti ； Burkina Faso ； Self-management ； D-39 Questionnaire

參考文獻

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