復原力介入措施對第1型糖尿病青少年的自我照顧行為及健康調適之成效

The effects of resilience intervention on self-care behaviors and health adaptation in adolescents with type 1 diabetes

唐善美(Shan-Mei Tang)

指導教授 ： 王瑞霞

高雄醫學大學/護理學院/護理學系碩士班/博士(2015年)

摘要

本研究目的為探討復原力介入策略，對第1型糖尿病青少年之自我照顧行為、生活品質與糖化血色素的成效。本研究為實驗性研究設計，採叢聚取樣於台灣南部三大醫學中心的小兒內分泌代謝或遺傳內分泌科門診收案，收案對象是確診第1型糖尿病至少六個月以上的10-18歲青少年，共收125位個案，透過隨機分配個案到介入組（45位）及對照組（80位）。對照組如過去的一般照護，未提供任何介入，而介入組會接受共三個月復原力介入SPADM策略，包括兩次面訪及三次的電訪追蹤關懷。介入後三個月以「自我照顧行為量表｣及「簡版青少年糖尿病生活品質量表中文版｣以測量個案自我照顧行為及糖尿病生活品質。並追蹤記錄個案介入前、介入後三個月及六個月的糖化血色素值。本研究的資料利用SPSS for Window17.7中文版軟體進行統計分析，統計方法包括頻率分配、百分比、平均數、標準差、獨立樣本t檢定、配對樣本t檢定、卡方檢定及廣義估計方程式（generalized estimating equation, GEE）。
研究結果顯示：（一）介入組的自我照顧行為於介入後三個月，顯著高於介入前，且介入完成後三個月與介入前增加的改變量，顯著高於對照組；（二）介入組於介入後三個月與介入前生活品質的改變量與對照組沒有顯著差異；（三）介入組的糖化血色素於介入後三個月及六個月，皆顯著低於前測，而對照組則反而顯著增加；且介入後三個月及六個月與介入前的降低改變量，介入組皆顯著高於對照組。
本研究結果可提供實務、研究及教育界能以復原力介入為基礎，來改善第1型糖尿病青少年自我照顧行為及糖化血色素的控制。

關鍵字

復原力 ； 第1型糖尿病 ； 青少年 ； 自我照顧行為 ； 健康調適

並列摘要

The purpose of this study was to examine the effects of the resilience strategy on self-care behavior, quality of life, and glycolated hemoglobin (HbA1c) of adolescents with type 1 diabetes. An experimental study design was applied. One hundred and twenty-five adolescents with type 1 diabetes aged 10-18 years were selected according to a cluster sampling and randomly assigned to the intervention group (n = 45) and the control group (n = 80) from three medical centers in southern Taiwan. Subjects in the control group received routine clinical care. Subjects in the intervention group received a resilience strategy. The strategy was held twice as face-to-face interviews and three times as telephone interviews over three months. Self-care behavior and quality of life were measured at pre-intervention. The HbA1c levels were measured on pre-intervention (T0), 3 months (T1) and 6 months (T2) after intervention. Data were analyzed using frequency, percentage, mean, standard deviation, independent samples t-test, paired samples t-test, chi-square test and generalized estimating equation (GEE).
The results of this study indicated that (1) subjects of the intervention group significantly improved their levels of self-care behaviors at T1. The improvement of self-behaviors at T1 in the intervention group were significantly higher than those of the control group; (2) The improvement of quality of life at T1in the intervention group did not significantly differ with that of the control group; and (3) The HbA1c levels of the intervention group significantly decreased at T1and T2. Nevertheless, the HbA1c levels of the control group significantly increased at T1 and T2. The decrease of HbA1c levels in the intervention group at T1 and T2 were significantly higher than those of the control group.
Healthcare providers can provide resilience interventions to improve self-care behavior and glycemic control of adolescents with T1DM.

並列關鍵字

Resilience ； type 1 diabetes ； adolescents ； self-care behaviors ； health adaptation

參考文獻

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