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  • 學位論文

以電子化施行充能式自我管理對代謝症候群成人之成效:系統性文獻回顧與統合分析

Effects of Using Electronic Device to Deliver Empowerment─based Self Management for Adult with Metabolic Syndrome: A Systematic Review and Meta-analysis

指導教授 : 林秋菊
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摘要


中文摘要 背景: 代謝症候群是全球健康主要問題之一,改變生活型態和飲食習慣的自我管理可以減緩疾病進展,而充能可以提升自我管理的動機和責任感,進而維持長期、有效的自我健康管理。系統性文獻回顧顯示充能式自我管理方案可以顯著改善成人代謝症候群的生理和心理問題,但礙於時空限制,有多篇研究採用電子化施行充能式自我管理方案,卻缺乏系統性文獻回顧探討其整體成效。 目的: 採系統性文獻回顧與統合分析探討以電子化施行充能式自我管理方案對成人代謝症候群健康行為、生理和心理指標的成效。 方法: 本研究運用系統性文獻回顧與統合分析法,使用Empowerment、Self-management、Eletronic-Based、Metabolic syndrome等關鍵字及其相關自然語言和MeSH語言,搜尋2015年2月以前於The Cochrane Library、PubMed、Cumulative index to Nursing and Allied Health Literature(CINAHL)、Medline及華藝線上圖書館五個電子資料庫發表之中、英文文獻,並以手工檢索搜尋相關文獻共6篇,篩選重覆與不符合標準文獻,最後評讀10篇隨機對照研究。本研究採用Modify Jadad Scale評價文章品質,再以Review Manager 5.3軟體進行資料萃取及分析。 結果: 10篇隨機對照研究納入分析,90%的研究品質良好(modify Jadad score≧4),研究追蹤時間從12週到1年不等,研究對象以糖尿病居多。納入統合分析者為8篇RCT,總計收案2483人,在健康行為和生理指標方面,電子化施行充能式自我管理方案與控制組相比可以改善身體活動量(p= .04)和健康飲食習慣( p= .002);但對糖化血色素( p= .08) 無明顯改善。在心理指標方面,電子化施行充能式自我管理方案與控制組相比可以改善生活品質(p= .01);但對充能( p= .5)、憂鬱(p= .78)、尋求社會支持(p= .08)、回診次數(p= .81)、壓力管理(p= .66)、健康困擾(p= .97)均無顯著改善。另外,電子化施行充能式自我管理方案與傳統面對面方式相比,糖化血色素( p= .59)及身體活動量( p= .32)均無統計學上的顯著差異。 結論: 電子化施行充能式自我管理方案可以改善代謝症候群的生理和心理狀態,特別是在身體活動量、健康飲食習慣和生活品質。對忙碌的現代人電子化施行充能式自我管理方案具有高度的可近性和即時性,並可克服學習上的時空限制,故建議可以運用電子化施行充能式自我管理方案於時間難以配合的個案來改善其健康狀態。

並列摘要


Abstract Background: Metabolic syndrome has been one of the major health issue in the world. Interventions for self-management on life style and eating habits have shown benefits in delaying disease progression. Literature review of studies on metabolic syndrome revealed that empowerment based self-management provides significantly improvements in patients’ physical and mental condition. On the other hand, few systematic significant results were found in those studies that adapted electronic-device to deliver empowerment based self-management on patients with metabolic syndrome. Purpose: The purpose of this study is to determine the effects of empowerment based self-management using electronic device for adults with metabolic syndrome by using systematic review and meta-analysis. Method: This research was a systematic review study with meta-analysis technique. Literature was retrieved by February, 2015. Electronic databases included The Cochrane Library, PubMed, Cumulative index to Nursing and Allied Health Literature(CINAHL), Medline and Airiti Library. Keywords included empowerment, self-management, electronic device, metabolic syndrome and relatives. All reference lists, including studies and related articles, were checked after selection based on title and abstract. We excluded overlapped reference and added hand search reference. Finally, we included ten randomized controlled trial for final analysis. All of the articles selected used Modify Jadad Score for appraisal quality. All data was calculated using review manager 5th software. The outcome results were combined using random effects model. Result: Ten randomized controlled trial were included, in which 90% have modify jadad score ≧4. In total 2483 participants were included in those trials with most of them sharing the same diagnosed of diabetes mellitus, and had follow up time ranged from 12 weeks to one year. In terms of changes in behavior, applying electronic device to deliver empowerment based self-management was shown to increase physical activity (p= .04) and health eating habits (p= .002). Regarding changes in physical status, results of patients using empowerment based self-management on electronic device didn't demonstrate significant changes in HbA1C(p= .08). As for improvement in mental status, empowerment based self-management using electronic drive was shown to have progress in higher quality of life(p= .01), however, findings weren’t significant in terms of empowerment(p= .5), depression(p= .78), seeking social support(p= .08), stress manage(p= .66) and health distress(p= .97). Conclusion: Electronic device delivered empowerment based self-management can improve patients with metabolic syndrome inters of their behavior, physical and mental status, specifically in activity level, eating habits and quality of life. For people in our busy modern society, empowerment based self-management provided by electronic device provides higher accessibility as well as instantaneity. Self-management on electronic drive empowerment can provide better results for those who wouldn’t benefit from other self-management methods to improve their health status due to other factors such as time constraints.

參考文獻


參考文獻
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