Evaluation of Health Literacy Management Among Type II Diabetes Patients in Two Community Hospitals in Kunming
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摘要:
目的 探讨2型糖尿病患者的健康素养管理及相关影响因素,为昆明社区医院糖尿病住院患者提高健康素养管理水平提供依据。 方法 采用方便抽样方法选择昆明市呈贡两社区医院185名2型糖尿病住院患者作为样本,运用糖尿病基本知识问卷、健康素养管理(HeLMS)量表和患者健康问卷-9 (PHQ-9)对目标人群进行测评。 结果 糖尿病患者在健康素养管理(HeMLS)4个维度总得分中发现经济支持的愿望得分比其他3个维度总分值低了30分(P < 0.05)。其中,糖尿病患病时间高于10 a的男性患者,糖尿病知识得分较低;健康素养水平越高,收入越高,能长期坚持运动锻炼的患者,糖尿病知识得分较高( P < 0.05)。 结论 性别、文化程度、低收入、糖尿病患病时间和是否坚持运动,是影响患者掌握糖尿病基本知识得分高低的影响因素,对该情形社区医院应加大力度进行有效的干预。 Abstract:Objective To explore the health literacy management and related influencing factors of type-Ⅱ diabetes mellitus patients and thus provide a basis for improving the health literacy management of diabetic inpatients in community hospitals in Kunming. Methods The convenience sampling method was used to select 185 inpatients with type-Ⅱ diabetes mellitus from two community hospitals in Chenggong, Kunming. The self-designed diabetes basic knowledge questionnaire, health literacy management scale (HeLMS), and patient health questionnaire-9 (PHQ-9) were used in this study. Results In the four dimensions of HeMLS, the scores of desire for financial support was 30 points lower than the total scores of other three dimensions for diabetic patients (P < 0.05), which indicates a strong desire for financial support in diabetic patients. Gender, education level, monthly income, duration of diabetes and physical exercise were the influencing factors for patient’s basic knowledge of diabetes score ( P < 0.05). The patients with low-income and long-term adherence to exercise are positively related to adequate basic knowledge of diabetes and the ability to manage health literacy. Conclusion The health literacy of knowledge score influence factors including gender, education level, low income, long-term diabetes and adherence to exercise . They are the main obstacles in improving health literacy management. In response to this situation, community hospitals should make efforts for effective intervention. -
表 1 185例患者的基本信息与健康素养管理水平得分
Table 1. 185 Patient’s Basic Information and HeLMs Score Situation
特征与赋值 被调查者 P n % HeMLS 均数(95%CI) 性别 0.231 男(= 1) 97 52.4 108.4 (104.8~112) 女(= 2) 88 47.6 105.2 (101.4~109) 年龄 ( 56.2 ± 12.1)岁 0.138 < 40(= 1) 19 10.3 111.4 (102.9~119.9) 40-(= 2) 37 20 110.6 (105.2~116.1) 50-(= 3) 58 31.4 107.3 (103~111.5) > 60(= 4) 71 28.4 103.4 (98.7~108.1) 居住地 0.002* 城市(= 1) 90 48.6 110.8 (107.2~114.4) 农村(= 2) 95 51.4 103.2 (99.5~106.9) 民族 0.633 汉(= 1) 160 86.5 107.1 (104.3~109.9) 其它(= 2) 25 13.5 105.3 (97.6~112.9) 婚姻状况 0.708 已婚(= 1) 179 96.8 106.9 (104.3~109.6) 未婚(= 2) 6 3.2 104.2 (82.7~125.7) 从事职业 0.003* 农业(= 1) 86 46.5 102.4 (98.7~106.2) 其它(= 2) 99 53.5 110.8 (107.3~114.3) 教育程度 < 0.001 * 文盲(= 1) 18 9.7 88.9 (78.2-99.7) 小学(= 2) 54 29.2 103.3 (98.9~107.7) 中学(= 3) 51 27.6 109.3 (104.6~113.9) 高中及以上(= 4) 62 33.5 113.2 (109.3~117.2) 收入 (元) < 0.001 * ≤ 3000(= 1) 87 48.1 100.4 (96.3 – 104.5) 3001 – (= 2) 56 30.9 112.7 (109.5 – 115.9) > 5000(= 3) 38 20 113.1 (107.3 – 118.9) 年限( 7.6 ± 5.7)a 0.452 < 10(= 1) 134 74.9 107.6 (104.7~110.6) > 10以上(= 2) 45 25.1 104.4 (98.6~110.2) 是否高血压 0.582 Yes(= 1) 74 40 105.9 (101.7~110.3) No(= 2) 111 60 107.5 (104.1~110.8) 基本知识得分 < 0.001 * 不充分 < 10(= 1) 33 17.9 91.9 (85.4-98.3) 充分10 – (= 2) 44 23.9 104.5 (98.9~110.1) 足够充分 > 12(= 3) 107 58.2 112.4 (109.6~115.3) 有规律的血糖测定 0.035* 有(= 1) 131 70.8 108.7 (105.7~111.8) 无(= 2) 54 29.2 102 (97.4~107.3) 高血压知识 0.027* 有(= 2) 139 75.1 108.6 (105.7~111.5) 无(= 1) 46 24.9 101.8 (96.2~107.4) 平常运动 0.036* 有(= 2) 120 64.9 108.9 (105.8~112.2) 无(= 1) 65 35.1 103 (98.5~107.6) 运动和血糖水平 0.042* 有(= 2) 41 22.2 108.6 (103.1~114.1) 无(= 1) 144 77.8 101.8 (98.7~104.9) 焦虑程度 (PHQ-9) 0.026* 一般(= 1) 71 47.4 110.3 (106.3~114.3) 中等(= 2) 54 36.2 105.4 (100.4~110.5) 重(= 3) 20 13.4 99.4 (88.6~110.2) 极重(= 4) 4 2.7 92.7 (68.7~116.8) 健康素养水平(105.7 ± 21.1) < 0.001 * 低 ≤ 110(= 1) 85 45.9 92.4 (88.7-96.2) 中111-(= 2) 44 23.8 115.5 (114.8~116.2) 高 = 120(= 3) 56 30.3 122.1 (121.4~122.8) *P < 0.05。 表 2 不同健康素养水平的患者糖尿病知识的正确率(%)比较
Table 2. Patient’s of Different HeLMs Level Associated with Correct Rate of DM Knowledge
糖尿病相关基本知识问题 不同健康素养管理水平糖尿病知识
正确率(%)P 低 中 高 1. 糖尿病的典型症状是“多饮、多食、多尿、体重
减轻”81.2 91.0 94.6 0.032* 2. 糖尿病人通过改善饮食行为方式,可以像正常人
一样健康长寿。71.8 81.8 75.0 0.584 3. 糖尿病人口味宜淡,尽量采用低钠饮食,防止高
血压的发生。78.8 90.9 91.1 0.024* 4. 糖尿病不是代谢病。 24.7 29.5 48.2 0.002* 5. 糖尿病人仅仅无糖是不够的,仅仅依赖药物也是
不行的,您是否认同?62.4 88.6 85.7 < 0.001 * 6. 糖尿病是老人家得的,年青人不可能患糖尿病的
说法正确吗?67.1 86.4 82.1 0.041* 7. 糖尿病会遗传吗? 52.9 59.1 73.2 0.036* 8. 坚持血糖监测是防治糖尿病的主要措施。 74.1 72.7 89.3 0.025* 9. 糖尿病分类主要为Ⅰ型、Ⅱ型和妊娠型糖尿病。 54.1 70.5 69.6 0.043* 10. 高血压患者或有高脂血症者不易得糖尿病。 52.9 70.5 67.9 0.056* 11. 空腹血糖≥7.0mmol/L是判断糖尿病的依据。 9.4 25.0 17.9 0.120 12. 糖尿病对健康的主要危害是心脏。 34.1 38.6 39.3 0.522 13. 超重或肥胖是引起糖尿病的主要原因之一。 80.0 84.1 82.1 0.713 14. 口服葡萄糖耐量试验(OGTT)2 h血糖≥
11.1 mmol/L可判断为糖尿病。49.4 52.3 69.6 0.038* 15. 暴饮暴食是诱发糖尿病的主要原因。 67.1 75.0 53.6 0.142 16. 糖尿病与免疫力有直接的关系。 45.9 63.6 64.3 0.046* 17. 男性比女性更容易患糖尿病。 21.2 27.3 25.0 0.562 18. 引起胰岛素绝对或相对分泌不足是糖尿病的主要
病因。47.1 84.1 85.7 < 0.001 * 19. 因为血糖高,黏膜屏障作用减低,伤口愈合会
非常缓慢。71.8 86.4 94.7 < 0.001 * 20. 糖尿病可引起白内障,导致视力下降,进展较快。 75.3 93.2 87.5 0.038* *P < 0.05。 表 3 糖尿病基本知识得分影响因素多重线性回归分析
Table 3. Multiple linear Regression on DM knowledge score of associated factors
影响因素 回归系数 标准误 P 健康素养管理 2.32 0.61 0.001* 性别 −0.94 0.48 0.050* 收入 (元) 2.23 0.57 0.001* 是否坚持运动 1.57 0.69 0.032* 患病年限 (a) −2.20 0.56 0.001* *P < 0.05。 -
[1] Wang L,Gao P,Zhang M. Prevalence and ethnic pattern of diabetes and pre-diabetes in china in 2013[J]. JAMA,2017,317(24):2515-2523. doi: 10.1001/jama.2017.7596 [2] Norris S L,Engelgau M M,Venkat Narayan K M. Effectiveness of self-management training in type 2 diabetes:A systematic review of randomized controlled trials[J]. Diabetes Care,2001,24(3):561-587. doi: 10.2337/diacare.24.3.561 [3] Simonds S K. Health education asassocial Policy[J]. Health Education Monographs,1974(21):1-10. [4] Cullen R,Wallis J. Empowering patients through health information literacy training[J]. Libr Rev,2005,54(4):231-244. doi: 10.1108/00242530510593425 [5] Kim S,Love F,Quistberg D A,Shea J A. Association of health literacy with self-management behavior in patients with diabetes[J]. Diabetes Care,2004,27(12):2980-2982. doi: 10.2337/diacare.27.12.2980 [6] 葛均波, 徐永健, 王辰 . 内科学[M] 北京: 人民卫生出版社: 2018: 725-734. [7] Machiko Inoue,Miyako Takahashi,Ichiro Kai. Impact of communicative and critical health literacy on understanding of diabetes care and self-efficacy in diabetes management:a cross-sectional study of primary care in Japan[J]. Bmc Fam Pract,2013,14(1):2301-2302. [8] Iannotti R J,Schneider S,Nansel T R,et al. Self-efficacy,outcome expectations,and diabetes self-management in adolescents with type 1 diabetes[J]. Dev Behav Pediatr,2006,27(2):98-105. [9] 张惠芝. 健康素养内涵及影响因素分析[J]中国伤残医学, 2012, 20(10): 151. [10] Nutbeam D. Health promotion glossary[J]. Health Promotion,1986,1(1):113-127. doi: 10.1093/heapro/1.1.113 [11] 刘敏,孟国祥. 徐州市社区卫生服务中心健康管理现状[J]. 现代生物医学进展,2014,14(18):3560-3562. doi: 10.13241/j.cnki.pmb.2014.18.041 [12] 李莉,李英华. 2012—2020年中国女性健康素养水平分析[J]. 中国健康教育,2021,37(10):889-893. doi: 10.16168/j.cnki.issn.1002-9982.2021.10.006 [13] 刘影,刘兆炜,李志新. 2020年四川省居民健康素养水平提升对策质性分析[J]. 预防医学情报杂志,2022,38(3):359-362,368. [14] 薛子豪,童莺歌,顾利慧. 美国健康素养型医疗机构评价工具研究进展[J]. 护理研究,2021,35(12):2145-2149. doi: 10.12102/j.issn.1009-6493.2021.12.014 [15] 邹国涛,谭宏韬. 兴围社区老年慢性非传染性疾病居民传染病防治素养调查与干预分析[J]. 现代医院,2021,21(8):1255-1257. doi: 10.3969/j.issn.1671-332X.2021.08.032