動機式晤談介入於第二型糖尿病病人自我效能、自我照顧行為及血糖控制之成效

Effects of a Motivational Interview Intervention on Self-Efficacy, Self-Care Behavior, and Glycemic Control in Type 2 Diabetic Patients

背景動機對糖尿病病人疾病管理是重要的因素，但有效的動機強化介入對病人的行為改變是一大挑戰。
目的本研究旨在探討動機式晤談介入對第二型糖尿病病人自我效能、自我照顧行為及血糖控制之成效。
方法採實驗性研究設計，隨機分派方式選取南區某區域醫院兩個綜合內科病房的第二型糖尿病病人共112人，以隨機分派到實驗組（n = 56）及對照組（n = 56）。實驗組接受一般性糖尿病照護外加上6次動機式晤談，每次50分鐘，為期三個月。對照組接受病房一般性糖尿病照護。研究工具包括：基本人口學調查表、中文版糖尿病自我效能量表、糖尿病自我照顧行為量表、糖化血色素值等於介入前及滿3個月後資料收集，使用微軟SPSS 22.0分析統計資料。
結果實驗組共55位、對照組共52位完成研究。動機式晤談介入6次後，實驗組與對照組前、三個月後測分數，經分析在自我效能、自我照顧行為達顯著差異（p < .001），實驗組三個月後測分數大於前測、糖化血色素前後測數值達顯著差異（p < .001），三個月後測數值低於前測。且改變成效實驗組優於對照組。在行動改變周期方面介入前及滿3個月後測的成效達顯著差異（χ2 = 43.89, p < .001），且改變成效實驗組優於對照組。
結論／實務應用動機式晤談介入6次有助於第二型糖尿病病人於自我效能、自我照顧行為及糖化血色素的控制成效，未來建議增加院內護理關於會談技巧之相關課程，以便護理人員於做治療時，可以利用簡短的時間，進行有效的晤談，增加病人控制血糖之動機，使病人於出院前學習血糖控制技巧，以達到血糖控制之目的。

Background: Motivation is an important factor in disease management for diabetic patients. However, motivational strengthening interventions have been inadequately effective in effecting behavior change in this group. Purpose: This study was designed to investigate the effect of a motivational interview intervention on self-efficacy, self-care behavior, and blood sugar control in patients with type 2 diabetes. Methods: The target population comprised patients with type 2 diabetes in two medical wards of a regional hospital in the southern Taiwan. The 112 participants were randomly assigned to the experimental group (n = 56) and control group (n = 56). Over a three month period, the experimental group received 6 motivational interview sessions of 50 minutes each in addition to usual diabetes care, while the control group received usual diabetes care on the ward. Both groups completed the demographic questionnaire, Chinese version of Diabetes Self-Efficacy Scale, Diabetes Self-Care Behavior Scale, glycosylated hemoglobin level pre-test, and 3 months post-test survey. The results were analyzed using SPSS 22.0 for Windows. Results: A total of 55 patients in the experimental group and 52 patients in the control group completed the study. After analysis, significant inter-group differences in self-efficacy and self-care behavior were found between the experimental group and the control group at pre-test and three-month post-test (p < .001). For the experimental group, the three-month post-test score and glycated hemoglobin value were higher than at pre-test. The three-month posttest value was significantly lower (p < .001) than the pre-test value, and the change effect in the experimental group was better than that in the control group. There was a significant difference in the stages of change between pre-test and posttest (χ2 = 43.89, p < .001), and the change effect in the experimental group was better than that in the control group. Conclusions/Implications for Practice: The proposed motivational interview intervention can help patients with type 2 diabetes admitted to medical wards improve their self-efficacy, self-care behavior, and glycated hemoglobin values. In the future, nursing education should improve the teaching of motivational interview skills to allow nurses to conduct effective interviews quickly during treatment, increase their patients' motivation to self-control blood sugar, and enable patients to learn blood sugar control skills before discharge to achieve effective blood sugar control.