評價復原力介入對第1型糖尿病青少年的自我照顧行為及血糖控制之成效

Evaluation of the effectiveness of a resilience intervention for self-care behavior and glycemic control of youth with type 1 diabetes

目標：研究顯示第1型糖尿病青少年的血糖控制較差，復原力強調協助青少年利用優勢克服逆境。本研究目的是探討復原力介入後對第1型糖尿病青少年的自我照顧行為、生活品質、復原力及糖化血色素之成效。方法：本研究為類實驗性研究設計，在南台灣三大醫學中心採方便取樣共125位10-18歲第1型糖尿病青少年隨機分派為兩組，對照組（n＝80）如過去的一般照護，未提供任何介入，而實驗組（n＝45）會接受共三個月復原力介入策略，包括認識自己及激發覺醒、解決問題、接受、轉移注意力及情緒支持，並透過兩次面訪及三次的電訪進行追蹤。介入前、介入後三個月皆測量自我照顧行為、復原力、生活品質及糖化血色素，介入後六個月再收集一次糖化血色素值。採用頻率、百分比、平均數、標準差、卡方檢定、t檢定及廣義估計方程式進行資料分析。結果：研究發現實驗組的自我照顧行為（p＝.030）及復原力（p＜.001）於介入後三個月，提升改變顯著高於對照組；實驗組於介入後三個月及六個月的糖化血色素降低的改變量顯著高於對照組（p＜.001），而兩組的生活品質改變未達顯著差異。結論：本研究可提供實務、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。

Objectives: Youth with type 1 diabetes have poor glycemic control. Resilience interventions emphasize helping youth use their advantages to overcome adversity. The purpose of this study was to investigate the effectiveness of a resilience intervention in improving the self-care behavior, resilience, quality of life, and glycosylated hemoglobin of youth with type 1 diabetes. Methods: A quasi-experimental design was used. Convenience sampling was adopted to recruit 125 participants aged 10-18 years and having type 1 diabetes from three major medical centers in southern Taiwan. The participants were randomly assigned to two groups. Those in the control group (n=80) received general care as in the past without the intervention. Those in the experimental group (n=45) received a 3-month intervention on resilience strategies, including self-awareness, problem-solving, acceptance, distraction, and mental support. Two face-to-face interviews and three telephone interviews were then conducted for tracking. Self-care behavior, resilience, quality of life, and glycosylated hemoglobin were measured before the intervention and 3 months postintervention, and glycosylated hemoglobin values were collected again 6 months postintervention. Frequency of use, percentage, average, standard deviation, chi-square test, t test, and generalized estimating equation were used in data analysis. Results: The improvement in self-care behavior (p= .03) and resilience (p< .001) of the experimental group at 3 months postintervention was significantly greater than that of the control group; the reduction in glycosylated hemoglobin in the experimental group at 3 and 6 months postintervention was also significantly higher (p< .001). Change in quality of life did not differ significantly between the groups. Conclusions: The study offers a reference to practical, research, and education circles for using a resilience intervention as the basis to improve the self-care behavior, resilience, and hemoglobin glycosylation control of youth with type 1 diabetes.