促進糖尿病患者社會支持與充能效果之介入研究

Evaluation of a Social Support and Empowerment Module for Diabetes

本研究主要目的在發展「社會支持與充能效果教學模組」，並進一步探討教育介入之成效。本研究採「不等組之實驗前測後測設計」，以台北市石牌地區吉慶里和石牌里現有的社區糖尿病患共49位為實驗對象。貫驗組在教育介入之前一週進行前測，並接受四週的糖尿病教育介入計畫，於教育介入之後一週進行後測，以瞭解教育介入的效果。前後測問卷一致者為34人，其中有24人參與完整課程。為考慮研究設計之嚴謹性，採「對照組後測之設計」，因此於實驗對象實施後測之同時，選取相鄰之奇岩里和東華里現有的糖尿病個案進行後測，作為對照資料，來做進一步的分析比較。本研究所得的重要結果如下：一、經「社會支持與充能效果教學模組」介入之後，實驗組的「社會支持」後測得分高於前測且達顯著差異。二、經「社會支持與充能效果教學模組」介入之後，實驗組的「充能效果」後測得分高於前測且達顯著差異；同時實驗組「掌控力」、「自我效能」和「自我照顧行為」 的後測得分高於前測且達顯著差異。三、經「社會支持與充能效果教學模組」介入之後，實驗組之「社會支持」和「充能效果」之後測得分高於對照組且達顯著差異。根據本研究結果，結合社會認知理論、社會支持、健康信念模式、行為改變階段模式與充能理念於「社會支持與充能效果教學模組」之教學，能有效的提升糖尿病患者的「社會支持」和「充能效果」，可見於以「全人」的充能觀點來教育，增進患者對社區生活資源的利用，且此具理論背景和策略之介入計畫，是具有效果的。建議在未來相關研究的推動上，考慮病患的心理社會和生活環境層面，有效結合社區中的生活資源和醫療服務，運用行為科學理論和策略於糖尿病教育，值得作進一步的研究和嘗試。

The purpose of this study was to develop an education module for diabetes titled Social Support and Empowerment Module (SSEM), and evaluate the impact on individual diabetics. The SSEM was based on social cognitive theory, social support, social belief model, strategies of behavior change and conception of empowerment. One-group pre-posttest design was adopted. Diabetics from two communities in Taipei City were purposely selected as subjects (n=49). Experimental group took part in a series of SSEM courses during intervention period (4 weeks). A closed-ended pre-posttest questionnaire was the instruments used to evaluate the outcome effects. In addition, collecting diabetics from other two communities next to experimental ones for control group in order to consider the credibility of study. Control group received posttest questionnaire survey compared with experimental ones (n=50). The data was analyzed by using paired test, wilcoxon's sign-rank test and mann-whitney u test with SPSS 9.0 statistical software package. The result of the study were as follow ： The SSEM education courses could significantly increase social support of the experimental group. The SSEM education courses could significantly increase empowerment of the experimental group, and empowering patients with power, self-efficacy and self-care behavior. After intervention, the experimental group was higher than the control one on social support and empowerment. According to the findings of the study, SSEM education courses accompanied with skill pratice has great effect. The result of study and application of the program were discussed and suggestions for research were proposed.