Steno糖尿病對話卡介入對第二型糖尿病社區長者在自覺健康、健康識能及血糖控制成效之探討

Effects of a Steno Diabetes Dialogue Card-Based Intervention on Self-Perceived Health, Health Literacy, and Glycemic Control in Older Adults With Type 2 Diabetes Mellitus Living in the Community

背景：老化使得身體功能退化，而較低的健康識能會影響資訊的獲得與理解。若使用Steno糖尿病對話卡會增強長者視覺傳遞的優勢，促進學習，以提升糖尿病健康識能、增加其參與血糖控制的遵從行為，進而達到血糖控制目標及延緩併發症的發生。
目的：比較Steno糖尿病對話卡與常規式衛教介入對社區糖尿病長者自覺健康、健康識能、糖化血色素及空腹血糖控制之成效。
方法：採實驗性研究設計，於北部某醫院新陳代謝科門診收案，透過隨機分派實驗組進行「Steno糖尿病對話卡」介入，對照組則維持常規式衛教。兩組均進行每月一次、連續3個月、每次15–20分鐘的個別衛教介入，並於介入前與介入完成後一個月分別收集自覺健康、健康識能、糖化血色素及空腹血糖之資料。
結果：在介入完成一個月後，與前測相比，實驗組在自覺健康（p = .005）、健康識能（p < .001）、糖化血色素（p < .001）以及空腹血糖（p = .002）等方面均達統計上顯著的改善。相較於對照組，實驗組在自覺健康與健康識能的改善程度達到顯著提升（p < .001）。然而，兩組在糖化血色素和空腹血糖的改善程度上，介入前後的變化並未達到統計上顯著差異。
結論／實務應用：Steno對話卡能改善長者之自覺健康、健康識能、糖化血色素及空腹血糖。Steno對話卡能增加長者自我血糖控制相關識能，進而提升疾病行為的遵從性以達到有效的血糖控制，建議於臨床實務中可加強推廣與應用。

Background: The process of aging is associated with the deterioration of normal body functions as well as lower health awareness due to a reduced ability to acquire and understand health-related information. The subjects of this study were older adults with diabetes mellitus living in community settings. Visual-learning-based Steno diabetes dialogue cards were used to strengthen the learning and knowledge absorption capabilities of the subjects to improve diabetes health knowledge and increase compliance with blood sugar control protocols to achieve blood sugar control goals and delay / reduce the severity of complications.
Purpose: This study was designed to assess the comparative effects of Steno diabetes dialogue cards and conventional health interventions on self-perceived health, health literacy, glycated hemoglobin (HbA1c) level, and fasting blood glucose level in older adults with diabetes.
Methods: An experimental study was conducted in an outpatient clinic of the department of metabolism in a hospital in northern Taiwan. The subjects were randomized into the experimental group (receiving the Steno diabetes dialogue cards intervention) and control group (receiving conventional health education). Individual health education interventions of 15–20 min each were conducted once a month for 3 consecutive months in both groups.
Results: There were 51 subjects in the experimental group and 47 in the control group, with an attrition rate of 10.91%. The changes in the experimental group and the control group before the intervention and three months after the intervention were analyzed, with significant between-group differences found in health literacy and self-perceived health (p < .001). The experimental group’s three-month post-test scores were both greater than the pre-test. Significantly, there were significant, positive differences between pre- and post-test values for self-perceived health (p = .005), health literacy (p < .001), glycated hemoglobin (p < .001) and fasting blood glucose (p = .002). Moreover, the improvements were greater in the experimental than the control group.
Conclusions/ Implications for Practice: The individual health education interventions improved glycemic control efficacy in all of the subjects. However, the experimental group showed more significant improvements in all measures. Therefore, Steno diabetes dialogue cards offer a clear benefit in enhancing older adults’knowledge regarding self-glycemic control and improving compliance with disease behaviors.