回授法联合微信全程健康教育对糖尿病患者自我效能与医疗依从性的影响

卿雪莲; 陈小玉; 廖娟; 张家佳; 李远

doi:10.16766/j.cnki.issn.1674-4152.004008

回授法联合微信全程健康教育对糖尿病患者自我效能与医疗依从性的影响

doi: 10.16766/j.cnki.issn.1674-4152.004008

1.
重庆医科大学附属永川医院医务科，重庆 402160
2.
重庆医科大学附属永川医院中心实验室

基金项目:

国家自然科学基金项目 11702047

重庆医科大学附属永川医院2024年院级课题 YJHL2024043

详细信息

通讯作者:
陈小玉，E-mail: 1834935259@qq.com

中图分类号: R587.1
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出版历程
- 收稿日期: 2024-09-19
- 网络出版日期: 2025-08-14

The effect of the teach-back method combined with WeChat whole process health education on the self-efficacy and medical compliance of diabetic patients

1.
Department of Medical Affairs, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China

摘要

摘要: 目的自我效能感和医疗依从性与糖尿病患者疾病进展关系密切，本研究旨在探讨回授法联合微信全程健康教育对2型糖尿病(T2DM)患者自我效能感与医疗依从性的影响，为其健康教育提供参考。方法招募重庆医科大学附属永川医院2023年8—9月收治的90例T2DM住院患者为研究对象，采用随机数字表法分为试验组与对照组，每组45例。对照组采用常规健康教育，试验组在对照组基础上采用teach-back联合微信全程健康教育。比较2组干预前和干预1、3、6个月空腹血糖水平、自我效能与医疗依从性。结果干预后，重复测量数据显示，2组空腹血糖水平、慢病自我效能感量表(SEMCD-6)、慢病医疗依从性量表各项评分及总分比较，差异均有统计学意义(P < 0.05)。简单效应分析显示，干预后试验组空腹血糖水平[(6.82±1.13)mmol/L vs. (8.02±1.68)mmol/L]、SEMCD-6各项评分及总分[(48.40±4.16)分vs. (40.67±6.00)分]和慢病医疗依从性量表各项评分及总分[134.0(129.0, 139.0)分vs. 118.0(110.5, 126.0)分]均优于对照组(P < 0.05)。结论回授法联合微信全程健康教育可有效控制T2DM患者血糖水平，提高患者自我效能感和医疗依从性。
- 2型糖尿病 /
- 回授法 /
- 微信平台 /
- 全程健康教育 /
- 自我效能感 /
- 医疗依从性
Abstract: Objective Self-efficacy and medical compliance are closely related to disease progression in diabetic patients, and the purpose of this study was to explore the effect of teach-back combined with WeChat whole process health education on self-efficacy and medical compliance in patients with type 2 diabetes mellitus (T2DM), and to provide a reference for their health education. Methods A total of 90 inpatients with T2DM admitted to Yongchuan Hospital of Chongqing Medical University from August to September 2023 were recruited as the study subjects, and they were divided into the experimental group and the control group by random number table method, with 45 cases in each group. The control group was given routine health education, and the experimental group was taught back combined with WeChat whole process health education on the basis of the control group. The fasting blood glucose levels, self-efficacy, and medical compliance before intervention, 1 month, 3 months, and 6 months were compared between the two groups. Results After the intervention, repeated measures data showed that there were statistically significant differences in fasting blood glucose levels, chronic disease self-efficacy scale (SEMCD-6), and chronic disease medical adherence scale between the two groups (P < 0.05). Simple effect analysis showed that after the intervention, the fasting blood glucose level in the experimental group [(6.82±1.13) mmol/L vs. (8.02±1.68) mmol/L], SEMCD-6 scores and total scores [(48.40±4.16) points vs. (40.67±6.00) points] and chronic disease medical compliance scale scores and total scores [134.0(129.0, 139.0) points vs. 118.0 (110.5, 126.0) points] in the experimental group were all better than those in the control group (P < 0.05). Conclusion Teach-back combined with WeChat whole process health education can effectively control the blood glucose level of patients with T2DM and improve their self-efficacy and medical compliance.
- Type 2 diabetes mellitus /
- Teach-back /
- WeChat platform /
- Whole process health education /
- Self-efficacy /
- Medical compliance

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表 1 T2DM患者健康教育内容

Table 1. Health education content of patients with T2DM

项目	健康教育内容
基础知识	糖尿病定义、流行病学现状、临床表现、血糖监测的重要性和方法等。
危险因素、危害、社区筛查与评估	糖尿病前期、代谢综合征、超重、肥胖等危险因素，糖尿病对心脑肾的危害，社区对重点人群的筛查与筛查项目及对患者病情的评估等。
用药管理	常用口服药物、胰岛素保存及注射注意事项及不良反应，不可随意停药或更改用药剂量等。
饮食指导	合理膳食，以谷类食物、高膳食纤维摄入、低盐低糖低脂肪为主，控制总热量，根据理想体重(kg)=身高(cm)-105计算每日所需总热量；每日三餐分配比例1/5、2/5、2/5或1/3、1/3、1/3；减少反式脂肪酸摄入，每日胆固醇摄入量宜在300 mg以下；建议用粗制米、面和一定量杂粮，忌用葡萄糖、甜糕点、饼干、含糖饮料等。
运动指导	运动的意义、时间、强度、频率、注意事项等；运动宜在餐后进行，运动量不宜过大，持续时间不宜过长；每周至少150 min中等强度有氧运动；如无禁忌证，每周最好进行2~3次抗阻运动，锻炼肌肉力量和耐力；减少静坐时间等。
生活方式与心理指导	戒烟，避免被动吸烟；不饮或限制饮酒；控制体重；培养良好的生活习惯，保证合理休息；保持心理平衡等。

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表 2 2组T2DM患者一般资料比较

Table 2. Comparison of general data of T2DM patients between the two groups

项目	试验组(n=45)	对照组(n=45)	统计量	P值
年龄(x±s，岁)	54.98±13.38	56.69±10.35	0.679^a	0.499
性别[例(%)]			0.048^b	0.827
男性	29(64.4)	28(62.2)
女性	16(35.6)	17(37.8)
文化程度[例(%)]			0.568^c	0.570
初中及以下	27(60.0)	30(66.7)
高中/中专	9(20.0)	7(15.6)
大专	4(8.9)	3(6.6)
本科及以上	5(11.1)	5(11.1)
居住地[例(%)]			0.431^b	0.512
农村	15(33.3)	18(40.0)
城镇	30(66.7)	27(60.0)
医保类型[例(%)]			1.264^b	0.532
职工医保	24(53.3)	25(55.6)
居民医保	20(44.5)	17(37.8)
其他	1(2.2)	3(6.6)
家庭每月平均收入[例(%)]			1.363^c	0.173
＜2 000元	13(28.9)	20(44.4)
2 000~5 000元	26(57.8)	20(44.4)
＞5 000元	6(13.3)	5(11.2)
病程[例(%)]			0.643^c	0.521
＜1年	18(40.0)	22(48.9)
1~3年	4(8.9)	2(4.4)
＞3年	23(51.1)	21(46.7)
合并慢病[例(%)]
高血压	17(37.8)	15(33.3)	0.194^b	0.660
冠心病	9(20.0)	11(24.4)	0.257^b	0.612
脑卒中	2(4.4)	0	0.511^b	0.475
慢性阻塞性肺疾病	3(6.7)	0	1.379^b	0.240
肿瘤	8(17.8)	13(28.9)	1.553^b	0.213
合并慢病个数[例(%)]			0.653^b	0.419
＜2个	38(84.4)	35(77.8)
≥2个	7(15.6)	10(22.2)
注：^a为t值，^b为χ²值，^c为Z值。

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表 3 2组T2DM患者不同时间点空腹血糖水平比较(x±s，mmol/L)

Table 3. Comparison of fasting blood glucose levels at different time points between the two groups of T2DM patients(x±s, mmol/L)

组别	例数	T0	T1	T2	T3
试验组	45	11.31±2.11	8.79±1.49^a	8.01±1.28^ab	6.82±1.13^abc
对照组	45	11.42±2.38	9.59±1.87^a	8.77±1.79^ab	8.02±1.68^abc
F值		0.229	2.257	2.309	3.964
P值		0.819	0.026	0.023	＜0.001
注：与同组T0比较，^aP < 0.05；与同组T1比较，^bP < 0.05；与同组T2比较，^cP < 0.05。

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表 4 2组T2DM患者不同时间点自我效能水平各维度得分及总分比较(x±s，分)

Table 4. Comparison of the scores and total scores of self-efficacy level at different time points between the two groups(x±s, points)

组别	例数	症状管理自我效能				疾病共性管理自我效能				总分
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3	T0	T1	T2	T3
试验组	45	5.46±1.87	6.29±1.67^a	6.95±1.30^ab	8.07±0.69^abc	5.32±2.19	6.28±1.72^a	6.99±1.22^ab	8.06±0.81^abc	32.47±10.50	37.73±8.88^a	41.78±7.09^ab	48.40±4.16^abc
对照组	45	5.19±1.76	5.50±1.65^a	6.21±1.27^ab	6.83±1.05^abc	4.44±1.87	5.46±1.59^a	6.00±1.26^ab	6.67±1.01^abc	29.67±9.21	32.91±8.62^a	36.84±7.05^ab	40.67±6.00^abc
F值		0.682	2.269	2.729	6.603	1.921	2.351	3.777	7.203	1.345	2.615	3.309	7.109
P值		0.497	0.026	0.008	＜0.001	0.055	0.021	＜0.001	＜0.001	0.182	0.010	0.001	＜0.001
注：与同组T0比较，^aP < 0.05；与同组T1比较，^bP < 0.05；与同组T2比较，^cP < 0.05。

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表 5 2组T2DM患者不同时间点医疗依从性水平各维度得分及总分比较[M(P₂₅, P₇₅), 分]

Table 5. Comparison of the scores and total scores of medical compliance levels at different time points between the two groups[M(P₂₅, P₇₅), points]

组别	例数	用药
组别	例数	T0	T1	T2	T3
试验组	45	28.0(22.0, 34.5)	33.0(29.0, 38.0)^a	37.0(32.0, 40.0)^ab	40.0(38.0, 42.5)^abc
对照组	45	29.0(26.5, 36.5)	29.0(27.5, 36.5)^a	32.0(30.0, 38.0)^ab	36.0(33.0, 40.0)^abc
Z值		1.803	2.252	2.653	3.716
P值		0.071	0.024	0.008	＜0.001

组别	例数	自我监测
组别	例数	T0	T1	T2	T3
试验组	45	12.0(8.0, 19.0)	18.0(15.5, 22.5)^a	22.0(20.0, 25.5)^ab	25.0(24.0, 29.0)^abc
对照组	45	8.0(8.0, 15.5)	16.0(14.0, 19.0)^a	19.0(16.0, 23.0)^ab	23.0(20.0, 26.0)^abc
Z值		1.083	2.235	3.337	3.462
P值		0.279	0.025	＜0.001	＜0.001

组别	例数	复诊
组别	例数	T0	T1	T2	T3
试验组	45	15.0(12.0, 23.0)	22.0(18.5, 26.0)^a	25.0(23.0, 28.0)^ab	30.0(28.0, 32.0)^abc
对照组	45	21.0(13.5, 23.0)	21.0(14.5, 23.0)^a	23.0(18.5, 25.5)^ab	26.0(23.0, 28.5)^abc
Z值		1.356	2.168	2.890	5.287
P值		0.175	0.030	0.004	＜0.001

组别	例数	行为改变
组别	例数	T0	T1	T2	T3
试验组	45	27.0(24.5, 29.5)	30.0(29.0, 33.0)^a	33.0(32.0, 35.5)^ab	38.0(36.0, 40.0)^abc
对照组	45	26.0(23.0, 30.0)	28.0(24.0, 31.0)^a	30.0(28.0, 33.0)^ab	33.0(31.0, 36.0)^abc
Z值		0.716	3.045	3.895	5.508
P值		0.474	0.002	＜0.001	＜0.001

组别	例数	总分
组别	例数	T0	T1	T2	T3
试验组	45	81.0(70.0, 98.0)	102.0(95.5, 115.0)^a	117.0(110.0, 125.5)^ab	134.0(129.0, 139.0)^abc
对照组	45	86.0(79.5, 98.0)	93.0(87.5, 104.5)^a	104.0(100.0, 114.0)^ab	118.0(110.5, 126.0)^abc
Z值		1.328	3.391	4.550	6.140
P值		0.184	＜0.001	＜0.001	＜0.001
注：与同组T0比较，^aP < 0.05；与同组T1比较，^bP < 0.05；与同组T2比较，^cP < 0.05。

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参考文献(20)

[1]	SUN H, SAEEDI P, KARURANGA S, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022, 183: 109119. DOI: 10.1016/j.diabres.2021.109119.
[2]	WANG J, ZHOU L, YIN W, et al. Trends of the burden of type 2 diabetes mellitus attributable to high body mass index from 1990 to 2019 in China[J]. Front Endocrinol (Lausanne), 2023, 14: 1193884. DOI: 10.3389/fendo.2023.1193884.
[3]	PHILLIP M, BERGENSTAL R M, CLOSE K L, et al. The digital/virtual diabetes clinic: the future is now-recommendations from an international panel on diabetes digital technologies introduction[J]. Diabetes Technol Ther, 2021, 23(2): 146-154.
[4]	戴亚端, 张小玲, 吴碧瑜, 等. 线上孕妇学校联合回授法在妊娠期糖尿病孕妇及其配偶中的应用及效果评价[J]. 中华护理杂志, 2023, 58(11): 1285-1292. doi: 10.3761/j.issn.0254-1769.2023.11.001 DAI Y D, ZHANG X L, WU B Y, et al. Effects of double subjects health education based on online maternal school combined with teach-back in pregnant women with gestational diabetes mellitus and their spouses[J]. Chinese Journal of Nursing, 2023, 58(11): 1285-1292. doi: 10.3761/j.issn.0254-1769.2023.11.001
[5]	黄雪芹, 龚放华, 邹家静, 等. 微视频联合回授法在慢性肾脏病行自体动静脉内瘘术后患者中的应用效果[J]. 湖南师范大学学报(医学版), 2024, 21(3): 173-178. HUANG X Q, GONG F H, ZOU J J, et al. Effectiveness of microvideo combined with teach-back method after autologous arteriovenous endovascular fistula in patients with chronic kidney disease[J]Journal of Hunan Normal University(Medical Sciences), 2024, 21(3): 173-178.
[6]	李冰冰, 赵佩, 魏晓燕. 全程健康教育模式对糖尿病患者疾病知晓率和遵医行为的影响[J]. 保健医学研究与实践, 2023, 20(1): 87-91. LI B B, ZHAO P, WEI X Y. Effect of whole-course health education on disease awareness and compliance behavior of diabetic patients[J]. Health Medicine Research and Practice, 2023, 20(1): 87-91.
[7]	赵钦, 李永咏, 刘沙沙, 等. 基于互联网的糖尿病健康教育路径在患者居家自护中的应用[J]. 河北医药, 2023, 45(13): 2019-2023. ZHAO Q, LI Y Y, LIU S S, et al. Application of Internet-based QR code of diabetes health education program in self-care ofpatientsat home[J]. Hebei Medical Journal, 2023, 45(13): 2019-2023.
[8]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)(上)[J]. 中国实用内科杂志, 2021, 41(8): 668-695. Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition)(Part 1)[J]. Chinese Journal of Practical Internal Medicine, 2021, 41(8): 668-695.
[9]	李燕萍, 杜娟, 南楠. 糖尿病健康教育手册[M]. 银川: 阳光出版社, 2022. LI Y P, DU J, NAN N. Diabetes health education handbook[M]. Yinchuan: Sunshine Press, 2022.
[10]	冯晓丹, 谢翠华, 龚妮容. 糖尿病诊治和健康管理[M]. 广州: 广东科学技术出版社, 2021. FENG X D, XIE C H, GONG N R. Diabetes diagnosis and treatment and health management[M]. Guangzhou: Guangdong Science and Technology Press, 2021.
[11]	LORIG K R, SOBEL D S, RITTER P L, et al. Effect of a self-management program on patients with chronic disease[J]. Eff Clin Pract, 2001, 4(6): 256-262.
[12]	臧梦云. 基于健康素养提升的慢性病患者医疗依从性研究[D]. 南京: 南京中医药大学, 2017. ZANG M Y. Study on medical compliance of patients with chronic diseases based on health literacy promotion[D]. Nanjing: Nanjing University of Chinese Medicine, 2017.
[13]	周潇, 周云婷, 孔小岑, 等. 基于动态血糖监测结果评价门诊教育对2型糖尿病患者血糖谱的影响研究[J]. 中国全科医学, 2024, 27(21): 2572-2577. ZHOU X, ZHOU Y T, KONG X C, et al. Effect of outpatient education on blood glucose profile of type 2 diabetes mellitus patients based on the results of continuous glucose monitoring[J]. Chinese General Practice, 2024, 27(21): 2572-2577.
[14]	YEEMARD F, SRICHAN P, APIDECHKUL T, et al. Prevalence and predictors of suboptimal glycemic control among patients with type 2 diabetes mellitus in Northern Thailand: a hospital-based cross-sectional control study[J]. PLoS One, 2022, 17(1): e262714. DOI: 10.1371/journal.pone.0262714.
[15]	宿冰, 范桂红, 吴林雪, 等. 回授法健康教育对2型糖尿病患者自我管理能力及生活质量的影响[J]. 中国健康教育, 2023, 39(3): 283-287. SU B, FAN G H, WU L X, et al. Effect of feedback health education on self-management ability and quality of life among patients with type 2 diabetes mellitus[J]. Chinese Journal of Health Education, 2023, 39(3): 283-287.
[16]	CLARK N M, DODGE J A. Exploring self-efficacy as a predictor of disease management[J]. Health Educ Behav, 1999, 26(1): 72-89.
[17]	白慧敏, 商临萍. 基于行为改变轮理论的出院准备干预方案在COPD病人中的应用[J]. 护理研究, 2024, 38(6): 1095-1100. BAI H M, SHANG L P. Application of discharge preparation intervention program based on behaviour change wheel theory in COPD patients[J]. Chinese Nursing Research, 2024, 38(6): 1095-1100.
[18]	RAHBAR S, ZARIFSANAIEY N, MEHRABI M. The effectiveness of social media-based microlearning in improving knowledge, self-efficacy, and self-care behaviors among adult patients with type 2 diabetes: an educational intervention[J]. BMC Endocr Disord, 2024, 24(1): 99.
[19]	江长勇, 杨梅, 胡薇. 社区高血压签约患者参与慢病健康管理的影响因素研究[J]. 中国全科医学, 2020, 23(3): 323-326. JIANG C Y, YANG M, HU W. Influencing factors of community hypertension contract patients participating in chronic disease health management[J]. Chinese General Practice, 2020, 23(3): 323-326.
[20]	田佳禾, 刘翔, 陈红, 等. 慢性非传染性疾病社区健康管理模式的内涵及对我国的启示[J]. 中华全科医学, 2022, 20(12): 1995-1999. doi: 10.16766/j.cnki.issn.1674-4152.002754 TIAN J H, LIU X, CHEN H, et al. Connotation of the community health management models of chronic non-communicable diseases and its revelations to our country[J]. Chinese Journal of General Practice, 2022, 20(12): 1995-1999. doi: 10.16766/j.cnki.issn.1674-4152.002754