摘要
背景医疗不信任可降低患者的医嘱遵从度和服药依从性,影响临床结局,可通过有效的干预得以改善,但相关研究较少。目的评估健康素养干预和运动干预对2型糖尿病(T2DM)患者医疗不信任的影响。方法本研究基于2015年2月至2016年3月开展的一项整群随机对照试验(RCT)。采用多阶段抽样法在上海市闵行区和长宁区各4家社区卫生服务中心的糖尿病管理系统中招募T2DM患者800例,以社区为群随机分入对照组和3个干预组。所有患者接受常规护理,3个干预组在此基础上分别实施基于提高糖尿病教育伙伴关系(PRIDE)工具包的健康素养干预、运动干预、健康素养+运动干预(综合干预)。基线时和干预实施3、6、12个月后及干预结束12个月后对患者开展调查,调查工具包括汉化版健康素养管理表(c-HeLMS)、汉化版糖尿病计算能力测试量表(c-DNT-5)、汉化版医疗不信任指数量表(c-MMI)。采用广义估计方程评估干预效果。结果最终纳入780例患者。c-MMI量表在本人群中具有较好的信度和效度,Cronbach'sα系数为0.826。c-MMI的中位得分为31(7)分,医疗不信任(≥30分)率为65.9%(514/780)。随访期间,四组患者的c-MMI得分及医疗不信任率整体呈下降趋势。与对照组相比,健康素养干预组在3、6个月时医疗不信任风险下降,OR(95%CI)分别为0.42(0.23,0.78)和0.46(0.24,0.88);运动干预组在6、12、24个月时医疗不信任风险下降,OR(95%CI)分别为0.50(0.25,0.99)、0.43(0.22,0.86)、0.37(0.19,0.72);综合干预组在6个月时医疗不信任风险降低,OR(95%CI)为0.30(0.16,0.56)。结论基于PRIDE工具包的健康素养干预和步行运动干预均可有效降低T2DM患者的c-MMI得分,有助于改善患者的医疗不信任。
Background Medical distrust in patients has been related with poor compliance to medications and suboptimal clinical outcomes.Effective interventions may improve medical distrust in patients which is warranted specific studies.Objective To evaluate the effect of health literacy and exercise interventions on medical mistrust in patients with type 2 diabetes(T2DM).Methods This study was based on a cluster randomized-controlled trial conducted during February 2015 to March 2016.A total of 800 T2DM patients were recruited from four community health service centers in Minhang and Changning Districts of Shanghai by using a multi-stage sampling method.All patients were randomly divided into the control group and 3 intervention groups in the community.Routine care was provided to all the patients,and on this basis,health literacy intervention,exercise intervention and health literacy+exercise intervention(comprehensive intervention)were performed to the three intervention groups based on partnership to improve diabetes education(PRIDE)toolkit,respectively.Information was collected using the Chinese versions of Health Literacy Management Scale(c-HeLMS),the 5-item Diabetes Numeracy Test Scale(c-DNT-5),and Medical Mistrust Index(c-MMI)at baseline,3-,6-,12-(end of intervention)and 24-months follow-up(post-intervention).The generalized estimating equation was used to evaluate the effect of the interventions at each time point.Results A total of 780 patients were recruited in this study.The c-MMI was a reliable and valid scale to measure medical mistrust in our subjects,with Cronbach'sαof 0.826.The median score and interquartile range of c-MMI was 31(7)at baseline while the rate of medical mistrust(scores≥30)was 65.9%(514/780),both of which decreased at almost each follow-up survey in four groups.Compared with the control group,a lower risk of medical mistrust was observed at the 3-months〔OR(95%CI)=0.42(0.23,0.78)〕and 6-months of follow-up〔OR(95%CI)=0.46(0.24,0.88)〕for the health literacy group,at the 6-months〔OR(
作者
王梦妍
王蕾
陈英耀
方红
夏庆华
Russell L Rothman
徐望红
WANG Mengyan;WANG Lei;CHEN Yingyao;FANG Hong;XIA Qinghua;Russell L Rothman;XU Wanghong(School of Public Health/Key Laboratory of Health Technology Assessment(National Health Commission),Fudan University,Shanghai 200032,China;Central for Disease Control and Prevention in Minhang District of Shanghai,Shanghai 201101,China;Central for Disease Control and Prevention in Changning District of Shanghai,Shanghai 200336,China;Department of Medicine,Vanderbilt University Medical Center,Nashville 37203,TN,USA)
出处
《中国全科医学》
CAS
北大核心
2022年第1期79-86,共8页
Chinese General Practice
基金
教育部人文社科规划基金项目(14YJAZH092)
美国中华医学基金会(CMB)公开竞争项目(13-159)。
关键词
糖尿病
2型
健康管理
健康素养
步行
医生病人关系
医疗不信任
提高糖尿病教育伙伴关系工具包
Diabetes mellitus,type 2
Health management
Health literacy
Walking
Physician-patient relations
Medical mistrust
Partnership to improve diabetes education toolkit
