تاثير مداخله آموزشي فشرده مبتني بر مدل مراحل تغيير بر بهبود رفتارهاي خود مراقبتي و كنترل قندخون در سالمندان مبتلا به ديابت نوع دو

The Effect of Intensive Educational Intervention Based on the Trans Theoretical Model on Improving Self-Care and Blood Sugar Control Behaviors in the Elderly with Type 2 Diabetes

زﻣﯿﻨﻪ و ﻫﺪف دﯾﺎﺑﺖ ﻧﻮع دو ﺑﻪ رﻓﺘﺎرﻫﺎي ﺧﻮدﻣﺮاﻗﺒﺘﯽ وﯾﮋه اي ﺗﺎ ﭘﺎﯾﺎن ﻋﻤﺮ ﻧﯿﺎز دارد. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪف ﺗﻌﯿﯿﻦ ﺗﺄﺛﯿﺮ آﻣﻮزش ﺑﺮ ﮐﻨﺘﺮل ﻗﻨﺪ ﺧﻮن در ﺳﺎﻟﻤﻨﺪان ﻣﺒﺘﻼ ﺑﻪ دﯾﺎﺑﺖ ﻧﻮع دو اﺟﺮا ﮔﺮدﯾﺪ .ﻣﻮاد و روشﻫﺎ: ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﯾﮏ ﻣﻄﺎﻟﻌﻪ ﻣﺪاﺧﻠﻪ اي ﺷﺎﻫﺪدار ﺗﺼﺎدﻓﯽ ﺷﺪه ﺑﺎ روش ﻧﻤﻮﻧﻪ ﮔﯿﺮي ﭼﻨﺪ ﻣﺮﺣﻠﻪ اي ﺗﺼﺎدﻓﯽ ﺑﺮ روي 110ﺳﺎﻟﻤﻨﺪ ﻣﺒﺘﻼ ﺑﻪ دﯾﺎﺑﺖ ﻧﻮع دو در ﺷﻬﺮﺳﺘﺎن ﻣﻼرد اﻧﺠﺎم ﮔﺮدﯾﺪ ) 55ﻧﻔﺮ در ﮔﺮوه ﻣﺪاﺧﻠﻪ و 55 ﻧﻔﺮ در ﮔﺮوه ﮐﻨﺘﺮل(. اﻓﺮاد ﮔﺮوه ﻣﺪاﺧﻠﻪ ﺗﺤﺖ دو ﺟﻠﺴﻪ آﻣﻮزﺷﯽ ﻓﺸﺮده و ﺳﭙﺲ ﭘﯿﮕﯿﺮي آﻣﻮزﺷﯽ از ﻃﺮﯾﻖ ارﺳﺎل روزاﻧﻪ ﭘﯿﺎم ﮐﻮﺗﺎه ﺑﻪ ﺗﻠﻔﻦ ﻫﻤﺮاه ﻗﺮار ﮔﺮﻓﺘﻨﺪ. داده ﻫﺎي ﻣﺮﺑﻮط ﺑﻪ وﺿﻌﯿﺖ دﻣﻮﮔﺮاﻓﯿﮏ، ﺷﺎﺧﺺ ﻫﺎي آﻧﺘﺮوﭘﻮﻣﺘﺮﯾﮏ، ﻣﯿﺰان ﺧﻮدﻣﺮاﻗﺒﺘﯽ و ﺷﺎﺧﺺﻫﺎي ﭘﺮوﻓﺎﯾﻞ ﻗﻨﺪي ﺑﯿﻤﺎران ﻗﺒﻞ و ﺑﻌﺪ از ﻣﺪاﺧﻠﻪ، ﺟﻤﻊ آوري و ﺑﺎ ﻧﺮم اﻓﺰار SPSS 22و آزﻣﻮن ﻫﺎي ﺗﯽ ﻣﺴﺘﻘﻞ، وارﯾﺎﻧﺲ ﯾﮏ ﻃﺮﻓﻪ وANOVA ﺗﺤﻠﯿﻞ ﺷﺪﻧﺪ. ﯾﺎﻓﺘﻪﻫﺎ: ﻧﺘﺎﯾﺞ ﻧﺸﺎندﻫﻨﺪه ﮐﺎﻫﺶ ﻣﻌﻨﯽدار ﻣﯿﺎﻧﮕﯿﻦ FBSو HbA1c در ﮔﺮوه ﻣﺪاﺧﻠﻪ ﺑﻮد 0 /001˂ p(. ﻫﻢ ﭼﻨﯿﻦ ﯾﺎﻓﺘﻪﻫﺎ ﻧﺸﺎن داد ﻣﯿﺎﻧﮕﯿﻦ ﺗﻤﺎم ﺣﯿﻄﻪ ﻫﺎي ﺧﻮدﻣﺮاﻗﺒﺘﯽ ﺑﻪﺟﺰ ﺣﯿﻄﻪ ﻣﺮﺗﺒﻂ ﺑﻪ ﻣﺼﺮف ﻧﮑﺮدن ﺳﯿﮕﺎر در ﺑﯿﻤﺎران ﮔﺮوه ﻣﺪاﺧﻠﻪ، اﻓﺰاﯾﺶ ﻣﻌﻨﯽدار داﺷﺘﻪ )0 /05˂p( و ﻣﯿﺎﻧﮕﯿﻦ ﻧﻤﺮه ﮐﻞ ﺧﻮدﻣﺮاﻗﺒﺘﯽ ﻧﯿﺰ از ﺳﻄﺢ ﻧﺎﻣﻄﻠﻮب و ﻧﯿﻤﻪ ﻣﻄﻠﻮب ﺑﻪ ﺳﻄﺢ ﻣﻄﻠﻮب ارﺗﻘﺎ ﭘﯿﺪا ﮐﺮده اﺳﺖ )0 /001˂p(.ﻧﺘﯿﺠﻪ ﮔﯿﺮي: رﻓﺘﺎرﻫﺎي ﺧﻮدﻣﺮاﻗﺒﺘﯽ و ﮐﻨﺘﺮل ﻗﻨﺪ ﺧﻮن ﺳﺎﻟﻤﻨﺪان دﯾﺎﺑﺘﯽ ﻧﻮع 2 ﺑﺎ ﺑﺮﻧﺎﻣﻪ آﻣﻮزﺷﯽ ﻓﺸﺮده ﻣﺒﺘﻨﯽ ﺑﺮ ﺗﺌﻮري ﻣﺮاﺣﻞ ﺗﻐﯿﯿﺮ ﺑﻪﻃﻮر ﻣﻌﻨﺎداري ﺑﻬﺒﻮد ﯾﺎﻓﺖ؛ ﺑﻨﺎﺑﺮاﯾﻦ ﺗﻮﺟﻪ ﺑﻪ ﻣﺘﻐﯿﺮﻫﺎي ﻣﺬﮐﻮر در ﻃﺮاﺣﯽ ﻣﺪاﺧﻼت آﻣﻮزﺷﯽ اﯾﻦ ﮔﺮوه ﺳﻨﯽ ﺿﺮوري ﺑﻪﻧﻈﺮ ﻣﯽرﺳﺪ.

Type 2 diabetes requires special self-care behaviors for the rest of your life. The present study was conducted to determine the effect of education on glycemic control in the elderly with type 2 diabetes. Materials and Methods: The present study was a randomized controlled intervention that was performed on 110 elderly people with type 2 diabetes by multi-stage random sampling method in Mallard city (55 patients in each group). The cases received 2 intensive training sessions and then the training follow-up by sending daily SMS to the mobile phone for a period of three months. Data related to demographic status, anthropometric indices, self-care rate and glucose profile indices of patients were collected before and after the intervention. Data were analyzed using SPSS software version 22 and independent t-test, one-way ANOVA and ANOVA. Results: Comparison of glucose profiles of control and intervention patients before and after three months of educational intervention showed a significant decrease in mean FBS and HbA1c (p<0/001). The results also showed that the mean of all areas of self-care except the area related to non-smoking in the intervention group had a significant increase (p<0/05) and the mean of their total self-care score increased from unfavorable and semi-desirable to the beginning of the desired level (p<0/001). Conclusion: Intensive training program based on theory of stages of change has been significantly effective on self-care behavior and glycemic control in the elderly with type 2 diabetes so it is necessary to pay attention to these variables in designing educational interventions for this age group.