【作者】 李洋；

【导师】 李菲；

【作者基本信息】 吉林大学 ， 护理硕士（专业学位）， 2025， 硕士

【摘要】 目的:本研究以ITHBC理论为研究框架,旨在调查成人1型糖尿病伴低血糖感知受损患者自我管理行为现状,探究该人群的自我管理体验,并通过并行三角互证混合研究设计深入分析该人群自我管理的影响因素。为该群体制定自我管理的干预措施提供科学依据和方向。方法:本研究采用并行三角互证混合研究设计,包含两个阶段。1.量性研究阶段,采用横断面研究设计。采用方便抽样法在长春市某所三级甲等医院选取142名成人T1DM伴IAH患者作为研究对象,描述其自我管理行为现状,基于ITHBC理论对其影响因素进行分析。研究工具主要为一般资料调查表、糖尿病患者自我管理行为量表(SDSCA)、治疗自我调节问卷(Treatment Self-Regulation Questionnaire,TSRQ)、糖尿病患者自我管理知识、态度和行为评价简化量表中的知识分量表、简易疾病感知问卷(Brief Illness Perception Questionnaire,BIPQ)、糖尿病患者自我管理自我效能量表(Self-efficacy for Diabetes Management Scale,SEDM)、社会支持评定量表(Social Support Rating Scale,SSRS)进行测量。使用Epi Data 3.1录入数据并建立数据库。通过IBM SPSS 25.0对数据进行统计分析,包括描述性统计分析、单因素分析、相关性分析和多元逐步回归分析等。2.质性研究阶段,采用描述性质性研究设计。采取目的抽样法,依据最大差异化原则,对14名就诊于长春市某三甲医院的成人T1DM伴IAH患者进行半结构化访谈,深度挖掘其日常生活中自我管理行为的真实感受,充分了解患者的困扰和需求。采用NVivo 12.0软件,运用主题分析法对访谈资料进行整理和分析。结果:1.量性研究阶段(1)T1DM伴有IAH患者糖尿病自我管理量表总分为18.55±3.69;自我调节量表总分为50.53±7.56;糖尿病知识量表总分为11.06±3.00;疾病感知量表总分为42.58±6.11;糖尿病自我效能总分为5.05±0.87;社会支持量表总分为31.51±5.96。(2)单因素分析结果显示,T1DM伴有IAH患者婚姻状况、半年内发生低血糖次数对自我管理行为的影响差异具有统计学意义(P<0.05)。(3)Pearson相关性分析结果表明,自我调节(r=0.380,P=0.000)、自主动机(r=0.326,P=0.000)、控制动机(r=0.287,P=0.001)、无动机(r=0.227,P=0.00);疾病感知(r=0.217,P=0.009)、疾病担忧(r=0.339,P=0.000)、疾病理解能力(r=0.304,p=0.000);自我效能(r=0.301,P=0.000)、饮食自我效能(r=0.211,P=0.012)、运动自我效能(r=0.317,P=0.000)、疾病控制自我效能(r=0.195,P=0.020);社会支持(r=0.217,P=0.009)、主观支持(r=0.217,P=0.009)、客观支持(r=0.217,P=0.009)均与自我管理行为得分成正相关。(4)多元逐步回归分析结果表明,低血糖次数(β=-0.272,P=0.000)、主观支持(β=0.320,P=0.000)、自我调节(β=0.248,P=0.001)、自我效能(β=0.201,P=0.004)是T1DM伴有IAH患者自我管理行为的统计学显著预测因子。模型中包含的变量解释了38.7%的方差(决定系数R~2=0.387;调整系数R~2=0.369;F=21.308)。2.质性研究阶段通过对14名成人T1DM伴IAH患者自我管理行为的访谈资料进行整理分析,提炼出3个主题和9个亚主题。主题一为"知识与信念不足",包括亚主题:知识缺乏和个人看法。主题二为"自我调节能力较差",包括亚主题:目标设定、自我监控与反思性思考、决策制定、规划和计划、自我评价。主题三为"渴望社会支持",包括亚主题:社会影响和社会支持。结论:(1)T1DM伴IAH患者的自我管理处于较低水平且仍有待提高。研究发现,这些患者还存在“知识与信念不足”、“自我调节能力差”和“渴望社会支持”的情况。(2)本研究基于ITHBC理论的并行三角互证混合研究,全面揭示了T1DM伴IAH患者自我管理的影响因素。在临床工作中,应重点关注这些影响因素,解决患者自我管理中的关键问题,专注于更好地满足其健康需求。(3)未来研究可以从提升自我效能感、自我调节技能和能力和社会支持入手,制定综合性、针对性的干预策略,以改善预后,使T1DM伴IAH患者更好地参与自我管理,提高其生活质量。更多还原

【Abstract】 Objective:Using ITHBC theory as a research framework,this study aims to investigate the current status of self-management behaviours of adult type 1 diabetes mellitus with impaired hypoglycemia perception,to explore the self-management experience of this population,and to analyse in-depth the influencing factors of self-management in this population through a parallel triangulated mutual evidences mixed research design.To provide scientific basis and direction for the development of self-management behavioural interventions for this population.Methods:This study adopted a parallel triangular mutual evidence mixed research design,containing two phases.1.A quantitative research phase with a cross-sectional research design.Convenience sampling method was used to select 142 adult T1DM with IAH patients in a tertiary hospital in changchun City as the study subjects,to describe the current status of their self-management behaviours,and to analyse their influencing factors based on ITHBC theory.The research instruments were a general information questionnaire,the Summary of Diabetes Self-Care Activities(SDSCA),the Treatment Self-RegulationQuestionnaire(TSRQ),the Knowledge subscale of the Simplified Scale of Evaluation of Self-Management Knowledge,Attitude and Behaviour in Diabetes,the Brief Illness Perception Questionnaire(BIPQ),Stanford Self-efficacy for Diabetes ManagementScale(SEDM),Social Support Rating Scale(SSRS)were measured.Data were entered and a database was created using Epi Data 3.1.Data were statistically analysed by IBM SPSS 25.0,including descriptive statistical analysis,one-way analysis,correlation analysis and multiple stepwise regression analysis.2.In the qualitative research phase,a descriptive qualitative research design was used. Purposive sampling method was adopted,based on the principle of maximum differentiation,to conduct semi-structured interviews with 14 adult T1DM with IAH patients attending a tertiary hospital in Changchun City,to deeply explore the real feelings of their self-management behaviours in their daily lives,and to fully understand the patients’distress and needs.NVivo 11.0 software was used to collate and analyse the interview data using thematic analysis.Results:1.Quantitative research stage(1)The total score of SDSCA for T1DM with IAH patients was 18.55±3.69;the total score of TSRQ was 50.53±7.56;the total score of Diabetes Knowledge Scale was 11.06±3.00;the total score of BIPQ was 42.58±6.11;the totalscore of SEDM was5.05±0.87;the total score of SSRS was 31.51±5.96.(2)The results of univariate analysis showed that the differences in the effects of marital status and the number of hypoglycemic episodes within six months onself-management behaviours in patients with T1DM with IAH were statistically significant.(3)The results of Pearson correlation analysis showed that self-regulation(r=0.380,P=0.000),autonomous motivation(r=0.326,P=0.000),control motivation(r=0.287,P=0.001),and unmotivated(r=0.227,P=0.00);disease perception(r=0.217,P=0.009),disease worry(r=0.339,P=0.000),illness comprehension(r=0.304,p=0.000);self-efficacy(r=0.301,P=0.000),dietary self-efficacy(r=0.211,P=0.012),exercise self-efficacy(r=0.317,P=0.000),and illness control self-efficacy(r=0.195,P=0.020);social support(r=0.217,P=0.009),subjective support(r=0.217,P=0.009),and objective support(r=0.217,P=0.009)were all positively correlated with self-management behaviour scores.(4)The results of multiple stepwise regression analysis showed that the number of hypoglycemia(β=-0.272,P=0.000),subjective support(β=0.320,P=0.000), self-regulation(β=0.248,P=0.001),and self-efficacy(β=0.201,P=0.004)were statistically significant self-management behaviours of the T1DM patients with IAH Predictors.The variables included in the model explained 38.7%of the variance (coefficient of determination R~2=0.387;adjustment coefficient R~2=0.369;F=21.308).2.Qualitative study phaseThree themes and nine sub-themes were extracted from the interview data of 14adults with T1DM with IAH on self-management behaviours.Theme 1 was‘Lack of knowledge and beliefs’,including sub-themes:lack of knowledge and personal perceptions.Theme 2 was‘poor self-regulation’,including sub-themes:goal setting,self-monitoring and reflective thinking,decision-making,planning and scheduling,and self-evaluation.Theme 3 was‘Desire for social support’and included thesubthemes:social influence and social support.Conclusions:(1)Self-management in patients with T1DM with IAH is low and needs to be improved.The study found that these patients also had‘insufficient knowledge and beliefs’,‘poor self-regulation’and‘desire for social support’.(2)This study is a parallel triangulated mixed study based on the ITHBC theory,which comprehensively reveals the influencing factors of self-management in patients with T1DM and IAH.In clinical work,these influencing factors should be focused on to address the key issues in patients’self-management and focus on better meeting their health needs.(3)Future research could start from improving self-efficacy,self-regulation skills and abilities,and social support to develop comprehensive and targeted intervention strategies to improve prognosis,enable T1DM with IAH patients to better participate in self-management,and improve their quality of life.更多还原