| Background:According to the latest statistics of International Diabetes Federation,there were 415 million people diagnosed with Diabetes Mellitus in 2015 all over the globe,indicating that Diabetes Mellitus has globally become one of the chronic diseases with the highest rate of onset;moreover,with Diabetes increasing more and more rapidly,it has caused various complications and brought high medical costs.Therefore,preventing Diabetes has become one focus of chronic disease prevention.Thus our government has always placed a high value on Diabetes prevention.To reinforce the health management of patients with diabetes,control the blood glucose effectively and prevent complications of diabetes,the relevant state department explicitly required that type 2 Diabetes Mellitus prevention should be incorporated into the basic public health service from 2009,involving: health records establishing,drug therapy regulating,public health lectures and physical examinations conducting,and guidance to healthy lifestyle providing,etc.And in recent years,a succession of pilot projects have been launched in some communities of Chongqing city,covering an increasing area.Located in the peri-urban area of Shapingba district of Chongqing city,Shuangbei Community Health Center is a place where there is relatively backward level of culture and economy,limited health resources and a large flow of people,leading to a great difficulty in the management of chronic diseases.To overcome this difficulty,in 2009,this community center became the experimental unit of Shapingba district where an intervention program of diabetes has been conducted,being the first to implement disease management.Based on the normative health records established for the residents in this district,patients diagnosed with diabetes have been included into the center for health management.In addition,follow-up visit was provided to raise patients' compliance.However,the current situation,the effect and remaining problems regarding to diabetes intervention need to be found,and a more effective lifestyle of health promoting behaviors needs to be explored.Research Purpose:1.With the diabetic patients in Shuangbei Community Health Center as the research object,the effectiveness of the diabetes intervention and its remaining problems were observed and analyzed.2.Through a combination of a qualitative study and an experimental study,a way to raise diabetic patients' compliance in the diabetes intervention in this community center.Research Method:1.Status Investigation1.1 Research Content.Going through all the normative health records established for the residents in this district,889 diabetic patients were found and surveyed.In addition,questionnaire survey,physical and laboratory examinations were utilized.The items of the questionnaire include: name,gender,ID card number,education,dietary and sports status;the items of the physical examination include: height,weight,waist circumference,blood pressure,body mass index calculation;and the items of laboratory examination include: blood glucose,urine routine,electrocardiogram,liver and renal function,and B-mode ultrasound and so on.The relevant criteria for reference:Criteria of Diabetes Diagnosis: Diabetes Diagnosis in accordance with the diagnostic criteria of WHO in 1999.Criteria of Effective Control of Blood Glucose: referring to National Basic Public Health Service Standard of 2011Criteria of Patients with High Risk of Diabetic Nephropathy: marked by proteinuria showing positive1.2 Content of analysis.The effectiveness of the intervention program on diabetes,the characteristics of patients during the program period and relevant factors leading to the effectiveness.1.3 Quality control.Before the survey was conducted,several necessary preparations were done to make sure the good quality and validity of the survey.A training was carried on among all the participants;unified technology and terms were provided to them;and an explanation of the survey was made among the participants in the center.1.4 Statistical analysis.SPSS Statistics Version 11 was utilized to conduct the analysis.T-tests were used for continuous variables,chi-square tests were utilized for categorical variables,and logistic regression was used for multivariate analysis.All of the tests were two-sided and a P value of below 0.05 was considered to be statistically significant.2.Research on Health Promoting Behaviors2.1 The content of Intervention of Health Promoting Behaviors.Intervention content was screened through systematic analysis and qualitative study by our research team(done by the other members of our team),involving 11 items of exercise,diet and health maintenance.2.2 Screening of Approaches of Health Promoting Behaviors.Qualitative study was adopted to gather and screen an approach to behaviors promotion of patients in this community.Sampling Method: Purposive and convenience sampling were used,and a sample of participants were selected and stratified by the different streets and respondents(varying from managerial staff,health workers,and patients in the community center).Also,based on the real task performance,a non-probabilistic sampling was also used to select participants of maximum difference.And the sample size was saturated.Research and analysis method: Semi-structured interview was used to collect information and data,from which an interview outline was formed.Then thematic framework analysis was utilized to organize and analyze the information and data;and with all the information and data encoded and marked,and they were sorted out,summarized and concluded according to themes,from which the research result was obtained.2.3 Intervention Effectiveness Comparison.Quantification comparative analysis was used to compare the difference between experimental group and control group.Recruitment Means.Through the method of epidemiological experiment,subjects were selected in four streets of similar environment conditions,various means were used to find diabetic and pre-diabetic patients.All the subjects filled up a form including the following items: age,gender,marital status,education and annual income.Besides,they completed a baseline test including the following items: height,weight,blood glucose,blood pressure,blood lipid,and so on.Sample Size and Group Design.Based on the data from the pretest,the rate of behavior change in intervention group and control group was respectively 39% and 16%,with a threshold of significance being ?=0.05(two-sided)and?=0.1.According to the result of the formula,112 subjects were decided.To avoid contamination and improve the their compliance in the intervention,groups were decided with the street as units and based on the results of the baseline test,ensuring that the two groups were well matched in terms of the index and thus comparable.In the end,there were 53 examples in intervention group and 59 examples in control group.Criteria of Diagnosis,Inclusion and Exclusion: the diagnostic criteria for type 2 Diabetes Mellitus can refer to the criteria of diabetes mentioned in the first part.Pre-diabetic patients were decided based on the index of the blood glucose two hours after the patients were tested.And the criteria for diagnosing pre-diabetic patients:(1)impaired fasting glucose abbreviated as IFG ?6.1mmol/L(110mg/dl)and<7.0mmol/L(126mg/dl),and at the same time,after the Oral glucose tolerance test abbreviated as OGTT,(2hPG)<7.8mmol/L(140mg/dl);(2)impaired glucose tolerance abbreviated as IGT: FG <7.0mmol/L(126mg/dl),after the OGTT,2hPG?7.8mmol/L(140mg/dl)and < 11.1mmol/L(200mg/dl).Criteria for Inclusion:(1)If all the subjects volunteered to participate in the study and signed the informed consent or not;(2)If they met the criteria for pre-diabetic diagnosis or not;(3)If they were more than 18 years old or not.Criteria for Exclusion:(1)those who one were diagnosed with diabetes;(2)those who had some disease seriously interrupting the intervention,such as severe cardiac-cerebral vascular disease,cancer and so on;(3)those who suffered from mental disorders and psychological disease and thus unable to communicate normally with others;(4)those who were pregnant or planned to be pregnant during the study period;(5)those who had a family member involved in the study as a worker;(6)those who already participated in other research project likely to interrupt our intervention project;(7)those who took weight-reducing medicine in the previous 6 months.The Content of Observation.A comparison of the difference was made between the two groups after a year of experiment.And the comparison was made based on the criteria mentioned in the first part,involving the index of behavior,blood glucose,blood lipid and liver and renal functions.2.4 Ethical principle.Subjects were required to sign the informed consent;the study protocol gained the approval from the ethics committee of the Third Military Medical University;and the study has been registered in the Chinese Clinical Trial Register,ChiCTR(the registration number is ChiCTR-IOR-15005901).2.5 Quality control.Refers to the first part.2.6 Statistical analysis.Refers to the first part.Research resultPart 11.In recent years,as required by the relevant state department,Shuangbei Community Health Center actively took an integrated management of the patients with type 2 diabetes.Among the 889 patients managed,810 questionnaires which are complete and valid have been collected,and the responsive rate was 91.1%.Among all the respondents,the youngest one was at the age of 28,while the oldest one was 92;and there were 325 males(38.1%),and 485 females(59.9%).2.Through the integrated management,of all the participants in the study,385(47.53%)were under good blood glucose control,including 147 male participants(38.10%),and 238 female participants(61.90%),showing a higher percentage of female participants;also,of the 385 participants under good blood glucose control,there were 330(77.9%)who were at the age of 60 or more than 60,and 85(22.1%)were below 60,showing a higher percentage of participants at the age of 60 or older.Grouped by the effectiveness of blood glucose control,there was no statistically significance in the differences of gender and age with the p value more than 0.05,(p>0.05).The percentage of participants under good blood glucose control varies from 33.3% to 50.0% among the groups of participants of 20 and 90.3.Grouped by the outcomes of blood glucose control of diabetic patients,among the group under a good blood glucose control,the index of triglycerides,ketone,waist circumference,body mass index calculation,heart rate were lower than those in the group under a poor control,showing that there was a statistically significance in the difference with the p value less than 0.01(p<0.01).Also,this showed that there was an improvement in weight,heart rate,and other relative serum indicators in the group under a good blood glucose control.4.Among the group under a good blood glucose control,the rates of glucose and urinary protein showing positive were lower than the group under poor control,showing that there was a statistically significance in the difference with the p value less than 0.01(p<0.01).And this showed that there was an improvement in glucose and urinary protein among those diabetic patients under a good blood glucose control.5.Of all the participants managed,231(28.5%)were at a high risk of diabetic nephropathy,and the main clinical features were micro-albuminuria and urine protein showing positive,which were likely to be the predictive index and risk factor.Part 21.Just as the qualitative study demonstrated,favorable factors leading to compliance include: a strong awareness of health,support from partners,a proper degree of behavior task,patients' fear of disease and so on.Yet,unfavorable factors include: uncertainty of the effectiveness of Health Promoting Behavior,a lack of patience and perseverance,a weak awareness of health,environmental factors and so on.Suggestions: a clear plan of tasks for Health Promoting Behavior needs to be made;task activities should be easy to accomplish,and suit participants' living habits;and the task activities should be enjoyable as much as possible but not be time-and money-consuming.Also,if the task activities are clear,lifestyle-suiting,interesting,and incentive,Health Promoting Behavior can have a better effect on raising patients' awareness of health and leading to their behavior change as well.2.On the basis of the qualitative study,the new mode of intervention in community was formed combining people's needs with social resources,with a behavioral theory of “ knowledge,belief,and action” as a foundation and exercise,diet and health as the targets.Meanwhile,the new mode of intervention is characterized by the combination of the supervision and motivation of behavior,people's interests and the use of “wechat,QQ,and text” as support.Then,after a study period of 6 months and 12 months,through the monitoring of consecutive behavior and physical index,the index of the fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG)of the participants among the intervention group were significantly lower than those among the control group,and 12 months later,the proportion of behavior promotion among the intervention group has been increased to a range of 9.43% to 81.13% from the baseline of 0% to 43.4%.Research Conclusion1.The intervention and management in the community center played a very prominent role in diabetes prevention and treatment,however,it was not enough to meet the reginaol government's requirement for the control of diabetes.Nevertheless,the intervention has helped diabetic patients promote their knowledge of diabetes,though a modification needs to be done on the basis of the existing intervention mode to better supervise and promote diabetic patients' health behaviors.2.This research built a mode of intervention with the improvement of exercise,die and health as a core target,and in the intervention economical and suitable way of supervision was used,and incentives and interests to the task activities were added.Through the experimental study in this area,the compliance of the participants in the intervention has been greatly improved,and with the physical index of patients improving,a further follow-up and observation need to be done. |
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