Application Of Health Behavior Intervention Program Based On HAPA Theory In Young And Middle-aged Patients With Type 2 Diabetes Mellitus

ObjectiveTo investigate and analyze the influencing factors of self-management behaviors in young and middle-aged patients with type 2 diabetes.According to the results of the current situation investigation and the expert meeting method,to explored the effect of an health behavior intervention plan for young and middle-aged patients with type 2 diabetes mellitus based on the health action process approach(HAPA),and to provide clinical practice basis for the promotion and application of the program.MethodsConvenience sampling method was adopted to survey young and middle-aged patients with type 2 diabetes who were hospitalized in the endocrinology department of a tertiary hospital in Hunan Province from November 2019 to June 2020.The general information table,diabetes management self-efficacy scale,type 2 diabetes self-management behavior scale and the revised version of quality of life scale for patients with type2 diabetes were used,A questionnaire survey was conducted among 256 young and middle-aged patients with type 2 diabetes to understand the status quo of self-management behavior,self-efficacy and quality of life of young and middle-aged patients with type 2 diabetes and its influencing factors.Based on the theory of HAPA,health behavior intervention program was constructed.100 patients with type 2 diabetes mellitus who met the inclusion criteria were randomly divided into intervention group(50 cases)and control group(50 cases).Patients in the control group received routine diabetes care,and patients in the intervention group received health behavior intervention program with "faith-plan-self-control" as the core content on the basis of routine diabetes care.The self-management behavior,self-efficacy,quality of life,fasting blood glucose(FPG),2-hour Post-meal Blood Glucose(2-hour PBG),blood pressure and BMI of the two groups were evaluated before and 12 weeks after the intervention.The IBM SPSS21.0 software was used to do the statistical analyze.Descriptive statistics was performed using constituent ratio,mean and standard deviation,chi-square test,t-test,Mann-Whitney U test,multiple linear regression analysis and spearman correlation analysis were used for statistical analysis.Results(1)The total score of self-management behavior of type 2 diabetes in young and middle-aged hospitalized patients was(76.65±14.52),and the index score rate of 60.86%,showing that the self-management behavior of the patients was at a medium level.Patients at low levels accounted for32.81%,and patients at high levels accounted for 21.09%.The highest score on the scale was the management dimension of medication prescribed by doctors.and the index score rate of 76.15%,while the dimensions of blood glucose test and foot care scored the lowest,and the index score rates of 52.07% and 56.84%;The scores of self-efficacy of young and middle-aged inpatients with type 2 diabetes was(94.24±15.81),their self-efficacy behavior was in the middle level;The quality of life of young and middle-aged inpatients with type 2 diabetes was(98.76±9.39),in the middle level.The results of correlation analysis showed that the selfmanagement behaviors of young and middle-aged inpatients with type 2diabetes inpatients was positively correlated with self-efficacy(r = 0.140～0.275,P < 0.05)and quality of life scores(r =-0.185～–0.359,P < 0.01).(2)The results of univariate analysis showed that there were statistically significant differences in the self-management behavior scores of young and middle-aged type 2 diabetes in patients in age,body mass index,family income,diabetes course,main diabetes treatment methods,number of hospitalizations,and complications(P <0.05).The results of multiple stepwise regression analysis showed that the age,the family income per capita,the course of diabetes,the main treatment methods of diabetes were the main factors affecting the self-management behavior of the young and middle-aged type 2 diabetes patients.(3)Before intervention,there was no significant difference in general demographic data,self-management behavior score,self-efficacy score,quality of life score,the glycosylated hemoglobin,fasting blood glucose(FBG),2h postprandial blood glucose(2h PBG),BMI,and blood pressure(systolic blood pressure)between the two groups of young and middle-aged hospitalized patients with type 2 diabetes(P > 0.05).(4)48 patients in each group completed the 12 week intervention,and the results were as follows.(1)The self-efficacy scores of two groups were higher than before the intervention(P <0.05);The self-efficacy scores of the intervention group were higher than those of the control group,and the difference was statistically significant(P <0.05).(2)The self-management behavior scores of two groups were higher than before the intervention(P <0.05);The self-management behavior scores of the intervention group were higher than those of the control group,and the difference was statistically significant(P <0.05).(3)The quality of life scores of two groups were higher than before the intervention(P <0.05);The quality of life scores of the intervention group were higher than those of the control group,and the difference was statistically significant(P <0.05).(4)After the intervention,there was no significant difference in glycosylated hemoglobin,BMI,blood pressure(systolic blood pressure)between the two groups(P <0.05),but after the intervention,the fasting blood glucose and 2-hour Post-meal Blood Glucose of the intervention group were significantly lower than those of the control group,the difference was statistically significant(P <0.05).Conclusion(1)Self-management behavior of young and middle-aged hospitalized patients with type 2 diabetes mellitus was at a middle level overall.Family income per capita,age,main treatment methods of diabetes mellitus and duration of diabetes mellitus were the main factors affecting self-management behavior of patients.Self-management behavior was positively correlated with self-efficacy and quality of life.(2)The application of health behavior intervention program based on HAPA theory can effectively improve the self-management behavior,selfefficacy and blood glucose control level of young and middle-aged patients with type 2 diabetes.