家庭参与对患者的自我护理和血糖控制既有帮助也有危害。
Family involvement is helpful and harmful to patients' self-care and glycemic control.
作者信息
Mayberry Lindsay Satterwhite, Osborn Chandra Y
机构信息
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
出版信息
Patient Educ Couns. 2014 Dec;97(3):418-25. doi: 10.1016/j.pec.2014.09.011. Epub 2014 Sep 20.
OBJECTIVE
We assessed the relationships between supportive and obstructive family behaviors and patients' diabetes self-care activities and HbA1C, and potential interaction effects and differences by demographic characteristics.
METHODS
In a cross-sectional study, 192 adults with type 2 diabetes completed the Diabetes Family Behavior Checklist-II, the Summary of Diabetes Self-Care Activities, and a glycemic control (HbA1C) test.
RESULTS
Participants reported similar rates of supportive and obstructive behaviors that were positively correlated (rho=0.61, p<0.001). In adjusted analyses, supportive family behaviors were associated with adherence to different self-care behaviors (β=0.20 to 0.50, p<0.05), whereas obstructive family behaviors were associated with less adherence to self-care behaviors (β=-0.28 to -0.39, p<0.01) and worse HbA1C (β=0.18, p<0.05). Supportive behaviors protected against the detrimental effect of obstructive behaviors on HbA1C (interaction β=-0.22, p<0.001). Non-Whites reported more supportive and obstructive behaviors than Whites, but race did not affect the relationships between family behaviors and self-care or HbA1C.
CONCLUSION
Involving family members in patients' diabetes management may impede patients' self-care and compromise their glycemic control unless family members are taught to avoid obstructive behaviors.
PRACTICE IMPLICATIONS
Our findings endorse interventions that help family members develop actionable plans to support patients' self-care and train them to communicate productively about diabetes management.
目的
我们评估了支持性和阻碍性家庭行为与患者糖尿病自我护理活动及糖化血红蛋白（HbA1C）之间的关系，以及按人口统计学特征划分的潜在交互作用和差异。
方法
在一项横断面研究中，192名2型糖尿病成年人完成了糖尿病家庭行为清单-II、糖尿病自我护理活动总结以及血糖控制（HbA1C）测试。
结果
参与者报告的支持性和阻碍性行为发生率相似，且呈正相关（rho = 0.61，p < 0.001）。在调整分析中，支持性家庭行为与不同自我护理行为的依从性相关（β = 0.20至0.50，p < 0.05），而阻碍性家庭行为与自我护理行为的依从性较低相关（β = -0.28至-0.39，p < 0.01）以及较差的HbA1C水平相关（β = 0.18，p < 0.05）。支持性行为可防止阻碍性行为对HbA1C产生不利影响（交互作用β = -0.22，p < 0.001）。非白人报告的支持性和阻碍性行为比白人更多，但种族并未影响家庭行为与自我护理或HbA1C之间的关系。
结论
让家庭成员参与患者的糖尿病管理可能会妨碍患者的自我护理并损害其血糖控制，除非教导家庭成员避免阻碍性行为。
实践意义
我们的研究结果支持一些干预措施，这些措施可帮助家庭成员制定可行的计划以支持患者的自我护理，并培训他们就糖尿病管理进行有效的沟通。
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