Impact of baseline patient characteristics on interventions to reduce diabetes distress: the role of personal conscientiousness and diabetes self-efficacy.
Impact of baseline patient characteristics on interventions to reduce diabetes distress: the role of personal conscientiousness and diabetes self-efficacy.
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DOI：
10.1111/dme.12403
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发表时间：
2014-06
期刊：
影响因子：
--
通讯作者：
Strycker L
中科院分区：
文献类型：
--
作者：
Fisher L;Hessler D;Masharani U;Strycker L
通过确定尽责性和糖尿病自我效能的基线水平对有效干预措施的结果（减少糖尿病困扰和改善疾病管理）的影响，来改善以患者为中心的护理。
患有糖尿病困扰和自我护理问题的2型糖尿病成年人（N = 392）被随机分配到三种减少困扰的干预措施中的一种：计算机辅助自我管理；计算机辅助自我管理加问题解决疗法；以及健康教育。基线评估包括尽责性和自我效能、人口统计学特征、糖尿病状况、治疗方案困扰、情感负担、药物依从性、饮食和身体活动。记录基线和12个月之间治疗方案困扰、情感负担和自我护理的变化，协方差分析模型评估尽责性和自我效能如何影响困扰和管理结果的显著改善。
基线尽责性高的参与者在药物依从性和情感负担方面的降低幅度明显大于基线尽责性低的参与者。基线自我效能高的参与者在饮食、身体活动和治疗方案困扰方面比基线自我效能低的参与者有更大的改善。尽责性和自我效能的影响相互独立，且在所有三个干预组中均存在。一个显著的交互作用表明，基线时自我效能和尽责性都高的参与者在12个月时身体活动的改善最大。
广泛的个人特质和特定疾病的预期都会影响有效干预措施的结果。这些发现强调需要从糖尿病干预的“一刀切”方法转变为一种根据个人特质和技能制定临床干预措施的方法。（临床试验注册号：NCT - 00714441）
To improve patient-centred care by determining the impact of baseline levels of conscientiousness and diabetes self-efficacy on the outcomes of efficacious interventions to reduce diabetes distress and improve disease management. Adults with Type 2 diabetes with diabetes distress and self-care problems (N=392) were randomized to one of three distress reduction interventions: computer-assisted self-management; computer-assisted self-management plus problem-solving therapy; and health education. The baseline assessment included conscientiousness and self-efficacy, demographics, diabetes status, regimen distress, emotional burden, medication adherence, diet and physical activity. Changes in regimen distress, emotional burden and self-care between baseline and 12 months were recorded and ANCOVA models assessed how conscientiousness and self-efficacy qualified the significant improvements in distress and management outcomes. Participants with high baseline conscientiousness displayed significantly larger reductions in medication adherence and emotional burden than participants with low baseline conscientiousness. Participants with high baseline self-efficacy showed greater improvements in diet, physical activity and regimen distress than participants with low baseline self-efficacy. The impact of conscientiousness and self-efficacy were independent of each other and occurred across all three intervention groups. A significant interaction indicated that those with both high self-efficacy and high conscientiousness at baseline had the biggest improvement in physical activity by 12 months. Both broad personal traits and disease-specific expectations qualify the outcomes of efficacious interventions. These findings reinforce the need to change from a one-size-fits-all approach to diabetes interventions to an approach that crafts clinical interventions in ways that fit the personal traits and skills of individual people. (Clinical Trials Registry No: NCT-00714441)
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影响因子：
3.5
作者：
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通讯作者：
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