PROMOTING MOTIVATION FOR THE MANAGEMENT OF DIABETES

描述：最近的研究表明，血糖控制与 直接降低以下疾病的发病率（如视网膜病变、肾病、神经病变）： 糖尿病患者，这表明它是非常重要的糖尿病患者 坚持能使血糖正常化的医疗方案。 这些糖尿病控制和并发症试验（DCCT）的结果来自于 在这项研究中，患者被预选为可能坚持，但它 提出了一个关键问题，即哪些因素促进了所有人的遵守 患者 拟议的工作整合了文献研究， 自我决定理论，病人激活，病人授权和 动机访谈，以制定患者自我调节模式 并推导出关于增强葡萄糖控制的假设。 以前的工作 表明激活患者可改善HbA 1c，因此建议 研究探讨了发生这种情况的调解过程。 的 一项提案假设，患者的自主自我调节介导 这种效果。 如果得到证实，这一假设的调解将指向其他 可能影响患者依从性的卫生保健环境因素。 建议在糖尿病中心进行两项研究。 第一个是 第一个是观察性研究，第二个是对患者的评估 干预 这些研究采用了问卷调查、 录音提供者-患者互动，血糖仪，医疗记录， 医学测试（HbA 1c），以测试研究者的关系模型 在医疗氛围、患者动机、患者行为和 健康成果。 这项工作可能具有相当大的意义， 制定具有潜在成本效益的保健战略 从业者使用，以提高患者的动机和依从性， 减少糖尿病的长期健康后果。

DESCRIPTION: Recent research has shown that glucose control relates directly to lower morbidity (e.g. retinopathy, nephropathy, neuropathy) for diabetics, suggesting that it is extremely important for diabetic patients to adhere to medical regimens that result in normalization of blood sugar. These Diabetes Control and Complications Trial (DCCT) findings emerged from a study in which patients were preselected as being likely to adhere, but it raises the critical question of what factors promote adherence for all patients. The proposed work integrates research from the literatures on Self Determination Theory, patient activation, patient empowerment and motivational interviewing to formulate a model of patient self-regulation and to derive hypotheses about enhancing glucose control. Previous work suggests that activating patients leads to improved HbA1c so the proposed research explores the mediating processes through which this occurs. The proposal hypothesizes that patients' autonomous self regulation mediates this effect. If confirmed, this hypothesized mediation will point to other factors in the health care climate that could influence patient adherence. Two studies in a Diabetes Center are proposed. The first is an observational study and the second is an evaluation of a patient intervention. The studies employ data from questionnaires, ratings of audiotaped provider-patient interactions, glucometers, medical records, and medical tests (HbA1c) to test the investigator's model of the relations among the health care climate, patients' motivation, patients' behavior and health outcomes. This work could be of considerable significance for developing potentially cost-effective strategies for health care practitioners to use in enhancing patient motivation and adherence and thus reducing the long term health consequences of diabetes.