PROMOTING MOTIVATION FOR THE MANAGEMENT OF DIABETES

描述：最近的研究表明，血糖控制与 直接降低发病率(例如视网膜病变、肾病、神经病变) 糖尿病患者，这表明它对糖尿病患者非常重要 坚持血糖正常化的药物治疗方案。 这些糖尿病控制和并发症试验(DCCT)的发现来自 一项研究中，患者被预先选择为可能会坚持的患者，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 病人。建议的工作综合了来自以下文献的研究 自主理论、患者激活、患者赋权和 激励性访谈构建患者自我调节模式 并得出关于加强血糖控制的假说。以前的工作 建议激活患者导致改善HbA1c，因此建议的 研究探索了这种情况发生的中介过程。这个 该提案假设患者的自主自我调节在 这种效果。如果得到证实，这个假想的调解将指向其他 医疗环境中可能影响患者依从性的因素。 在糖尿病中心进行的两项研究被提出。第一个是一个 观察性研究，第二个是对患者的评估 干预。这些研究使用了来自调查问卷的数据，评级 录制的提供者与患者的互动、血糖仪、医疗记录和 医学测试(HbA1c)以测试研究人员的关系模型 在医疗氛围中，患者的动机、患者的行为和 健康结果。这项工作可能对以下方面具有相当的意义 制定具有潜在成本效益的医疗保健战略 从业者用来增强患者的积极性和坚持性，从而 减少糖尿病对健康的长期影响。

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.